Department of Neurology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China.
Department of Epidemiology and Biostatistics, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China.
Stroke Vasc Neurol. 2023 Jun;8(3):238-248. doi: 10.1136/svn-2022-001598. Epub 2022 Nov 23.
Stroke imposes a substantial burden worldwide. With the rapid economic and lifestyle transition in China, trends of the prevalence of stroke across different geographic regions in China remain largely unknown. Capitalizing on the data in the National Health Services Surveys (NHSS), we assessed the prevalence and risk factors of stroke in China from 2003 to 2018. In this study, data from 2003, 2008, 2013, and 2018 NHSS were collected. Stroke cases were based on participants' self-report of a previous diagnosis by clinicians. We estimated the trends of stroke prevalence for the overall population and subgroups by age, sex, and socioeconomic factors, then compared across different geographic regions. We applied multivariable logistic regression to assess associations between stroke and risk factors. The number of participants aged 15 years or older were 154,077, 146,231, 230,067, and 212,318 in 2003, 2008, 2013, and 2018, respectively, among whom, 1435, 1996, 3781, and 6069 were stroke patients. The age and sex standardized prevalence per 100,000 individuals was 879 in 2003, 1100 in 2008, 1098 in 2013, and 1613 in 2018. Prevalence per 100,000 individuals in rural areas increased from 669 in 2003 to 1898 in 2018, while urban areas had a stable trend from 1261 in 2003 to 1365 in 2018. Across geographic regions, the central region consistently had the highest prevalence, but the western region has an alarmingly increasing trend from 623/100,000 in 2003 to 1898/100,000 in 2018 ( <0.001), surpassing the eastern region in 2013. Advanced age, male sex, rural area, central region, hypertension, diabetes, depression, low education and income level, retirement or unemployment, excessive physical activity, and unimproved sanitation facilities were significantly associated with stroke. In conclusion, the increasing prevalence of stroke in China was primarily driven by economically underdeveloped regions. It is important to develop targeted prevention programs in underdeveloped regions. Besides traditional risk factors, more attention should be paid to nontraditional risk factors to improve the prevention of stroke.
脑卒中在全球造成了巨大负担。随着中国经济和生活方式的快速转变，中国不同地理区域脑卒中流行趋势仍很大程度上不为人知。利用国家卫生服务调查（NHSS）的数据，我们评估了 2003 年至 2018 年中国脑卒中的患病率和危险因素。本研究收集了 2003、2008、2013 和 2018 年 NHSS 的数据。脑卒中病例基于参与者由临床医生诊断的既往病史。我们根据年龄、性别和社会经济因素估计了全人群和亚组的脑卒中患病率趋势，并在不同地理区域进行了比较。我们应用多变量逻辑回归评估了脑卒中与危险因素之间的关联。2003 年、2008 年、2013 年和 2018 年，年龄在 15 岁及以上的参与者分别为 154077、146231、230067 和 212318 人，其中 1435、1996、3781 和 6069 人患有脑卒中。2003 年、2008 年、2013 年和 2018 年，每 10 万人中年龄和性别标准化的患病率分别为 879、1100、1098 和 1613。农村地区每 10 万人的患病率从 2003 年的 669 上升到 2018 年的 1898，而城市地区从 2003 年的 1261 到 2018 年的 1365 保持稳定趋势。在地理区域方面，中部地区的患病率一直最高，但西部地区的患病率从 2003 年的 623/100,000 到 2018 年的 1898/100,000 呈惊人的上升趋势（<0.001），并在 2013 年超过了东部地区。高龄、男性、农村地区、中部地区、高血压、糖尿病、抑郁、低教育和收入水平、退休或失业、过度体力活动和未改善的卫生设施与脑卒中显著相关。总之，中国脑卒中患病率的上升主要是由经济欠发达地区推动的。在欠发达地区制定有针对性的预防计划非常重要。除了传统危险因素外，还应更加关注非传统危险因素，以改善脑卒中的预防。
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