Abstract: Background Intracranial hemorrhage（ICH）is a leading cause of death and disability globally，and analyzing its disease burden is crucial for developing effective prevention strategies. Objective To analyze the evolution of the ICH disease burden and its risk factors in China and globally from 1990 to 2021，and to predict the disease burden trend from 2022 to 2035，providing a scientific basis for precise prevention and control measures. Methods Based on the Global Burden of Disease（GBD）2021 database，we analyzed ICH incidence，mortality，and disability-adjusted life years（DALY）in China and globally. Joinpoint regression was used to calculate the average annual percentage change（AAPC）in disease burden trends，and a Bayesian age-period-cohort（BAPC）model was applied to predict ICH incidence，mortality，and DALY burden from 2022 to 2035. The comparative risk assessment framework of GBD was used to evaluate the attributable effects of risk factors such as high systolic blood pressure，smoking，and air pollution on the disease burden. Results In 2021，the number of ICH cases globally and in China was 3 444 338 and 1 173 288，respectively，representing increases of 46.1% and 51.6% compared to 1990. From 1990 to 2021，the global age-standardized incidence rate showed a downward trend（AAPC=-0.589%，P<0.001），with a more significant decline in China（AAPC=-1.507%，P<0.001）. In 2021，the number of ICH deaths globally and in China was 3 308 367 and 1 322 893，respectively，representing increases of 41.3% and 44.9% compared to 1990. The global age-standardized mortality rate decreased（AAPC=-0.731%，P<0.001），with a more substantial decrease in China（AAPC=-2.265%，P<0.001）. China's age-standardized DALY rate for ICH in 2021 showed a significant decline compared to 1990（AAPC=-47.371%，P<0.001），while the global age-standardized DALY rate also decreased（AAPC=-19.309%，P<0.001）. High systolic blood pressure，smoking，and environmental particulate pollution were the main risk factors. The disease burden was higher in males than in females across all age groups，with the highest burden in those aged 65 and older. Predictive analysis indicates a declining trend in the global ICH disease burden from 2022 to 2035. Conclusion China has made positive progress in controlling the ICH disease burden but still needs to focus on prevention and control measures for males，the elderly，and major risk factors. In the future，strengthening public health policies，improving medical resource efficiency，and promoting healthy lifestyles could further reduce the ICH disease burden and enhance patients' quality of life.

Key words: Intracranial hemorrhage, Public health strategy, Global burden of disease, Risk factors, Predictive analysis

摘要： 背景 脑出血（ICH）是全球死亡和残疾的主要原因之一，分析其疾病负担对制定防控策略意义重大。目的 分析1990—2021年中国与全球ICH疾病负担演变及危险因素，并预测2022—2035年趋势，为精准防控提供依据。方法 基于全球疾病负担（GBD）2021数据库，分析中国及全球ICH发病率、死亡率、伤残调整寿命年（DALY）等指标。采用Joinpoint回归模型计算平均年度百分比（AAPC）评估趋势变化，运用贝叶斯年龄-时期-队列（BAPC）模型预测2022—2035年发病、死亡和DALY负担。基于GBD比较性风险评估框架，评估高收缩压、吸烟及空气污染等危险因素对DALY的归因效应。结果 2021年全球与中国ICH发病数分别为3444338例与1173288例，较1990年分别增长46.1%与51.6%。1990—2021年全球年龄标准化发病率呈下降趋势（AAPC=-0.589%，P<0.001），中国降幅更显著（AAPC=-1.507%，P<0.001）。2021年全球与中国ICH死亡数分别为3308367例与1322893例，较1990年分别增长41.3%与44.9%，全球年龄标准化死亡率降速为AAPC=-0.731%（P<0.001），中国达AAPC=-2.265%（P<0.001）。2021年中国ICH标化DALY率较1990年显著下降（AAPC=-47.371%，P<0.001），全球标化DALY率下降（AAPC=-19.309%，P<0.001）。高收缩压、吸烟和环境颗粒物污染是主要危险因素。性别与年龄分布显示，全球与中国疾病负担均为男性高于女性，且主要集中在65岁以上老年人群。预测分析表明，2022—2035年全球ICH疾病负担呈下降趋势。结论 中国在控制脑出血疾病负担方面已取得积极成效，但仍需持续关注男性、老年群体和主要风险因素的防控。未来，通过加强公共卫生政策、提高医疗资源利用效率和推广健康生活方式，有望进一步降低ICH的疾病负担，改善患者生活质量。

关键词: 脑出血, 公共卫生策略, 全球疾病负担, 风险因素, 预测分析