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To systematically examine the prevalence and time trend of stroke in China over the past two decades, and investigate if stroke rate decreased due to the national prevention efforts.Databases of China National Knowledge Infrastructure, Wanfang and VIP, and PubMed were searched for studies published during 2000–2017 in English and Chinese on stroke in China. Two investigators extracted the data and assessed the quality of each study. The prevalence and its 95% confidence intervals were calculated using Stata, and differences by age, gender, period, and region were compared.In total 96 papers met inclusion criteria and were included. The overall prevalence of stroke was 5.1% (96 studies). Men had a high prevalence of stroke than women (7.3% vs 5.6% in 29 studies). The prevalence increased with age: 1.2%, 2.9%, 5.9% and 8.7% in the 40∼49, 50∼59, 60∼69 and ≥70 years groups, respectively. An increase of stroke was observed in recent years: from 5.2% in 2000–2005, 4.7% in 2006–2011, to 5.4% in 2012–2017. Large differences existed across regions, 2.7% in Taiwan, 3.1% in South China, 3.4% in Southwest China, 3.6% in East China, 5.0% in Central China, 5.8% in Northwest China, 6.0% in Northeast China, 8.0% in North China.In China stroke prevalence increased with age, was higher in men than women, and varied largely across regions with the highest rate in North China and the lowest in South China. The prevalence seemed increased over time. More future national prevention efforts are needed.