Estimated Burden of Stroke in China in 2020

Author:

Tu Wen-Jun123,Zhao Zhenping4,Yin Peng4,Cao Lei1,Zeng Jingsheng5,Chen Huisheng6,Fan Dongsheng7,Fang Qi8,Gao Pei9,Gu Yuxiang10,Tan Guojun11,Han Jianfeng12,He Li13,Hu Bo14,Hua Yang15,Kang Dezhi16,Li Hongyan17,Liu Jianmin18,Liu Yuanli19,Lou Min20,Luo Benyan21,Pan Suyue22,Peng Bin23,Ren Lijie24,Wang Lihua25,Wu Jian26,Xu Yuming27,Xu Yun28,Yang Yi29,Zhang Meng30,Zhang Shu31,Zhu Liangfu32,Zhu Yicheng23,Li Zixiao33,Chu Lan34,An Xiuli35,Wang Lingxiao1,Yin Meng1,Li Mei36,Yin Li37,Yan Wei38,Li Chuan39,Tang Junli40,Zhou Maigeng4,Wang Longde1

Affiliation:

1. The General Office of Stroke Prevention Project Committee, National Health Commission of the People's Republic of China, Beijing, China

2. Department of Radiobiology, Institute of Radiation Medicine, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin, China

3. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

4. National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China

5. Department of Neurology, the First Affiliated Hospital of Sun Yat–sen University, Guangzhou, China

6. Department of Neurology, The General Hospital of Northern Theater Command of the Chinese People’s Liberation Army, Shenyang, China

7. Department of Neurology, Peking University Third Hospital, Beijing, China

8. Department of Neurology, the First Affiliated Hospital of Soochow University, Suzhou, China

9. Peking University School of Public Health, Beijing, China

10. Department of Neurosurgery, Huashan Hospital Fudan University, Shanghai, China

11. Department of Neurology, the Second Hospital of Hebei Medical University, Shijiazhuang, China

12. Department of Neurology, the First Affiliated Hospital of Xi'an Jiaotong University, Xi’an, China

13. Department of Neurology, West China Hospital of Sichuan University, Chengdu, China

14. Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

15. Department of Ultrasound Vascular, Xuanwu Hospital Capital Medical University, Beijing, China

16. Department of Neurosurgery, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China

17. Department of Neurology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China

18. Department of Neurosurgery, Shanghai Changhai Hospital, Shanghai, China

19. School of Health and Health Management Policy, Peking Union Medical College, Beijing, China

20. Department of Neurology, the Second Affiliated Hospital of Zhejiang University, Hangzhou, China

21. Department of Neurology, the First Affiliated Hospital of Zhejiang University, Hangzhou, China

22. Department of Neurology, Nanfang Hospital of Southern Medical University, Guangzhou, China

23. Department of Neurology, Peking Union Medical College Hospital, Beijing, China

24. Department of Neurology, Shenzhen Second Hospital, Shenzhen, China

25. Department of Neurology, the Second Affiliated Hospital of Harbin Medical University, Harbin, China

26. Department of Neurology, Beijing Tsinghua Changgung Memoria Hospital, Beijing, China

27. Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China

28. Department of Neurology, Drum Tower Hospital Affiliated to Nanjing University School of Medicine, China

29. Department of Neurology, the First Bethune Hospital of Jilin University, Changchun, China

30. Department of Neurology, Daping Hospital, Army Medical University, Chongqing, China

31. Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, China

32. Department of Cerebrovascular Disease, Henan Provincial People's Hospital, Zhengzhou, China

33. Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

34. Department of Neurology, the Affiliated Hospital of Guizhou Medical University, Guiyang, China

35. Department of Neurology, Harbin Second Hospital, Harbin, China

36. Chronic Noncommunicable Disease Prevention and Control Institute, Hebei Provincial Center for Disease Control and Prevention, Shijiazhuang, China

37. Department of Chronic Disease, Hunan Provincial Center for Disease Control and Prevention, Changsha, China

38. Chronic Noncommunicable Disease Prevention and Control Institute, Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, China

39. Chronic Noncommunicable Disease Prevention and Control Institute, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China

40. Chronic Noncommunicable Disease Prevention and Control Institute, Shandong Provincial Center for Disease Control and Prevention, Jinan, China

Abstract

ImportanceStroke is the leading cause of death in China. However, recent data about the up-to-date stroke burden in China are limited.ObjectiveTo investigate the urban-rural disparity of stroke burden in the Chinese adult population, including prevalence, incidence, and mortality rate, and disparities between urban and rural populations.Design, Setting, and ParticipantsThis cross-sectional study was based on a nationally representative survey that included 676 394 participants aged 40 years and older. It was conducted from July 2020 to December 2020 in 31 provinces in mainland China.Main Outcomes and MeasuresPrimary outcome was self-reported stroke verified by trained neurologists during a face-to-face interviews using a standardized protocol. Stroke incidence were assessed by defining first-ever strokes that occurred during 1 year preceding the survey. Strokes causing death that occurred during the 1 year preceding the survey were considered as death cases.ResultsThe study included 676 394 Chinese adults (395 122 [58.4%] females; mean [SD] age, 59.7 [11.0] years). In 2020, the weighted prevalence, incidence, and mortality rates of stroke in China were 2.6% (95% CI, 2.6%-2.6%), 505.2 (95% CI, 488.5-522.0) per 100 000 person-years, and 343.4 (95% CI, 329.6-357.2) per 100 000 person-years, respectively. It was estimated that among the Chinese population aged 40 years and older in 2020, there were 3.4 (95% CI, 3.3-3.6) million incident cases of stroke, 17.8 (95% CI, 17.5-18.0) million prevalent cases of stroke, and 2.3 (95% CI, 2.2-2.4) million deaths from stroke. Ischemic stroke constituted 15.5 (95% CI, 15.2-15.6) million (86.8%) of all incident strokes in 2020, while intracerebral hemorrhage constituted 2.1 (95% CI, 2.1-2.1) million (11.9%) and subarachnoid hemorrhage constituted 0.2 (95% CI, 0.2-0.2) million (1.3%). The prevalence of stroke was higher in urban than in rural areas (2.7% [95% CI, 2.6%-2.7%] vs 2.5% [95% CI, 2.5%-2.6%]; P = .02), but the incidence rate (485.5 [95% CI, 462.8-508.3] vs 520.8 [95% CI, 496.3-545.2] per 100 000 person-years; P < .001) and mortality rate (309.9 [95% CI, 291.7-328.1] vs 369.7 [95% CI, 349.1-390.3] per 100 000 person-years; P < .001) were lower in urban areas than in rural areas. In 2020, the leading risk factor for stroke was hypertension (OR, 3.20 [95% CI, 3.09-3.32]).Conclusions and RelevanceIn a large, nationally representative sample of adults aged 40 years or older, the estimated prevalence, incidence, and mortality rate of stroke in China in 2020 were 2.6%, 505.2 per 100 000 person-years, and 343.4 per 100 000 person-years, respectively, indicating the need for an improved stroke prevention strategy in the general Chinese population.

Publisher

American Medical Association (AMA)

Subject

General Medicine

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