Neuroscience Center, Department of Neurology, First Hospital of Jilin University, No. 71 Xinmin Street, Chaoyang, Changchun, Jilin, 130021, China.
BMC Public Health. 2024 Aug 8;24(1):2155. doi: 10.1186/s12889-024-19615-2.
The prevalence of stroke disability associated with high BMI has significantly increased over the past three decades. However, it remains uncertain whether high body-mass index (BMI) exerts a similar impact on the disease burden of different stroke subtypes. The aim of this study is to assess the long-term trends of stroke and subtypes mortality attributable to high BMI in China between 1990 and 2019.
Data on stroke and subtypes mortality attributable to high BMI in China was extracted in the Global Burden of Disease (GBD) 2019. The trends of age-standardized mortality rate (ASMR) were calculated using the linear regression and age-period-cohort framework.
The changing trend of ASMR on stroke attributable to high BMI in China differed among subtypes, with an estimated annual percentage change (EAPC) and 95%CI of 2.04 (1.86 to 2.21) for ischemic stroke (IS), 0.36 (-0.03 to 0.75) for intracerebral hemorrhage (ICH), and - 4.62 (-5.44 to -3.78) for subarachnoid hemorrhage (SAH). Net and local drift analyses revealed a gradual increase in the proportion of older people with IS and a gradual increase in the proportion of younger people with hemorrhagic strokes. The cohort and period rate ratios varied by subtype, showing an increasing trend for IS and ICH but a decreasing trend for SAH. The stroke mortality attributable to high BMI increased significantly with age for IS and ICH, peaking between ages 50-70 for SAH. Notably, males had higher ASMR related to stroke but exhibited slighter declines or higher growth compared to females in China. Moreover, the population affected by fatal strokes tended to be older among females but more evenly distributed across a wider age range encompassing both younger and older individuals.
The research findings indicate a rising trend in the ASMR of stroke and subtypes attributable to high BMI in China from 1990 to 2019, with different patterns of change for different subtypes, genders and ages. Consequently, it is imperative for public health authorities in China to formulate guidelines for specific stroke subtypes, genders and ages to prevent the burden of stroke attributable to high BMI.
过去三十年来，与高 BMI 相关的卒中残疾的患病率显著增加。然而，高体重指数（BMI）是否对不同卒中亚型的疾病负担产生类似的影响仍不确定。本研究旨在评估 1990 年至 2019 年中国因高 BMI 导致的卒中及亚型死亡率的长期变化趋势。
从全球疾病负担（GBD）2019 中提取中国因高 BMI 导致的卒中及亚型死亡率的数据。使用线性回归和年龄-时期-队列框架计算年龄标准化死亡率（ASMR）的变化趋势。
中国因高 BMI 导致的卒中亚型的 ASMR 变化趋势不同，缺血性卒中（IS）的估计年变化百分比（EAPC）及 95%置信区间（CI）为 2.04（1.86 至 2.21），颅内出血（ICH）为 0.36（-0.03 至 0.75），蛛网膜下腔出血（SAH）为-4.62（-5.44 至-3.78）。净漂移和局部漂移分析表明，IS 中老年人的比例逐渐增加，出血性卒中患者中年轻人的比例逐渐增加。队列和时期率比因亚型而异，IS 和 ICH 呈上升趋势，而 SAH 呈下降趋势。因高 BMI 导致的卒中死亡率随年龄增长显著增加，SAH 中 50-70 岁年龄组达到峰值。值得注意的是，中国男性与卒中相关的 ASMR 较高，但与女性相比，下降幅度较小或增长幅度较大。此外，致命性卒中的发病人口在中国女性中趋于老龄化，但在更广泛的年龄范围内分布更为均匀，涵盖了年轻人和老年人。
研究结果表明，1990 年至 2019 年，中国因高 BMI 导致的卒中及亚型的 ASMR 呈上升趋势，不同亚型、性别和年龄的变化模式不同。因此，中国公共卫生当局必须制定针对特定卒中亚型、性别和年龄的指南，以预防高 BMI 导致的卒中负担。
