Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (Y.W., J.W., S.C., X.L., J.L.).
Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing, China (Y.W., J.W., J.L.).
Stroke. 2023 Apr;54(4):1078-1087. doi: 10.1161/STROKEAHA.122.040848. Epub 2023 Feb 2.
It is unclear whether sodium intake had similar effects on mortality of stroke subtypes. The purpose of this study is to compare the long-term trends in mortality of stroke subtypes attributable to high sodium intake in China during 1990 to 2019.
Data for China in the GBD (Global Burden of Disease) 2019 study were obtained mainly from the Chinese surveillance systems and the KaiLuan Study. The trends in stroke mortality due to high sodium intake (>5 g/d) were evaluated using join-point regression and age-period-cohort methods adjusting for age, period, and cohort.
The age-standardized mortality rates of stroke attributable to high sodium intake showed downward trends during 1990 to 2019 in China, with an average annual percentage change of -0.6 (95% CI, -0.8 to -0.4) for ischemic stroke, -2.5 (95% CI, -2.8 to -2.2) for intracerebral hemorrhage, and -6.1 (95% CI, -6.6 to -5.7) for subarachnoid hemorrhage. The curves of local drifts, which reflected the average annual percentage change of stroke mortality due to high sodium intake across age groups, showed a slow upward trend with age for ischemic stroke, a slow downward trend for intracerebral hemorrhage, and a sharp downward trend for subarachnoid hemorrhage. The high sodium-related mortality increased dramatically with age for ischemic stroke and intracerebral hemorrhage, while it reached a peak at 50 to 70 years old for subarachnoid hemorrhage. The period and cohort rate ratios of stroke mortality due to high sodium intake decreased in the past 3 decades, with the greatest decline for subarachnoid hemorrhage and the weakest decrease for ischemic stroke. Notably, men had higher high sodium-related mortality and risk but slighter declines for all stroke subtypes than women.
Our results provided powerful evidence that high sodium-related age-standardized mortality rates and risk of stroke in China decreased in the past 3 decades, with diverse changing patterns for different stroke subtypes, highlighting that salt reduction had distinct impact on stroke subtypes.
目前尚不清楚钠摄入量对中风亚型死亡率是否有相似的影响。本研究旨在比较 1990 年至 2019 年中国因高钠摄入导致的中风亚型的长期死亡率趋势。
本研究数据来自全球疾病负担（GBD）2019 年中国研究中的中国监测系统和开滦研究。采用 Join-Point 回归和年龄-时期-队列方法，调整年龄、时期和队列因素，评估因高钠摄入（>5g/d）导致的中风死亡率趋势。
1990 年至 2019 年，中国因高钠摄入导致的中风标化死亡率呈下降趋势，缺血性中风、脑出血和蛛网膜下腔出血的平均年变化率分别为-0.6（95%CI，-0.8 至-0.4）、-2.5（95%CI，-2.8 至-2.2）和-6.1（95%CI，-6.6 至-5.7）。局部漂移曲线反映了各年龄段因高钠摄入导致的中风死亡率的平均年变化率，显示缺血性中风呈缓慢上升趋势，脑出血呈缓慢下降趋势，蛛网膜下腔出血呈急剧下降趋势。缺血性中风和脑出血的高钠相关死亡率随年龄增长而显著增加，而蛛网膜下腔出血则在 50 至 70 岁达到峰值。过去 30 年来，因高钠摄入导致的中风死亡率的时期和队列率比均下降，蛛网膜下腔出血下降幅度最大，缺血性中风下降幅度最小。值得注意的是，男性因高钠摄入导致的中风死亡率和风险均高于女性，但所有中风亚型的死亡率下降幅度均较小。
本研究结果为中国过去 30 年来因高钠摄入导致的年龄标准化死亡率和中风风险下降提供了有力证据，不同中风亚型的变化模式不同，突出了减盐对中风亚型的不同影响。
