Abstract: Objective  To analyze the trends of stroke mortality and disability-adjusted life year (DALY) rates among residents in Jing’an District, Shanghai from 2005 to 2024, and predict the stroke disease burden in this region from 2025 to 2030, so as to provide evidence for developing targeted stroke prevention and control strategies. 
Methods  Data were derived from the death surveillance records of residents in Jing’an District, which were included in the death registration information system of the Shanghai Municipal Center for Disease Control and Prevention. Death cases with stroke as the underlying cause of death from January 1, 2005 to December 31, 2024 were extracted. The crude mortality was calculated, and the crude DALY rate was indirectly estimated based on the global burden of disease (GBD) 2021 data. The age-standardized mortality and DALY rates were calculated using the world standard population age composition released by GBD 2021, hereinafter referred to as the world age-standardized mortality rate and world age-standardized DALY rate. The Joinpoint regression model was used to analyze the annual percent change (APC), average annual percent change (AAPC), temporal trends, and trend turning points of crude mortality rate, crude DALY rate, and their world age‑standardized rates. The Bayesian age-period-cohort (BAPC) model was employed to predict the world age-standardized mortality and DALY rates in Jing’an District, Shanghai from 2025 to 2030. 
Results  From 2005 to 2024, a total of 35 817 stroke-related deaths were reported in Jing’an District, Shanghai, accounting for 19.90% of all deaths in the district during the same period, among which ischemic stroke deaths accounted for 74.91%. The proportion of comorbidities, including hypertension, coronary heart disease, and diabetes mellitus, among stroke deaths showed a fluctuating upward trend. Joinpoint regression analysis revealed that the world age-standardized mortality (AAPC －2.23%, 95%CI －2.95%-－1.51%, P<0.001) and world age-standardized DALY rate (AAPC －2.35%, 95%CI －3.10%-－1.60%, P<0.001) for stroke in the overall population of Jing’an District, Shanghai from 2005 to 2024 both showed downward trends. Since 2016, the declining trends in the world age-standardized mortality and world age-standardized DALY rates for stroke in males have stagnated, yet the changes were not statistically significant. Age-stratified analysis revealed that residents aged 85 years and above had relatively high stroke mortality. Moreover, the declining trend in stroke mortality among those aged 65-74 reversed to an upward trend after 2017. The BAPC model predicted that the world age-standardized mortality and DALY rates for stroke in Jing’an District, Shanghai would continue to decline from 2025 to 2030.
Conclusions  Overall decreasing trends in the world age-standardized mortality and DALY rates for stroke were observed in Jing’an District, Shanghai from 2005 to 2024, reflecting favorable outcomes of regional stroke prevention and control. However, the declining trend in stroke disease burden among males has stagnated since 2016. With deepening population aging and growing chronic comorbidity burden, future stroke prevention and control should prioritize males and the elderly, and shift the management paradigm from single-disease intervention to integrated multimorbidity management.

Key words: Stroke; Mortality; Disability-adjusted life year; Joinpoint regression; Bayesian age-period-cohort model

摘要： 目的 分析2005—2024年上海市静安区居民卒中死亡率与伤残调整生命年（disability-adjusted life year，DALY）率的变化趋势，并预测2025—2030年该区的卒中疾病负担，为制订卒中精准防控策略提供依据。
方法 研究数据来源于上海市疾病预防控制中心死亡登记信息系统中的静安区居民死亡监测资料，提取2005年1月1日—2024年12月31日根本死因为卒中的居民病例。计算该区的卒中粗死亡率，并依据全球疾病负担（global burden of disease，GBD）2021研究数据间接计算卒中粗DALY率；基于GBD 2021公布的世界标准人口年龄构成计算其世界年龄标化死亡率（简称世标死亡率）和世界年龄标化DALY率（简称世标DALY率）。采用Joinpoint回归模型分析卒中粗死亡率、粗DALY率及其世标率的年度变化百分比（annual percent change，APC）、平均年度变化百分比（average annual percent change，AAPC）、变化趋势及趋势转折点；运用贝叶斯年龄-时期-队列（Bayesian age-period-cohort，BAPC）模型预测2025—2030年上海市静安区的卒中世标死亡率和世标DALY率。
结果 2005—2024年，上海市静安区累计报告卒中死亡35 817人，占该区同期总死亡人数的19.90%，其中缺血性卒中死亡占卒中死亡的74.91%。在卒中死亡人群中，高血压、冠心病和糖尿病的共病比例呈波动上升趋势。Joinpoint回归分析显示，2005—2024年上海市静安区总人群的卒中世标死亡率（AAPC －2.23%，95%CI －2.95%～－1.51%，P<0.001）与世标DALY率（AAPC －2.35%，95%CI －3.10%～－1.60%，P<0.001）均呈下降趋势。自2016年起，男性的卒中世标死亡率与世标DALY率下降趋势均趋于停滞，变化趋势无统计学意义。年龄分层分析显示，≥85岁年龄段人群的卒中死亡率较高，65～74岁年龄段人群的卒中死亡率于2017年后由下降趋势转为上升趋势。BAPC模型预测结果显示，2025—2030年上海市静安区的卒中世标死亡率和世标DALY率仍呈下降趋势。
结论 2005—2024年，上海市静安区的卒中世标死亡率、世标DALY率整体呈下降趋势，区域卒中防控工作已取得积极成效。但男性的卒中疾病负担自2016年起下降趋势停滞。伴随人口老龄化程度加深、慢性病共病问题日益凸显等现状，未来卒中防控工作应重点关注男性及老年人群，推动卒中防控模式由单一疾病管理向多病综合共管转变。

关键词: 卒中; 死亡率; 伤残调整生命年; Joinpoint回归; 贝叶斯年龄-时期-队列模型