National and provincial trends of mortality and years of life lost due to stroke in children and adolescents in China, 2005-2020: An analysis of national mortality surveillance data.

Background: Stroke is associated with substantial mortality among children and adolescents, yet evidence on the death burden of stroke in this group in China is scarce.

Aims: To assess the trends of mortality and years of life lost (YLL) due to stroke in children and adolescents in China.

Methods: We estimated the number and age-standardized rate of death and YLL caused by stroke and its subtypes among children and adolescents aged 0-19 years in China and its provinces from 2005 to 2020, utilizing data from National Mortality Surveillance System.

Results: In China, the age-standardized mortality rate due to stroke among children and adolescents aged 0-19 years decreased from 1.40/100,000 to 0.51/100,000 during 2005-2020, and the YLL rate decreased from 116.28/100,000 to 38.79/100,000. During 2005-2020, intracerebral hemorrhage (ICH) consistently showed significantly higher age-standardized mortality rate than ischemic stroke (IS) and subarachnoid hemorrhage (SAH). In 2020, the mortality rate of ICH was 11.35-fold and 4.96-fold greater than that of IS and SAH, respectively (ICH 0.40/100,000, IS 0.04/100,000, SAH 0.08/100,000). Overall, males among children and adolescents exhibited higher age-standardized mortality and YLL rate due to stroke compared to females. Notably, the stroke mortality rate in 15-19 years age group increased by 16.10% during 2005-2020, primarily attributed to the significant increases in mortality rate of ICH and SAH among males in this age group (ICH males 25.51%, SAH males 107.83%). In 2020, Yunnan (1.56/100,000), Tibet (1.54/100,000), and Henan (1.47/100,000) had the highest age-standardized mortality rate of stroke among children and adolescents, while Shanghai, Fujian and Jiangsu had the lowest rates. In addition, a negative association was observed between the age-standardized YLL rates of stroke among individuals aged 0-19 years and the socio-demographic index across 31 provinces in China from 2005 to 2020.

Conclusion: In China, the death burden of ICH among children and adolescents was considerably heavier than that of SAH and IS. The rising mortality rate of ICH and SAH among males aged 15-19 years requires greater emphasis. Targeted interventions for stroke in children and adolescents should be expedited to reduce the disease burden in this particular population.