ABSTRACT: Background: Stroke is a leading cause of long-term adult disability and death in China, and primary prevention is essential for stroke. The aim of this study is to compare the four anthropometric indexes (body mass index, waist circumference, waist-to-hip ratio, and waist-to-height ratio) and identify the index that is most closely related to stroke in areas with high incidence of stroke. Methods: A total of 4,052 participants aged 40 years or older were selected by the multistage stratified cluster sampling method in Dehui City in Jilin province, China. Face-to-face interviews and physical examinations were conducted to collect the participants' information. Descriptive data analyses were conducted. Multivariable logistic analyses were used to explore the adjusted association between stroke and body fat measuring indexes. Results: For body mass index (adjusted odds ratio (OR): 1.13, 95% confident interval (CI): 0.77-1.65), waist circumference (adjusted OR: 1.32, 95% CI: 0.88-1.99), and waist-to-hip ratio (adjusted OR: 1.34, 95% CI: 0.92-1.93), the patients in the highest quartile did not have a higher risk of stroke than those in the lowest quartile. For waist-to-height ratio, the patients in the highest quartile were more likely have a stroke than those in the lowest quartile (adjusted OR: 1.81, 95% CI: 1.16-2.82). The area under the curve of waist-to-height ratio, waist-to-hip ratio, waist circumference, and body mass index for stroke were 0.627 (95% CI: 0.595-0.659; sensitivity: 65.10%; specificity: 56.00%), 0.596 (95% CI: 0.593-0.629; sensitivity: 69.90%, specificity: 45.90%), 0.612 (95% CI: 0.579-0.644; sensitivity: 52.70%, specificity: 64.70%), and 0.548 (95% CI: 0.514-0.583; sensitivity: 57.90%, specificity: 51.10%), respectively. Conclusions: The waist-to-height ratio was more closely related to the prevalence of stroke than body mass index, waist circumference, and weight-to-hip ratio among the study participants aged ? 40 years.