Age-period-cohort analysis of stroke mortality attributable to high systolic blood pressure in China and Japan

Jinhong Cao,Ahmed Arafa,Ehab S Eshak,Keyang Liu,Haytham A Sheerah,Chuanhua Yu

doi:10.1038/s41598-021-98072-y

Jinhong Cao, Ahmed Arafa + Show 4 more

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https://doi.org/10.1038/s41598-021-98072-y

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Abstract

Stroke is a principal cause of mortality in China and Japan. High systolic blood pressure (SBP) was considered a chief risk factor for stroke mortality. Herein, we evaluated temporal trends of high SBP-attributable stroke mortality in China and Japan between 1990 and 2017. Data on stroke mortality were retrieved from the Global Burden of Disease Study 2017 (GBD 2017). Using the age-period-cohort method, we computed overall net drifts, local drifts, longitudinal age curves, and cohort/period rate ratios (RRs) for high SBP-attributable stroke mortality. The age-standardized mortality rates (ASMRs) displayed decreasing trends for high SBP-attributable stroke mortality. The annual net drift values were − 1.4% and − 3.5% in Chinese men and women versus − 3.1% and − 4.9% in Japanese men and women. The local drift values in both countries were < 0 among all age groups but were lower in women than in men. The longitudinal age curves showed a greater high SBP-attributable stroke mortality in men than in women across all age groups. Similar decreasing patterns were shown in the period and cohort RRs in both sexes with women having a quicker decline than men. In China and Japan, the ASMRs, as well as the period and cohort RRs of high SBP-attributable stroke mortality, decreased between 1990 and 2017 in both sexes and across all age groups. Yet, the prevalence of high SBP remained worrisome in both countries. Thus, SBP control should be encouraged to prevent stroke mortality.

Highlights

Stroke is a principal cause of mortality in China and Japan
High systolic blood pressure (SBP) can contribute to the increased risk of stroke mortality via inducing smooth muscle hypertrophy and remodeling that result in arterial wall thickness and lumen narrowing, enhancing endothelial dysfunction which increases vascular permeability that leads to local thrombi, and accelerating the atherosclerosis process in the intracerebral arteries via enhancing oxidative stress and inflammation that ends with vascular r esistance[11,12]
Since mortality rates reflect the accumulation of health risks[15], we further investigated the independent impacts of age, period, and cohort on the long-term trends via an age-period-cohort model (APC) of estimable functions using the same data

Summary

Introduction

Stroke is a principal cause of mortality in China and Japan. High systolic blood pressure (SBP) was considered a chief risk factor for stroke mortality. The longitudinal age curves showed a greater high SBP-attributable stroke mortality in men than in women across all age groups. In China and Japan, the ASMRs, as well as the period and cohort RRs of high SBP-attributable stroke mortality, decreased between 1990 and 2017 in both sexes and across all age groups. In China, the disease burden has been increasing over the past d ecades[13] with a concomitant increase in the age-standardized mortality rates (ASMRs) attributable to high SBP of at least 110–115 mmHg from 1232.6 to 2334.5 per 100,000 population during the period between 1990 and 2 0152. We used data from the Global Burden of Disease (GBD) 2017 to investigate the differences in stroke mortality attributable to SBP of at least 110–115 mmHg in China and Japan during the period between 1990 and 2017. Since mortality rates reflect the accumulation of health risks[15], we further investigated the independent impacts of age, period, and cohort on the long-term trends via an age-period-cohort model (APC) of estimable functions using the same data

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