Department of Neurology, Janakpuri Superspeciality Hospital, New Delhi, India.
Department of Neurology, Aga Khan University, Karachi, Pakistan.
J Neurol Neurosurg Psychiatry. 2014 Dec;85(12):1308-12. doi: 10.1136/jnnp-2013-306992. Epub 2014 Apr 25.
Asian countries are in various stages of epidemiological transition and therefore exhibit a great diversity in disease patterns. Collectively, they comprise almost two-third of the world's total mortality due to stroke. The purpose of this review is to explore existing epidemiological data on stroke, highlight the temporal trends in stroke epidemiology in various regions of Asia and predict future patterns based on these observations. Our search revealed that there is a lack of good epidemiological data from most Asian countries. Whatever data exist are not comparable due to lack of standardised methodology for ascertaining stroke and its subtypes. For this and other reasons, these estimates exhibit country-to-country variation and also within-country variability. We have also reviewed temporal trends in stroke incidence and prevalence in 12 Asian countries and the evolution of stroke subtypes over the past two decades. Important observations include a rise in stroke incidence in most Asian countries, an earlier age at onset compared with the West, a relative increase in the proportion of ischaemic strokes and a decline in haemorrhagic strokes. Among ischaemic stroke subtypes, lacunar strokes, which were once the commonest variety, are now declining. Emerging data suggest that large artery atherosclerosis and in particular that of intracranial vessels is the predominant aetiology in most Asian countries. The review also identified important gender differences in terms of stroke risk factors, prevalence and outcomes. There is need for sound epidemiological data from most countries to understand the disease better and plan policy-level interventions to decrease the burden. We identify a need for standard format or guidelines for conducting stroke epidemiological studies especially in developing Asian countries. This region must be identified as a priority region for stroke-related interventions and preventive strategies by global healthcare authorities and organisations.
亚洲国家处于不同的流行病学转变阶段，因此疾病模式存在很大差异。总的来说，亚洲国家占全球中风总死亡率的近三分之二。本综述的目的是探讨现有的中风流行病学数据，强调亚洲各地区中风流行病学的时间趋势，并根据这些观察结果预测未来模式。我们的研究发现，大多数亚洲国家缺乏良好的流行病学数据。由于缺乏确定中风及其亚型的标准化方法，现有的数据也不可比。由于这些原因和其他原因，这些估计值存在国家间的差异，也存在国内的差异。我们还回顾了 12 个亚洲国家中风发病率和患病率的时间趋势，以及过去二十年中风亚型的演变。重要的观察结果包括大多数亚洲国家中风发病率的上升，与西方相比发病年龄更早，缺血性中风的比例相对增加，出血性中风的比例下降。在缺血性中风亚型中，曾经是最常见的腔隙性中风现在正在减少。新出现的数据表明，在大多数亚洲国家，大动脉粥样硬化，特别是颅内血管的粥样硬化，是主要病因。该综述还确定了中风风险因素、患病率和结果方面的重要性别差异。大多数国家都需要有可靠的流行病学数据，以便更好地了解这种疾病，并制定政策层面的干预措施来减轻负担。我们认为，特别是在发展中国家的亚洲国家，有必要制定进行中风流行病学研究的标准格式或指南。全球卫生当局和组织必须将该地区确定为中风相关干预措施和预防策略的优先地区。
