National Surveillance-Based Retrospective Ecological Longitudinal Analysis of Stroke Incidence Trends and Health-Screening Indicators in Korea, 2011–2023, with Model-Based Projections to 2028 Using National Health Insurance Service Data

Background: Stroke remains a leading cause of mortality, disability, and health-system burden in Korea’s rapidly aging population. We aimed to describe national stroke incidence trends from 2011 to 2023, characterize ecological associations between stroke incidence and health-screening indicators, and generate model-based projections through 2028 to support health-system planning. Methods: This retrospective ecological longitudinal analysis used three publicly available aggregate national data sources: (1) NHIS annual aggregate statistics on crude and age-standardized stroke incidence, stroke case counts, first-onset vs. recurrent stroke, and case-fatality rates (2011–2023); (2) regional standardized health-awareness survey rates for stroke symptoms, myocardial infarction symptoms, blood pressure, and blood glucose (2017–2025); and (3) national cancer-screening outcome tallies for breast and cervical cancer (2010–2024). All analyses used pre-aggregated annual summary data; individual-level NHIS records were not used. Annual trends were modeled with ordinary least-squares linear regression (n = 13 annual observations). Pearson correlations were computed only for overlapping observation windows. Model-based projections are presented with 95% prediction intervals and are explicitly distinguished from observed NHIS values. This study is purely descriptive and ecological; no causal inference is made. Results: Crude stroke incidence increased from 199.2 to 221.1 per 100,000 (2011–2023; slope +2.32/year, R2 = 0.83), whereas age-standardized incidence declined from 158.3 to 113.2 per 100,000 (slope −3.41/year, R2 = 0.96), a pattern consistent with demographic aging as a contributing factor to growing absolute burden, though formal age-decomposition analysis would be required to confirm this inference. Total cases increased from 99,837 to 113,098; the 30-day case-fatality rate declined from 8.5% to 7.5%. Ecological correlations showed that blood glucose awareness was strongly negatively correlated with age-standardized incidence (r = −0.944, p = 0.001, n = 7), though these are ecological associations and must not be interpreted as individual-level causal relationships. Model-based projections estimate crude incidence near 230.7 (95%PI 219.2–242.2) and age-standardized incidence near 103.2 (95%PI 95.7–110.8) per 100,000 by 2026. Conclusions: Concurrent increase in crude burden and decline in age-standardized incidence reflects demographic aging as the primary driver of Korea’s stroke burden. Projections support integrated cardiovascular prevention, public health education, and age-sensitive service planning. All projections are short-horizon statistical extrapolations intended for policy scenario planning only and must not be interpreted as observed future NHIS outcomes.