ObjectiveTo understand the burden of stroke disease and age-period-cohort effects in China from 1990 to 2021, and to provide scientific basis for formulating relevant prevention and treatment strategies. MethodsBased on GBD2021 data, the Joinpoint regression model was used to analyze the trend of incidence rate, mortality and DALYs rate of stroke, and the APC model was used to analyze the impact of age, period and birth cohort on the incidence and mortality of stroke. ResultsFrom 1990 to 2021, the standardized incidence rate, standardized mortality rate and standardized DALYs rate of stroke in China showed an overall downward trend, with AAPC of −0.37% (95%CI −0.45% to −0.29%), −1.79% (95%CI −1.99% to −1.59%), and −1.93% (95%CI −2.07% to −1.80%), respectively. The results of the age-period-cohort model showed that the incidence and mortality risks of stroke increased with age; The risk of female onset remained stable in the early stage but increased rapidly in the later stage, while the risk of male mortality showed a slight upward trend; The risk of onset and death generally decreased with the passage of the birth cohort. Hypertension had always been the primary risk factor for stroke, and metabolic factors such as high blood sugar had become the main factors affecting disease burden. ConclusionThe burden of stroke disease in China is still relatively heavy, and differentiated intervention measures should be developed for different age and gender groups based on controllable risk factors, especially focusing on the elderly and male population.