Neuroscience Center, Department of Neurology, First Hospital of Jilin University, Changchun, China.
Stroke. 2024 Jan;55(1):59-68. doi: 10.1161/STROKEAHA.123.044505. Epub 2023 Dec 4.
It is unknown whether high systolic blood pressure had a similar effect on the disease burden of stroke subtypes. The aim of our study is to compare the long-term trends of stroke subtypes and sex groups attributable to high systolic blood pressure in China from 1990 to 2019.
Data about the age-standardized mortality rate and the age-standardized disability-adjusted life-year rate of stroke subtypes attributable to high systolic blood pressure in China were extracted in GBD (Global Burden of Disease) 2019. The trends in the age-standardized mortality rate and the age-standardized disability-adjusted life-year rate were calculated using the liner regression and age-period-cohort method, adjusted for age, period, and cohort.
The estimated annual percentage change for mortality of stroke attributable to high systolic blood pressure was different from subtypes, with an estimated annual percentage change and 95% CI of 0.56 (0.37-0.74) for ischemic stroke (IS), -1.52 (-1.97 to -1.07) for intracerebral hemorrhage, and -7.02 (-7.86 to -6.17) for subarachnoid hemorrhage (SAH). The curve of the net drifts showed a downward trend for intracerebral hemorrhage and SAH, but that showed a stable trend for IS. The curve of local drifts showed a slow upward trend with age for IS, a slow downward trend for intracerebral hemorrhage, and a sharp downward trend for SAH. The drift curves showed different trends for males and females. The proportion of stroke mortality in young males was gradually increasing. The cohort rate ratio varied by subtypes, with the greatest decline for SAH, a slight decrease for intracerebral hemorrhage, and a slight increase for IS. The period rate ratio had decreased over the past 3 decades, with the greatest decline for SAH and the weakest decrease for IS. Moreover, both the period and cohort rate ratios for IS mortality due to high systolic blood pressure in males have increased significantly over the past 3 decades.
Our results provided strong evidence that the disease burden of stroke attributable to high systolic blood pressure varied by subtypes and sex in China from 1990 to 2019. The age-standardized mortality rate and the age-standardized disability-adjusted life-year rate decreased for hemorrhagic stroke but increased for IS. Males had a higher mortality and exposure risk but a slighter decreasing trend than females. Our study suggested that greater attention should be given to the prevention of the burden of IS attributable to systolic blood pressure in China, especially for males.
目前尚不清楚收缩压升高是否对卒中亚型的疾病负担有类似的影响。本研究旨在比较 1990 年至 2019 年中国因收缩压升高导致的卒中亚型和性别组别的长期变化趋势。
从 2019 年全球疾病负担研究（GBD）中提取中国因收缩压升高导致的卒中亚型归因于高收缩压的年龄标准化死亡率和年龄标准化伤残调整生命年率的数据。采用线性回归和年龄-时期-队列方法计算年龄标准化死亡率和年龄标准化伤残调整生命年率的变化趋势，调整因素为年龄、时期和队列。
因收缩压升高导致的卒中死亡率的估计年变化率因亚型而异，估计的年变化率和 95%可信区间分别为缺血性卒中（IS）为 0.56（0.37-0.74）、脑出血为-1.52（-1.97 至-1.07）、蛛网膜下腔出血（SAH）为-7.02（-7.86 至-6.17）。净漂移曲线显示脑出血和 SAH 呈下降趋势，而 IS 呈稳定趋势。局域漂移曲线显示 IS 随年龄呈缓慢上升趋势，脑出血呈缓慢下降趋势，SAH 呈急剧下降趋势。男性和女性的漂移曲线显示出不同的趋势。年轻男性卒中死亡率的比例逐渐增加。亚组的队列率比有所不同，SAH 降幅最大，脑出血略有下降，IS 略有增加。过去 30 年来，时期率比呈下降趋势，SAH 降幅最大，IS 降幅最小。此外，过去 30 年来，男性因收缩压升高导致的 IS 死亡率的时期和队列率比均显著增加。
本研究结果为 1990 年至 2019 年中国因收缩压升高导致的卒中亚型的疾病负担因亚型和性别而异提供了有力证据。脑出血的年龄标准化死亡率和年龄标准化伤残调整生命年率下降，而 IS 则上升。男性的死亡率和暴露风险较高，但下降趋势较女性轻微。本研究表明，中国应更加重视预防因收缩压升高导致的 IS 负担，特别是针对男性。
