Ischemic Stroke Burden in China and Other G20 Nations (1990–2021): A Comparative Analysis From the Global Burden of Disease Study 2021 and Trend Projections Through 2031

ABSTRACT Background Ischemic stroke (IS) persists as a major global health challenge. This study assesses IS burden, epidemiological trends, and associations with the Socio‐demographic Index (SDI) across China and G20 nations (1990–2021), projecting trends to 2031 to inform resource prioritization. Methods Utilizing Global Burden of Disease (GBD) 2021 data, we analyzed age‐standardized incidence rates (ASIR) and age‐standardized mortality rates (ASMR), disability‐adjusted life years (DALYs), and mortality‐to‐incidence ratio (MIR) using Joinpoint regression (trends), autoregressive integrated moving average (projections), and Pearson correlation (SDI linkage), stratified by age and sex. Results From 1990 to 2021, China experienced rising crude IS incidence (+27.4%) contrasting with G20 declines. Although ASMR and DALYs decreased globally, China's ASMR initially increased (1999–2004) before declining, unlike sustained G20 reductions. China's ASIR rose 35.7% versus a 15.6% G20 reduction. Projections indicate stable ASMR with rising ASIR in China, diverging from declining ASMR and stable ASIR in the G20. SDI‐linked disparities persisted, with China's ASIR/ASMR exceeding G20 averages relative to SDI. Conclusion China's distinct trajectory—characterized by rising incidence and delayed mortality decline—underscores the necessity for tailored interventions. Addressing SDI‐driven disparities is essential for equitable global prevention and care strategies.