The epidemiological transition of first-ever stroke among low-income population in China: a population-based study from 1992 to 2014

Abstract

BackgroundStroke is the leading cause of death in rural areas and the third cause of death in urban areas in China, but the epidemiological transition of stroke during periods of rapid economic development is unknown in China, especially in rural areas. We aimed to investigate the secular trends in incidence, prevalence, and the 30-day case fatality of first-ever stroke in rural China between 1992 and 2014. MethodsWe assessed the secular trends in the epidemiological transition of stroke in Tianjin, China. The study population was from the Tianjin Brain Study, a population-based stroke surveillance study among low-income residents in a township in Tianjin, China, where stroke events and all deaths have been registered annually from 1992 to 2014. We used data from the Tianjin Brain Study to estimate case-fatality rates, the age-standardised incidence and prevalence of first-ever stroke per 100 000 population with the world standardisation population. Trends in age-standardised incidence and prevalence of stroke were assessed from annual percentage of change by sex and subtypes using the regression model: log(rt)=a+bt, where log denotes the natural logarithm and t is the year, and 100b represents the estimated annual percentage of change. FindingsBetween 1992 and 2014, the age-standardised incidence of first-ever stroke per 100 000 population increased annually by 6·3% overall, by 5·5% in men, and by 7·8% in women (p<0·0001); the case fatality decreased annually by 3·9% overall (p=0·024) and by 6·0% in women (p=0·015), but did not change in men (p=0·072). Simultaneously, the age-standardised prevalence of first-ever stroke per 100 000 population increased annually by 10·6% overall, by 9·9% in men, and by 11·5% in women (p<0·0001). With respect to stroke subtypes, the age-standardised incidence of first-ever stroke from intracerebral haemorrhage increased annually by 4·6% overall (p=0·022), by 3·5% in men (p=0·009), and by 4·8% in women (p=0·016), whereas the incidence of ischaemic stroke increased annually by 7·2% overall, by 6·6% in men, and by 8·3% in women (p<0·0001). The corresponding prevalence of intracerebral haemorrhage increased annually by 8·0% overall, 7·0% in men, and 9·9% in women, whereas the prevalence of ischaemic stroke increased annually by 11·4% overall, by 10·9% in men, and by 12·4% in women. InterpretationThe epidemiological transition of stroke was found among a low-income population in China. The incidence and prevalence of stroke from intracerebral haemorrhage and ischaemic stroke increased rapidly in both men and women. These findings suggest that it is crucial to prevent stroke among low-income population in China to reduce the burden of disease worldwide. FundingThe Ministry of Science and Technology of the People's Republic of China and National Key Project of Clinical Neurology, Tianjin Medical University General Hospital.