Attributable Macroeconomic Burden and Projected Trends of Ischemic Stroke Due to Hypertension, Hyperglycemia, and Hyperlipidemia in Chinese Working-Age Adults Using a Bayesian Productivity-Adjusted Life-Year Framework

BACKGROUND: Hypertension, hyperglycemia, and hyperlipidemia are the leading modifiable risk factors for ischemic stroke in China, yet their combined long-term macroeconomic consequences for the working-age population remain poorly quantified. METHODS: Using data from the Global Burden of Disease Study 2023, we assessed deaths and disability-adjusted life years (DALYs) attributable to these three metabolic risk factors among Chinese adults aged 20-64 years from 1990 to 2023. Temporal trends were evaluated via Joinpoint regression. Future disease burden through 2050 was projected using a Bayesian age-period-cohort (BAPC) model. The macroeconomic burden from 2024 to 2030 was estimated using a Bayesian productivity-adjusted life-year (PALY) framework, with GDP losses expressed in purchasing power parity (PPP) international dollars (Intl$). RESULTS: In 2023, these risk factors accounted for 105,469 deaths and 5,246,634 DALYs, with age-standardized rates of 12.98 and 645.85 per 100,000, respectively. Age-standardized rates declined consistently from 1990 to 2023 (AAPC: -3.07% for mortality; -2.18% for DALYs). Despite this, the absolute number of deaths is projected to reach 249,779 by 2050. The macroeconomic burden is projected to escalate to 4.08 million PALYs lost and a GDP loss of PPP intl $162.74 billion by 2030, disproportionately affecting males and adults aged 55-64 years. CONCLUSION: Although age-standardized burden has declined, the absolute and macroeconomic burden attributable to metabolic risk factors is projected to rise substantially, underscoring the urgent need for integrated prevention targeting high-risk working-age groups.