Objective:To explore the relationship between red meat intake level and the incidence of stroke in Chinese adults.Methods:The baseline data were from China Chronic Disease Surveillance Project conducted in 60 surveillance sites in 11 provinces in China in 2010. A total of 27 762 subjects with complete data in baseline survey were included in the cohort follow-up from 2016 to 2017. Multivariate nutrient-density cox proportional hazards regression model was used to analyze the association between red meat intake level and the incidence of stroke. Subgroup analysis were performed based on baseline characteristics. Sensitivity analysis was performed by using standard multivariate model, energy partition model and nutrient residual model.Results:In the 26 187 subjects, 1 259 stroke cases, including 1 074 ischemic stroke cases, occurred during an average of 6.0 years of follow-up, the incidence density was 815.0/100 000 person-years for stroke and 692.0/100 000 person-years for ischemic stroke. In models using the multivariate nutrient-density model of energy adjustment, compared with quintile group, red meat intake in quintile 2 group showed no significant association with stroke [hazard ratio ( HR)=1.07, 95% CI: 0.87-1.32] and ischemic stroke ( HR=1.03, 95% CI: 0.80-1.32) and in group of quintile 3-5, the red meat intake related risk for stroke increased by 23% ( HR=1.23, 95% CI: 1.00-1.51), 27% ( HR=1.27, 95% CI: 1.03-1.58) and 32% ( HR=1.32, 95% CI: 1.06-1.64), respectively, while the risk for ischemic stroke increased by 32% ( HR=1.32, 95% CI: 1.04-1.68), 35% ( HR=1.35, 95% CI: 1.05-1.73) and 38% ( HR=1.38, 95% CI: 1.07-1.79), respectively. Subgroup analysis revealed that blood pressure had modification effect on the association between red meat intake and incidence of stroke (interaction P=0.037). The sensitivity analysis showed no changes. Conclusions:These findings suggest that higher intake of red meat is significantly associated with an increased risk for stroke and ischemic stroke. It is necessary to take red meat intake level as one of the important indicators of stroke prevention and control.