Background Research has indicated that extreme temperatures significantly increase stroke mortality risk among Chinese residents, with low temperatures exerting a substantially greater impact on stroke burden than high temperatures. Analyzing and predicting these patterns can inform stroke prevention and treatment strategies.

Objective To analyze changes in stroke burden attributable to low-temperature environments in China between 1990 and 2021.

Methods Using data from the Global Burden of Disease Study 2021 (GBD2021), we estimated stroke mortality and disability adjusted life years (DALYs) attributable to low-temperature environments in China. Joinpoint regression modeling was applied to analyze trends by average annual percentage change (AAPC) of the attributable mortality rate and DALY rate. Estimated annual percentage change (EAPC) was used to describe gender and age distribution of these attributable low-temperature mortality and DALY rates between 1990 and 2021. Finally, autoregressive integrated moving average (ARIMA) modeling and Bayesian age-period-cohort (BAPC) modeling were used to predict attributable standardized mortality rate (ASMR) and standardized DALY rate associated with low-temperature environments in China from 2022 to 2036.

Results From 1990 to 2021, the age-standardized mortality rate (ASMR) and age-standardized DALY rate (ASDR) for stroke attributable to low temperatures in China demonstrated an overall downward trend, with AAPCs of −2.07% and −2.36%, respectively. The ASMR and ASDR experienced the most significant reduction in the population under 20 years old, with absolute EAPC exceeding 3%. Conversely, the crude mortality rate and crude DALY rate remained consistently highest among those over 70 years old. In 2021, the crude mortality rate for this older age group exceeded 50 per 100 000, and the crude DALY rate exceeded 1000 per 100 000. Across all age groups and throughout the study period, the burden of stroke due to low temperatures was consistently higher among Chinese men compared to women. In 2021, the ASMR and ASDR attributable to low temperatures were 14.55 per 100 000 and 249.48 per 100 000 for men, respectively, significantly exceeding the rates for women (8.14 per 100 000 and 137.87 per 100 000). Projections from the BAPC model indicated that from 2022 to 2036, both the attributable mortality rate and DALY rate for stroke due to low temperatures in China were projected to continue declining. Specifically, the attributable ASMR for Chinese men was projected to decrease from 14.62 per 100 000 in 2022 to 11.42 per 100 000 in 2036, while the attributable ASDR from 265.25 per 100 000 to 237.55 per 100 000. For women, the attributable ASMR was projected to decrease from 8.06 per 100 000 in 2022 to 5.68 per 100 000 in 2036, and the attributable ASDR from 138.92 per 100 000 to 109.34 per 100,000. This projected decline was more pronounced among women than among men. Furthermore, the prediction results from the ARIMA model aligned with those of the BAPC model, indicating relatively stable projections.

Conclusion From 1990 to 2021 in China, the attributable mortality and DALY rates for stroke caused by low-temperature environments show a decreasing trend across different age groups and genders, indicating a reduction in the disease burden. However, males and the elderly remain high-risk groups. This suggests that focused interventions and targeted prevention and control measures should be prioritized for these high-risk populations.