Chen X R, Yan L X, Long Z, Hou L, Cai X N, Wang L M, Wu J
National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China.
Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
Zhonghua Yu Fang Yi Xue Za Zhi. 2025 Feb 6;59(2):202-208. doi: 10.3760/cma.j.cn112150-20240412-00299.
To analyze the characteristics and changes in incidence and mortality of ischemic and hemorrhagic stroke among Chinese residents from 2015 to 2019. The incidence and mortality data of ischemic and hemorrhagic stroke from 2015 to 2019 were collected from the China Registry of Cardiovascular Events (China RACE), which was established in 2014 and covered 100 counties (cities and districts) in 31 provinces in China. The age-standardized incidence rate (ASIR) was calculated using the Seventh National Census data as the standard population. The ratio of the incidence rate of ischemic stroke to hemorrhagic stroke was calculated. The subtype-specific mortality-to-incidence ratio (M/I) was calculated by the ratio of the number of deaths to the reported incidence cases. The relative ratio (RR) of M/I for ischemic to hemorrhagic stroke was calculated. The Joinpoint model was used to analyze the annual percentage change (APC) and trend of the incidence rate of stroke. From 2015 to 2019, a total of 1 354 614 new stroke cases were reported, including 1 077 244 (79.52%) ischemic stroke and 277 370 (20.48%) hemorrhagic stroke cases, respectively. A total of 248 620 stroke deaths were reported, including 119 819 (48.19%) ischemic stroke deaths and 128 801 (51.81%) hemorrhagic stroke deaths. The incidence ratio of ischemic/hemorrhagic stroke from 2015 to 2019 was 3.50∶1, 3.76∶1, 3.63∶1, 4.23∶1, and 4.35∶1, respectively. From 2015 to 2019, there was no statistically significant annual trend of ASIR of ischemic stroke in overall, urban and rural areas and males (>0.05), while there was a downward trend in females (APC=-1.02%, =0.042). The incidence of hemorrhagic stroke in the whole population, rural areas, males and females showed a downward trend (<0.05). Patients aged 45-49 years had an upward trend in the incidence rate of ischemic stroke (APC=3.82%, =0.011), while those aged 70-74 years (APC=-7.37%, =0.034), 80-84 years (APC=-9.75%, =0.001) and 85 years and over (APC=-11.22%, =0.017) presented a downward trend in the incidence of hemorrhagic stroke. During the period, the overall relative ratio of M/I (RR) for ischemic to hemorrhagic stroke was 4.2∶1, which was lower in urban than in rural areas (3.8 vs. 4.3). The largest gap between urban and rural areas was in the 55-59 age group (6.8 vs. 9.3). The incidence and mortality of ischemic and hemorrhagic stroke among Chinese residents are severe from 2015 to 2019, and there are regional and population differences.
分析2015年至2019年中国居民缺血性和出血性卒中的发病与死亡特征及变化情况。2015年至2019年缺血性和出血性卒中的发病与死亡数据来自于2014年建立的中国心血管病事件登记系统(China RACE),该系统覆盖中国31个省的100个县(市、区)。采用第七次全国人口普查数据作为标准人口计算年龄标准化发病率(ASIR)。计算缺血性卒中与出血性卒中的发病率之比。通过死亡人数与报告发病例数之比计算各亚型的死亡率与发病率之比(M/I)。计算缺血性与出血性卒中M/I的相对比(RR)。采用Joinpoint模型分析卒中发病率的年度变化百分比(APC)及趋势。2015年至2019年,共报告1354614例新发卒中病例,其中缺血性卒中1077244例(79.52%),出血性卒中277370例(20.48%)。共报告248620例卒中死亡病例,其中缺血性卒中死亡119819例(48.19%),出血性卒中死亡128801例(51.81%)。2015年至2019年缺血性/出血性卒中的发病率之比分别为3.50∶1、3.76∶1、3.63∶1、4.23∶1和4.35∶1。2015年至2019年,总体、城市、农村及男性缺血性卒中的ASIR无统计学显著年度趋势(>0.05),而女性呈下降趋势(APC=-1.02%,P=0.042)。全人群、农村地区、男性及女性出血性卒中发病率呈下降趋势(P<0.05)。45 - 49岁患者缺血性卒中发病率呈上升趋势(APC=3.82%,P=0.011),而70 - 74岁(APC=-7.37%,P=0.034)、80 - 84岁(APC=-9.75%,P=0.001)及85岁及以上(APC=-11.22%,P=0.017)患者出血性卒中发病率呈下降趋势。在此期间,缺血性与出血性卒中的总体M/I相对比(RR)为4.2∶1,城市低于农村(3.8比4.3)。城乡差距最大的是55 - 59岁年龄组(6.8比9.3)。2015年至2019年中国居民缺血性和出血性卒中的发病与死亡情况严峻,且存在地区和人群差异。