Zhao Peng, Liu Jie, Hao Yuhan, Lin Qiuxing, Gao Ying, Tu Jun, Wang Jinghua, Wang Yaogang, Ning Xianjia
Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.
Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, China.
Front Neurol. 2020 May 13;11:385. doi: 10.3389/fneur.2020.00385. eCollection 2020.
Low socioeconomic status is associated with a high stroke risk. However, few studies have quantitatively assessed the relationship between stroke burden and national economic development indicators. We explored the quantitative association between macroeconomic development and stroke burden in rural China. In this population-based, prospective study (1992-2016), we collected data on annual registrations of stroke events and deaths in Tianjin, China. Economic development over the period was represented by gross domestic product annually adjusted for purchasing power parity (PPP-aGDP) and per capita net income (PCNI) of rural residents in China. We assessed the association of first-ever stroke incidence with PPP-aGDP and PCNI. During the 25-year study period, there were 1,185 stroke events and 362,296 person years of surveillance. First-ever stroke incidence increased by an average of 10.7% per 1,000 USD increase in overall PPP-aGDP and by 12.0% per 1,000 Yuan increase in PCNI; respectively, the mean increases were 9.6 and 10.8% in men and 13.0 and 14.4% in women (all, < 0.001). These same changes in PPP-aGDP and PCNI also resulted in increases in the incidence of ischemic stroke (12.6 and 14.3%, respectively; < 0.05), and intracerebral hemorrhage (both, 6.2%; < 0.05). Similarly, in men, the age of onset of intracerebral hemorrhage decreased by 0.96-years ( = 0.002) for each 1,000 USD increase in PPP-aGDP and by 1.08-years ( = 0.003) for each 1,000 Yuan increase in PCNI. Macroeconomic development was positively associated with stroke incidence in rural China. Thus, enhancing health-care investments is crucial for containing the stroke burden during this remarkable economic development in China. Our findings could guide other developing countries with information regarding the timely control of stroke risk factors and reductions in stroke burden during the initial stages of economic development.
社会经济地位低下与中风风险高相关。然而，很少有研究定量评估中风负担与国家经济发展指标之间的关系。我们探讨了中国农村宏观经济发展与中风负担之间的定量关联。在这项基于人群的前瞻性研究（1992 - 2016年）中，我们收集了中国天津中风事件和死亡的年度登记数据。该时期的经济发展以经购买力平价调整的年度国内生产总值（PPP - aGDP）和中国农村居民人均纯收入（PCNI）来表示。我们评估了首次中风发病率与PPP - aGDP和PCNI的关联。在25年的研究期间，有1185例中风事件和362296人年的监测。总体PPP - aGDP每增加1000美元，首次中风发病率平均增加10.7%；PCNI每增加1000元，首次中风发病率平均增加12.0%；男性的平均增幅分别为9.6%和10.8%，女性为13.0%和14.4%（均P < 0.001）。PPP - aGDP和PCNI的这些相同变化也导致缺血性中风发病率增加（分别为12.6%和14.3%；P < 0.05）以及脑出血发病率增加（均为6.2%；P < 0.05）。同样，在男性中，PPP - aGDP每增加1000美元，脑出血发病年龄降低0.96岁（P = 0.002）；PCNI每增加1000元，脑出血发病年龄降低1.08岁（P = 0.003）。宏观经济发展与中国农村中风发病率呈正相关。因此，在中国这一显著的经济发展过程中，加强医疗保健投资对于控制中风负担至关重要。我们的研究结果可为其他发展中国家提供有关在经济发展初期及时控制中风风险因素和减轻中风负担的信息。
