Objective To systematically review the risk factors of stroke-associated pneumonia (SAP) and its pathogenetic characteristics in Chinese stroke patients. Methods The Web of Science, PubMed, Embase, CNKI, WanFang Data, and VIP databases were electronically searched to collect studies on the risk factors of stroke patients with concurrent SAP or studies on the pathogenetic characterization of stroke patients with concurrent SAP from the time of database inception to August 2024. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using Stata 18 software. Results A total of 52 papers were included, all of which were retrospective studies, comprising 44 715 stroke patients, including 11 740 patients with SAP. Meta-analysis results showed that the prevalence of concomitant SAP in stroke patients was 24%. The length of hospital stay (≥14 days), invasive manipulation, dysphagia, age ≥60 years, chronic obstructive pulmonary disease (COPD), and nasogastric feeding, Glasgow Coma scale (GCS) score (≤8), history of smoking, diabetes mellitus, impaired consciousness, indwelling gastric tube, and hypoproteinaemia were risk factors for SAP episodes in stroke patients. Ventilator-assisted ventilation (≥3 days) and mechanical ventilation (≥24 hours) were independent risk factors for pulmonary infection in stroke patients. Pseudomonas aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, Enterobacter cloacae, Escherichia coli, Stenotrophomonas maltophilia, Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pneumoniae, Staphylococcus haemolyticus, Enterococcus, Pseudomona albicans, Pseudomonas tropicalis, and Pseudomona glabrata were the common causative organisms in stroke patients with concomitant SAP. Conclusion In clinical practice, the above risk factors should be focused on and included in the stroke assessment system to achieve earlier prevention or diagnosis of stroke-complicated SAP. The common pathogens in stroke-complicated SAP should be examined and medicated for better therapeutic effects.