Prevalence, Incidence and Mortality of Stroke in China: Results from a Nationwide Population-Based Survey of 480,687 Adults
Background—China bears the biggest stroke burden in the world. However, little is known about the current prevalence, incidence, and mortality of stroke at the national level, and the trend in the last 30 years.
Methods—In 2013 a nationally-representative door-to-door survey was conducted in 155 urban and rural centres in 31 provinces in China, totalling 480,687 adults aged ≥20 years. All stroke survivors were considered as prevalent stroke cases at the prevalent time (August 31, 2013). First-ever strokes that occurred during one year preceding the survey point-prevalent time were considered as incident cases. According to CT/MRI/autopsy findings, strokes were categorized into ischemic stroke (IS), intracerebral haemorrhage (ICH), subarachnoid haemorrhage (SAH), and stroke of undetermined type (UND).
Results—Of 480,687 participants, 7,672 were diagnosed with a prevalent stroke (1596.0 per 100,000 people) and 1643 with incident strokes (345.1 per 100,000 person-years). The age-standardized prevalence, incidence and mortality rates were 1114.8 per 100,000 people, 246.8 and 114.8 per 100,000 person-years, respectively. Pathological type of stroke was documented by CT/MRI brain scanning in 90% of prevalent and 83% of incident stroke cases. Among incident and prevalent strokes, IS constituted 69.6% and 77.8%, ICH 23.8% and 15.8%, SAH 4.4% and 4.4%, and UND - 2.1% and 2.0%, respectively. Age-specific stroke prevalence in men aged ≥40 years was significantly greater than those in women (p<0.001). The most prevalent risk factors among stroke survivors were hypertension (88%), smoking (48%) and alcohol use (44%). Stroke prevalence estimates in 2013 were statistically greater than those reported in China three decades ago, especially among rural residents (p=0.017). The highest annual incidence and mortality of stroke was in Northeast(365 and 159 per 100,000 person-years), then Central areas (326 and 154 per 100,000 person-years), and the lowest incidence was in Southwest (154 per 100,000 person-years) and the lowest mortality- in South China (65 per 100,000 person-years) (p<0.002).
Conclusions—Stroke burden in China has increased over the last 30 years, and remains particularly high in rural areas. There is a north-to-south gradient in stroke in China, with the greatest stroke burden observed in the northern and central regions.
- Received August 30, 2016.
- Revision received December 12, 2016.
- Accepted December 19, 2016.