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. 2025 Mar 13;15(3):e70389. doi: 10.1002/brb3.70389

Evaluating the Rehabilitation Needs of Stroke Patients in China: A Trend Analysis From 1990 to 2019

Peng Zhao 1, Huaxia Sun 2,✉
PMCID: PMC11904947  PMID: 40079486

ABSTRACT

Background

Stroke remains a leading cause of death and long‐term disability in China. Rehabilitation is known to be an effective intervention for reducing disability among stroke survivors. This study seeks to quantify the rehabilitation needs of stroke patients in China by analyzing prevalence and years lived with disability (YLDs).

Methods

To assess rehabilitation needs, we first estimated the prevalence and YLDs among stroke patients in China using data from the Global Burden of Disease Study 2019. The WHO Rehabilitation Need Estimator was then applied to these estimates to derive the rehabilitation requirements.

Results

Our study reveals a substantial need for stroke rehabilitation services in China in 2019. An estimated 25.0 million stroke patients (95% uncertainty interval [UI] 22.0–28.0) could benefit from these services, accounting for 6.1 million years lived with disability (YLDs) [4.3–7.8]. This burden is disproportionately distributed between genders, with males experiencing 11.0 [9.5–12.0] million prevalent cases and 2.5 [1.8–3.2] million YLDs, compared to females with 14.0 [12.0–16.0] million cases and 3.6 [2.5–4.8] million YLDs. Worryingly, the age‐standardized prevalence of stroke in China has increased by 15.2% since 1990, rising from 11.2 per 1000 (95UI, 10.1–12.5) to 12.9 per 1000 (95UI, 11.5–14.4). Similarly, the age‐standardized YLD rate has grown by 15.8%, from 2.72 per 1000 (95UI, 1.94–3.49) to 3.15 per 1000 (95UI, 2.21–4.48). This upward trend in China contrasts sharply with the global picture, where age‐standardized prevalence and YLD rates have decreased by 6.2% and 4.8%, respectively.

Conclusions

These findings demonstrate a critical need for expanded access to rehabilitation services within China's stroke care system. To enhance patient outcomes and address this growing need, increased investment in stroke rehabilitation infrastructure, training, and research is essential.

Keywords: China, rehabilitation, stroke

In this study, we aim to quantify the rehabilitation needs of stroke patients in China by analyzing the prevalence and years lived with disability (YLDs). Age‐standardized stroke prevalence and disability burden (YLDs) in China have shown a slight increase from 1990 to 2019, affecting both men and women. Over the past three decades, the prevalence of stroke and its associated disability have demonstrated a modest upward trend. Our findings emphasize that this growing stroke burden in China underscores the ongoing need for strengthened prevention and rehabilitation strategies.

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1. Introduction

Stroke is the leading cause of mortality and long‐term disability in China (Chao et al. 2021), placing immense pressure on the healthcare system and impacting millions of lives. While rehabilitation is a highly effective treatment for reducing disability in stroke patients (Dobkin 2005), access remains a significant challenge. It is estimated that only 40% to 70% of stroke survivors have access to these vital services, with the majority receiving inpatient treatment (Kam Yuet Wong et al. 2022). Furthermore, post‐discharge rehabilitation often lacks adequate professional guidance (Tu et al. 2023).

Stroke rehabilitation plays a crucial role in reducing disability and improving quality of life, yet a comprehensive assessment of the evolving rehabilitation needs in China is lacking. This study provides a detailed analysis of these needs, focusing on changes over the past three decades. Using data from the Global Burden of Disease Study 2019 (GBD 2019), we estimate prevalence, years lived with disability (YLDs), and assess the percentage change from 1990 to 2019

2. Methods

This study utilized data from the GBD Study 2019, as detailed in previous publications (Cieza et al. 2020; Feigin et al. 2021). The WHO Rehabilitation Need Estimator (available at https://vizhub.healthdata.org/rehabilitation/) was employed to calculate the prevalence and YLDs associated with stroke. Specifically, we selected “China and Global” in the “Location” section and “Cerebrovascular disease (stroke)” in the “Condition” section. This study was approved by the Ethics Committee of the Second Affiliated Hospital of Hebei North University, with a waiver of informed consent granted.

Our analysis included data for all ages and both sexes, encompassing the number of prevalent stroke cases and the prevalence per 1000 individuals. Age‐standardized prevalence and YLD rates were also calculated.

Following the GBD methodology, uncertainty was estimated by generating 1000 draws for each metric. The 95% uncertainty interval (UI) was then constructed using the 2.5th and 97.5th percentiles of these draws.

Percentage change from 1990 to 2019 was calculated as: (2019 value − 1990 value)/1990 value × 100%.

3. Results

In 2019, an estimated 25.0 million people in China (95%UI 22.0–28.0) needed stroke rehabilitation services, resulting in 6.1 million YLDs [4.3–7.8]. This burden was distributed across genders, with 11.0 million males [9.5–12.0] and 14.0 million females [12.0–16.0] requiring rehabilitation, contributing to 2.5 [1.8–3.2] and 3.6 [2.5–4.8] million YLDs, respectively (see Table 1).

TABLE 1.

Global and China prevalence and years of life lived with disability for stroke patients in need of rehabilitation, all‐age counts, and age‐standardized rates for 1990 and 2019.

Prevalence Years of life lived with disability
All ages (millions) Age‐standardized rate (per 1000) All ages (millions) Age‐standardized rate (per 1000)
2019 1990 2019 1990 2019 1990 2019 1990
China ALL 25 (22–28) 10 (9–11) 12.9 (11.5–14.4) 11.2 (10.1–12.5) 6.1 (4.3–7.8) 2.4 (1.7–3.1) 3.15 (2.21–4.08) 2.72 (1.94–3.49)
Male 11 (9.5–12) 4.3 (4.9–4.8) 11.2 (10.0–12.7) 9.53 (8.63–10.6) 2.5 (1.8–3.2) 0.99 (0.71–1.3) 2.64 (1.88–3.43) 2.22 (1.59–2.87)
Female 14 (12–16) 5.7 (5.1–6.3) 14.3 (12.6–16.0) 12.6 (11.3–14.0) 3.6 (2.5–4.8) 1.4 (1.0–1.8) 3.58 (2.49–4.61) 3.13 (2.23–4.04)
Global ALL 86 (79–94) 46 (42–50) 10.5 (9.66–11.5) 11.2 (10.3–12.2) 18 (13–23) 9.4 (6.8–12.0) 2.18 (1.57–2.77) 2.29 (1.65–2.91)
Male 37 (34–41) 19 (18–21) 9.52 (8.71–10.4) 9.92 (9.05–10.9) 7.3 (5.3–9.3) 3.7 (2.7–4.7) 1.88 (1.36–2.40) 1.92 (1.39–2.45)
Female 49 (45–53) 27 (25–29) 11.4 (10.5–12.4) 12.2 (11.3–13.3) 10.0 (7.5–13.0) 5.7 (4.1–7.2) 2.44 (1.75–3.08) 2.59 (1.87–3.28)
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Alarmingly, the need for stroke rehabilitation has dramatically increased over the past three decades. From 1990 to 2019, the number of prevalent cases needing rehabilitation surged by 150.0%—a growth rate far exceeding the global average (150.0% vs. 87.0%). This increase was observed in both males (155.8%) and females (145.6%). Similarly, YLDs related to stroke increased by 154.2% in China, compared to 91.5% globally, with comparable increases seen in both genders (see Table 2).

TABLE 2.

The percentage change of prevalent cases and years of life lived with disability of stroke contributing to the need for rehabilitation services from 1990 to 2019 in China and the Global.

Prevalence (%) Years of life lived with disability (%)
All age Age‐standardized rate All age Age‐standardized rate
China ALL 150.0 15.2 154.2 15.8
Male 155.8 17.5 152.5 18.9
Female 145.6 13.5 157.1 14.4
Global ALL 87.0 −6.2 91.5 −4.8
Male 94.7 −4.0 102.7 −2.1
Female 81.5 −6.6 75.4 −5.8
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Worryingly, age‐standardized prevalence and YLD rates in China have also climbed steadily since 1990. The prevalence rate rose from 11.2 per 1000 (95UI, 10.1–12.5) to 12.9 per 1000 (95UI, 11.5–14.4), marking a 15.2% increase. Similarly, the YLD rate increased by 15.8%, from 2.72 per 1000 (95UI, 1.94–3.49) to 3.15 per 1000 (95UI, 2.21–4.48). This upward trend was observed for both males (17.5% increase in prevalence, 18.9% increase in YLDs) and females (13.5% and 14.4%, respectively) (see Table 2 and Figure 1).

FIGURE 1.

FIGURE 1

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The age‐standardized prevalence and years of life lived with disability (YLDs) rates of stroke contributed to the need for rehabilitation services per 100k from 1990 to 2019.

This rise in China stands in stark contrast to the global trend. Worldwide, age‐standardized prevalence and YLD rates have seen modest declines of 6.2% and 4.8%, respectively, since 1990, with both genders experiencing similar downward trends (see Table 2).

Furthermore, China's contribution to the global burden of stroke has grown significantly over the past three decades. Its share of global prevalence has risen from 21.7% to 29.1%, while its share of global YLDs has climbed from 25.5% to 33.9%. Within China, the proportion of stroke cases requiring rehabilitation has increased from 3.7% to 5.4%, and the proportion of YLDs attributable to stroke requiring rehabilitation has risen from 6.7% to 9.7%. These figures paint a clear picture: The demand for stroke rehabilitation services in China is not only immense but also continues to grow, indicating that the peak of this burden has yet to be reached.

Figure 2 illustrates the age‐specific prevalence of stroke per 100,000 population. Notably, the prevalence in 2019 shows a significant increase in the older age groups (65+) compared to 1990. This trend likely reflects improved survival rates among older stroke patients, leading to a larger population living with the long‐term effects of stroke and requiring rehabilitation.

FIGURE 2.

FIGURE 2

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The prevalent stroke cases contribute to the need for rehabilitation services per 100k in different age groups.

4. Discussion

Globally, age‐standardized prevalence and YLD rates have shown modest declines since 1990, suggesting that the overall increase in stroke cases is largely attributable to population growth and aging (Cieza et al. 2020). However, China presents a different picture. Both the number of stroke cases and age‐standardized rates have risen, indicating a concerning increase in stroke incidence beyond what can be explained by demographic shifts. This trend is further evidenced by the consistent growth in stroke prevalence observed in China over the past decade (Tu et al. 2022). With China's aging population projected to peak in the next 20 years (Tu et al. 2022), the demand for stroke rehabilitation services is poised to escalate dramatically, placing an even greater strain on the healthcare system.

Despite this escalating need, access to timely stroke rehabilitation in China remains severely limited. Studies reveal a concerning gap between need and provision: Only 11.5% of stroke patients receive rehabilitation within 1 week of onset, a crucial window for recovery, and a staggering 42.4% receive no rehabilitation at all (Asakawa et al. 2017). This inadequacy is further underscored by research from Bettger et al. (2017), which found suboptimal rehabilitation assessment rates among acute ischemic stroke (AIS) patients in China, with significant variability across 219 hospitals (ranging from 41.4% to 81.5%).

This starkly contrasts with stroke rehabilitation rates in other developed countries. In the United States, for instance, participation in outpatient stroke rehabilitation increased from 27.2% in 2013 to 35.5% in 2015 (Ayala et al. 2018). Japan demonstrates even greater success with its long‐term care system for stroke, where 73.0% of patients receive rehabilitation treatment (Kinoshita et al. 2022). Similarly, in Germany, approximately half of all stroke patients receive specialized neurological or geriatric rehabilitation care (De Peretti et al. 2018). These comparisons highlight the potential for improvement in China's stroke rehabilitation services and underscore the need for increased investment and systemic change.

It is crucial to recognize that stroke impacts men and women differently. Women generally experience worse outcomes after stroke compared to men (Phan et al. 2017), highlighting the need for gender‐specific considerations in stroke management and rehabilitation (Glader et al. 2003). An extensive international trial (n = 19,652) found that while women with ischemic stroke had better survival rates, they were also more likely to experience greater disability and poorer quality of life after stroke (Carcel et al. 2019). This underscores the importance of tailoring rehabilitation programs to address the unique needs and challenges faced by women. Further research is needed to explore sex‐specific factors, such as functional cerebral asymmetries, to optimize stroke management and improve outcomes for both men and women (Bonkhoff et al. 2021).

Our study revealed a noteworthy trend: The percentage change in age‐standardized prevalence and YLDs was more pronounced among Chinese male stroke patients compared to females. This contrasts with the global pattern, where reduction rates were lower for males than for females. This finding highlights the need to pay particular attention to the needs of male stroke patients in China, who appear to be experiencing a disproportionate increase in stroke burden. As gender equity gains increasing prominence in healthcare discussions worldwide (McInnes et al. 2008; Volpe et al. 2023), it is essential to ensure that stroke rehabilitation services are accessible and effective for both men and women, addressing the unique needs and challenges faced by each gender (Tu and Wei 2024).

This study focuses solely on prevalence and YLDs to estimate rehabilitation needs in China. It does not address the specific types of rehabilitation required, the availability of such services, or their quality. While demand for rehabilitation is high, early rehabilitation services in China are inadequate (Asakawa et al. 2017). For example, studies have shown that only 11.5% of stroke patients receive rehabilitation within 1 week, and 42.4% receive no rehabilitation at all (Asakawa et al. 2017; Liu et al. 2020). In addition, in this study we found that the prevalence in 2019 shows a significant increase in the older age groups (65+) compared to 1990. Several factors likely contributed to this outcome. First, acute stroke treatments, such as intravenous thrombolysis (IVT) and endovascular therapy (EVT), are becoming increasingly prevalent. A recent study demonstrated a significant increase in IVT and EVT rates for AIS in China between 2019 and 2020, with overall rates of 5.64% for IVT and 1.45% for EVT (Ye et al. 2022). Additionally, effective control of stroke risk factors such as hypertension and diabetes has reduced the likelihood of stroke recurrence (Wu et al. 2019). Finally, overall life expectancy has increased (Chen et al. 2020).

5. Conclusions

This study provides the first comprehensive estimate of stroke rehabilitation needs in China, highlighting the substantial burden faced by the country. Our findings reveal that nearly one‐third of stroke patients requiring rehabilitation worldwide are in China, with a dramatic increase in cases over the past three decades. This underscores the urgent need for increased investment in rehabilitation infrastructure, training, and research, and for the integration of these services into the national stroke care system.

Author Contributions

Peng Zhao: conceptualization, investigation, funding acquisition, writing – original draft, visualization, validation, methodology, software, formal analysis. Huaxia Sun: conceptualization, investigation, funding acquisition, writing – review and editing, visualization, validation, project administration, resources, supervision, data curation.

Conflicts of Interest

The authors declare no conflicts of interest.

Peer Review

The peer review history for this article is available at https://publons.com/publon/10.1002/brb3.70389.

Acknowledgments

The authors thank the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) Group and the WHO Rehabilitation Need Estimator.

Funding: The authors received no specific funding for this work.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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