Incidence Of Stroke In China Research Articles

Analysis of Stroke Burden in China from 1990 to 2021 and Projections for the Next Decade.

This study aims to describe the temporal trends of stroke burden in different age and sex groups in China from 1990 to 2021, including incidence, prevalence, mortality, and disability-adjusted life years (DALYs), and to compare these data with global figures. Using data from the Global Burden of Disease (GBD) database from 1990 to 2021, we analyzed changes in stroke burden in China and globally. The average annual percentage change (AAPC) was calculated using Joinpoint software to reflect trends. Stroke burden differences across various age groups and sexes were compared, and the ARIMA model was utilized for future projections. Between 1990 and 2021, the age-standardized incidence rate (ASIR) of stroke in China decreased from 226.938 to 204.753 per 100,000, while the global ASIR decreased from 180.973 to 141.553 per 100,000. The age-standardized prevalence rate (ASPR) in China increased from 1167.425 to 1301.42 per 100,000, whereas the global ASPR decreased from 1201.111 to 1099.31 per 100,000. The age-standardized mortality rate (ASMR) in China fell from 242.18 to 138.029 per 100,000, while the global ASMR decreased from 144.313 to 87.454 per 100,000. China's age-standardized DALY rate (ASDR) declined from 4834.791 to 2648.025 per 100,000, whereas the global ASDR decreased from 3078.952 to 1886.196 per 100,000. The AAPCs for ASIR, ASPR, ASMR, and ASDR in China were -0.370%, 0.326%, -1.793%, and -1.933%, respectively, compared to -0.291%, -0.807%, -1.601%, and -1.570% globally from 1990 to 2021. Age and sex significantly influenced the stroke burden, with higher incidence and mortality rates in males than in females. Projections for the next decade indicate that stroke incidence in China will remain stable, with an expected rise in ASPR, and declines in ASMR and ASDR. Globally, ASIR is expected to decline, while ASPR will rise, and ASMR and ASDR will continue to decrease. From 1990 to 2021, the incidence, mortality, and DALYs of stroke in China have decreased, while the prevalence has increased. Stroke burden is age-related, with higher prevalence in older adults and higher mortality in the elderly. Males are more susceptible to stroke and have a higher risk of death. Over the next decade, stroke prevalence in China is expected to rise, posing challenges due to population aging, even as mortality and disability rates decline. Sustained public health efforts will be necessary.

Incidence and influencing factors of urinary incontinence in stroke patients: A meta-analysis.

The incidence of stroke in China ranks first in the world and is the leading cause of death and disability in adults. Urinary incontinence is an independent risk factor leading to poor prognosis of stroke. However, studies on the incidence of urinary incontinence in stroke patients and its influencing factors are different, fluctuate greatly, and there is no unified basis. To quantitatively analyze the incidence of urinary incontinence in stroke patients and its related influencing factors, and further make public health strategic decisions to reduce the occurrence of adverse outcomes. Computer searches were conducted in PubMed, Medline, Web of Science, Cochrane Library, Embase, CLNAHL Complete, China National Knowledge Infrastructure (CNKI), Chinese Biomedical database(CBM), Wan Fang Database, VIP Database, observational studies such as cohort studies, case-control studies or cross-sectional studies on the incidence or influencing factors of urinary incontinence in stroke patients from the establishment of the database to the publication in August 2023. Studies selection, quality evaluation and data extraction were conducted independently by two researchers according to the established search strategy. Stata 14.0 statistical software was used for meta-analysis. A total of 21 manuscripts were included, with a cumulative sample size of 7327 cases, including 2887 patients with urinary incontinence. Meta-analysis results showed that the incidence of urinary incontinence in stroke patients was 38% [95% confidence interval (34%, 41%)], including married patients and lacunar infarction were the protective factors for urinary incontinence in stroke patients, while age, chaperone, low educational level, chronic cough, lesion sites (parietal lobe, frontal lobe, and temporal lobe), stroke type (cerebral hemorrhage, subarachnoid hemorrhage and cerebral hemorrhage complicated with subarachnoid hemorrhage), dysfunction (aphasia dyslexia, dysphagia, eye movement abnormalities, leg muscle disorders), post-stroke depression, the higher the NIHSS score, the lower the Bachmann index (BI) score, OCSP classification (total anterior circulation infarction) and other 11 items were risk factors for urinary incontinence in stroke patients. The incidence of urinary incontinence in stroke patients is 38%. Marriage and lacunar infarction are the protective factors of urinary incontinence. Age, carer, low educational level, chronic cough, lesion site (parietal, frontal and temporal lobes), stroke type (cerebral hemorrhage, subarachnoid hemorrhage, cerebral hemorrhage combined with subarachnoid hemorrhage), dysfunction (aphasia and dysarthria syndrome, dysphagia, eye movement abnormalities, leg muscle disorders), post-stroke depression, and higher NIHSS score, Lower BI score and OCSP classification (total anterior circulation infarction) were risk factors for urinary incontinence in stroke patients.

Association between alcohol consumption and risk of stroke among adults: results from a prospective cohort study in Chongqing, China

BackgroundThe incidence of stroke in China is increasing, along with a clear trend in the prevalence of risk factors. Alcohol consumption is also a risk factor for stroke. Many cohort studies have explored the relationship between alcohol consumption and stroke risk. However, findings have been inconsistent.MethodsWe used cluster sampling to select 13 districts and counties (at the same level) in Chongqing, China. Then, we used stratified random sampling to distribute the number of people in each district and county. 23,308 adults aged 30–79 were recruited between October 2018 and February 2019. Follow-up was conducted through a monitoring system and questionnaires until September 2022. Information on alcohol consumption and other covariates was collected using a standardized questionnaire. Participants were asked to report their weekly frequency of drinking over the past year and weekly intake of various alcoholic beverages in general. The frequency of drinking was divided into three categories: 1–2 d/week, 3–5 d/week, and 6–7 d/week. The average daily alcohol consumption is calculated based on the amount of alcohol contained in different alcoholic beverages. It is classified as nondrinker (0 g/day), light (0 to 12 g/day), moderate (13 to 36 g/day), and high (> 36 g/day). Cox proportional hazard regression models were used to estimate the association between alcohol consumption and stroke risk. Results are shown as multivariate-adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs).ResultsWith an average follow-up of 3.80 years, there were 310 new stroke events. The incidence of total stroke was 368.69 per 100,000 person-years. Overall, after adjusting for covariates, moderate alcohol consumption (average daily alcohol consumption 13–36 g/d) was associated with a lower risk of total stroke (HR: 0.48; 95% CI: 0.25–0.92) compared with nondrinkers. The adjusted HR and 95% CI for total stroke and ischemic stroke for those who drank alcohol 6–7 days per week were 0.60(0.37, 0.96) and 0.53(0.30, 0.94), respectively. The risk of total stroke (HR: 0.39; 95% CI: 0.17–0.89) was reduced in a pattern of drinking 6–7 days per week but with a mean alcohol consumption of less than 36 g/d. There was no significant association between alcohol consumption and hemorrhagic stroke.ConclusionThis study suggests moderate alcohol consumption is associated with a lower risk of total stroke. And healthy drinking patterns should be of more significant concern.

Age at smoking initiation and smoking cessation influence the incidence of stroke in China: a 10-year follow-up study.

Our study aimed to explore the correlation between age at smoking initiation and smoking cessation for the risk for stroke in China. We investigated 50,174 participants from one of the urban areas of China Kadoorie Biobank (CKB) Study. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) for association between smoking and incidence of stroke were estimated using Cox regression model. During a median of 10.7 years of follow-up, 4370 total stroke cases were documented. Among men, comparing current smokers to never smokers, the HR of total stroke for current smokers was 1.279 (95% CI, 1.134-1.443) for total stroke. The HRs of total stroke were 1.344 (1.151-1.570) for those started smoking at age less than 20 years, 1.254 (1.090-1.443) for those started smoking at age 20-30 years, and 1.205 (1.012-1.435) for those started smoking at age 30 year and above, with a dose-response relation (P for trend, 0.004). Comparing former smokers to current smokers, in the low pack-year group, those stopped smoking at age less than 65 years had a 18.2% decreased risk for total stroke (0.818; 0.673-0.994). The decreased risk was not found in those stopped smoking at age 65 years and above. Similar results were observed in the high pack-year group. In conclusion, we found that current smokers had a higher stroke risk than never smokers, and the risk increased with a younger age at smoking initiation. Smoking cessation can reduce the risk for stroke, especially could benefit from cessation at a younger age.

Design and implementation of informatization for unified management of stroke rehabilitation in urban multi-level hospitals.

With the aging of the population, the prevalence and incidence of stroke in China are increasing every year. China advocates the establishment of a three-level medical service system for stroke rehabilitation, but it lacks uniform information management among all levels of medical institutions. To achieve unified management of stroke patient rehabilitation in multilevel hospitals in the region through informatization construction. The need for informatization of three-level stroke rehabilitation management was analyzed. Then, network connections were established, and a common rehabilitation information management system (RIMS) was developed for all levels of hospitals to enable daily stroke rehabilitation management, inter-hospitals referral, and remote video consultation. Finally, the impact on the efficiency of daily rehabilitation work, the functioning and satisfaction of stroke patients were investigated after implementing the three-level rehabilitation network. One year after implementation, 338 two-way referrals and 56 remote consultations were completed using RIMS. The stroke RIMS improved the efficiency of doctors' orders, reduced therapists' time to write medical documents, simplified statistical analysis of data and made referrals and remote consultations more convenient compared to the traditional model. The curative effect of stroke patients managed by RIMS is better than that of traditional management. Patient satisfaction with rehabilitation services in the region has increased. The three-level stroke rehabilitation informatization has enabled the unified management of stroke rehabilitation in multilevel hospitals in the region. The developed RIMS improved the efficiency of daily work, improved the clinical outcomes of stroke patients, and increased patient satisfaction.

Effects of Magnetic Nanoparticle Drug Delivery Systems on Thrombosis and Neuroprotection in Brain Stroke Model.

Nanomaterials refer to solid materials that are composed of ultrafine particles on the order of nanometers. Nanomaterials show broad application prospects in the fields of chemistry, metallurgy, electronics, aerospace, biology and medicine. The incidence of stroke in China ranks first in the world and the mortality rate is much higher than that in European and American countries. Drugs that are sensitive to the internal environment of the living body can be combined in the nuclear department to prevent them from reacting with the biological environment before reaching the target site, thereby reducing the efficacy or causing toxic side effects on other cells, tissues and organs. This project uses transgenic mice as experimental materials to establish an animal model of cerebral stroke. The light-embedded stroke model is used to simulate the pathological state of acute ischemic stroke. In vivo imaging and immunohistochemical techniques are used to analyze the administration of magnetic nanoparticles. Effects of the system on thrombolysis and neurological function protection in cerebral stroke models.

Secular trends of stroke incidence and mortality in China, 1990 to 2016: The Global Burden of Disease Study 2016

BackgroundThe impact of socioeconomic developments on stroke incidence and mortality must be understood to target prevention strategies appropriately. We assessed the secular trends in stroke incidence and mortality in China based on data from the Global Burden of Disease Study 2016. MethodsTrends of stroke incidence and mortality of China was described in different categories of age, sex and stroke type using the GBD study database. Also a comparative study was conducted between China and Japan, U.S. to find reasonable references for development. Secular trends in incidence and mortality (per 100,000 population) were assessed for stroke, including ischemic and hemorrhagic stroke from 1990 to 2016. Population pyramid was used to illustrate changes in age- and sex-specific incidence and mortality rates. ResultsDuring the study period, stroke incidence in China increased from 204.52 to 403.08 and mortality increased from 122.09 to 130.94; the corresponding age-standardized rates changed from 335.63 to 353.70 and from 231.28 to 132.84, respectively. Among those aged 15–49 and 50–69 years, the incidence rates of ischemic stroke and hemorrhagic stroke both tended to increase, whereas the mortality rates tended to decline in all age groups. The incidence and mortality were highest among those aged ≥70 years. Compared with the U.S. and Japan, age-standardized rates of incidence and mortality were higher in China. ConclusionsAlthough the incidence of stroke has increased in China, overall mortality has decreased. A priority of stroke prevention and control strategies will transition from reducing mortality to controlling the incidence in at-risk populations.

Association between socioeconomic status and incident stroke in China

BackgroundLittle is known about the impact of socioeconomic status (SES) on incidence of stroke in China. This study aimed to examine the association of SES, which was measured by different...

Stroke epidemiology and stroke policies in China from 1980 to 2017: A systematic review and meta-analysis.

Stroke is the leading cause of death and years of life lost in China, and this problem is growing because stroke risk factors such as hypertension and hypercholesteremia have been on the rise as China experiences the demographic transition. The Chinese government has created public health initiatives in the form of guidelines, policies and programs to combat this problem, but the dissemination and effectiveness of these policies are not well known. The aim of this study was to determine trends in stroke incidence, prevalence, and stroke-related mortality in China and to report these trends in the context of stroke initiatives that have been enacted by the Chinese government. We systematically reviewed articles on stroke rates and stroke initiatives from 1980 to 2017. A meta-regression including 11 studies showed that stroke incidence remained stable at 128.3 per 100,000 per year from 1980 to 2005 and has increased by 21.3 per 100,000 per year since then to 298.7 per 100,000 per year in 2013. A meta-regression including seven studies demonstrated a gradual decline in stroke-related mortality by 6.5 per 100,000 per year since 1980 (a decline from 369.2 in 1980 to 154.7 per 100,000 per year in 2013). Average stroke prevalence was 898.4 per 100,000 over the entire time-period. Limitations included heterogeneity between the studies. We identified 12 stroke initiatives, the first of which was enacted in 2006. Despite numerous public health initiatives aimed at combating stroke that started in 2006, stroke incidence in China has increased over the last decade, likely as a result of aging and urbanization of the Chinese population.

Long-term prognosis of patients with stroke associated with middle cerebral artery occlusion. Single-centre registration study

IntroductionLarge artery intracranial occlusive disease including middle cerebral artery (MCA) is a major contributor to the incidence of stroke in China. The data on the prognosis of symptomatic atherosclerotic MCA occlusions (MCAO) are limited. We aimed to investigate the related factors of unfavorable outcomes in patients with stroke associated with MCAO.Material and methodsA total of 119 patients with MCAO symptom were enrolled in this retrospective longitudinal cohort study. All patients met inclusion criteria of cerebral angiography by CT angiography or magnetic resonance angiography. Stroke severity was assessed on admission using the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS).ResultsWe showed an average follow-up time of 46.8 months, within which 20 (19.6%) cases died and 14 (13.7%) cases had stroke recurrence. Using mRS as an evaluation index, the patients were divided into an unfavourable outcome group (mRS > 2, 48 cases) and a favourable outcome group (mRS ≤ 2, 54 cases). Logistic regression analysis suggests that age and NIHSS score were independent risk factors for a poor outcome value. Coexisting other cerebral vascular occlusion was an independent risk factor for stroke recurrence. Age was an independent risk factor for death.ConclusionsThe prognosis of patients with MCAO was generally optimistic, with higher survival rate and longer survival time. As compared, elder age and higher NIHSS score both tend to be associated with worse prognosis of survival. MCAO patients with other extracranial or intracranial vascular occlusion have higher risk of recurrent stroke. Death rate increases with age among the MCAO patients.

Perceptions of Perioperative Stroke Among Chinese Anesthesiologists: Starting a Long March to Eliminate This Underappreciated Complication.

Perceptions of Perioperative Stroke Among Chinese Anesthesiologists: Starting a Long March to Eliminate This Underappreciated Complication.

Abstract TP376: Disparities in Outcomes among Inpatient Stroke in Women Associated with Rural-Urban Insurance Status in China

Background: The annual incidence of stroke in China has increased more drastically in women; moreover, women who experience stroke are less likely to recover. Despite a few studies that have demonstrated gender differences in stroke care and outcomes, there has been limited research exploring insurance-related disparities in outcomes, particularly among female stroke patients. We examined the relationship between rural/urban insurance status on the 1-year clinical outcomes of stroke in women. Method: Cox proportional hazard model was employed to analysis the clinical outcome endpoints in our model. The logistic regression model was used to select significant risk factors. The generalized estimating equation model was applied to control the cluster effect of hospitals in order to obtain a more precise estimation. Results: Compared with women covered by the Urban Resident/Employee Basic Medical Insurance (URBMI/UEBMI), those covered by the New Rural Cooperative Medical Scheme (NRCMS) were younger, less likely to have vascular risk factors and stroke awareness or undergone treatment for hypertension and dyslipidemia, and more likely to have received early antithrombotics, antithrombotics at discharge, and lipid-lowering drugs (Table 1). One-year stroke recurrence and mortality was significantly higher in women covered by the NRCMS (Table 2). Significant differences in age, stroke risk factors, awareness and treatment, care process, and 1-year stroke recurrence and mortality were observed. Conclusion: Healthcare policymakers need to focus their attention on these disparities and take suitable steps to improve primary healthcare service in rural areas.

OP.1B.10] INTRACRANIAL STENOSIS IN FIRST-GENERATION CHINESE MIGRANTS WITH NEWLY DIAGNOSED DIABETES

Objective: Ethnic differences might influence the value of current approach to cardiovascular risk stratification. Intracranial atherosclerotic disease was indeed reported as a common cause of ischemic stroke among patients of Asian ancestry and stroke incidence in China is high. However, no study investigated the prevalence of intracranial stenosis (ICS) in Chinese migrants with newly diagnosed DM and the screening of vascular lesions is still mainly focused on the more accessible extracranial carotid artery. Present survey was thus performed to determine the prevalence of intracranial stenosis in Chinese migrants with newly diagnosed diabetes. Design and method: A cross-sectional community-based survey enrolled Chinese first generation migrants (n = 1200) and native Italians (n = 291) aged 35–59 years. Hypertension was diagnosed according to ESH guidelines. Diagnosis of DM was based on fasting plasma glucose criteria (more than 125 mg/dl confirmed by repeat testing), and/or current treatment with glucose-lowering drugs. Chinese patients with newly diagnosed diabetes were screened for intracranial stenosis using Doppler ultrasound. ICS (any degree of stenosis) was diagnosed when the peak flow velocity at Transcranial Doppler (TCD) was higher than: 120 cm/s for anterior cerebral arteries (ACA); 155 cm/s for middle cerebral arteries (MCA); 100 cm/s for posterior cerebral arteries (PCA); 100 cm/s for basilar artery (BA); 90 cm/s for intracranial vertebral arteries (VA). Results: DM was diagnosed in 168 (14.0%) and 21 (7.3%) participants in the Chinese and Italian cohorts respectively (age- and gender adjusted OR 2.29; 95% C.L. 1.41 to 3.72). Difference was not reduced when obesity and socioeconomic indexes were included in the model. Ninety-six Chinese patients with newly diagnosed DM accepted to undergo the screening of cerebral vascular lesions. No patient had carotid stenosis of any degree wheres per-person prevalence of intracranial stenosis was 18.2%. Nine out of the 17 patients with any intracranial stenosis (52%) had more than 1 intracranial lesions. Conclusions: The high prevalence of asymptomatic intracranial stenosis in Chinese patients with newly diagnosed diabetes emphasizes the importance of paying attention to intracranial vessels in this minority group.

Rapid transitions in the epidemiology of stroke and its risk factors in China from 2002 to 2013.

To estimate the current prevalence, temporal incidence trends, and contribution of risk factors for stroke in China. The China National Stroke Screening Survey (CNSSS) is an ongoing nationwide population-based program. A representative sample of 1,292,010 adults over 40 years old with 31,188 identified stroke cases from the 2013 and 2014 CNSSS database was analyzed to provide descriptive statistics of the prevalence and risk factors for stroke in 2014. In addition, a retrospective evaluation of 12,526 first-ever stroke cases in 2002-2013 and stroke mortality data from the 2002-2013 China Public Health Statistical Yearbook was conducted to estimate the incidence rates. In 2014, the adjusted stroke prevalence was 2.06% in adults aged 40 years and older. After full adjustments, all risk factors assessed showed significant associations with stroke (p < 0.01); the largest contributor was hypertension (population-attributable risk 53.2%), followed by family history, dyslipidemia, atrial fibrillation, diabetes, physical inactivity, smoking, and overweight/obesity. The incidence of first-ever stroke in adults aged 40-74 years increased from 189/100,000 individuals in 2002 to 379/100,000 in 2013-an overall annual increase of 8.3%. Stroke-specific mortality in adults aged 40-74 years has remained stable, at approximately 124 deaths/100,000 individuals in both 2002 and 2013. In 2002-2013, the incidence of stroke in China increased rapidly. Combined with a high prevalence, a trend toward a younger age, and stable mortality, this finding suggests that additional clinical and behavioral interventions for metabolic and lifestyle risk factors are necessary to prevent stroke, particularly in certain populations.

Features and risk factors of carotid atherosclerosis in a population with high stroke incidence in China.

Epidemiological studies have reported associations between traditional cardiovascular risk factors and carotid intima-media thickness (CIMT) or carotid plaque. However, definite risk factors at different phases of carotid atherosclerosis remain controversial. We aimed to explore risk factors and characteristics of carotid atherosclerosis at different stages in a low-income population with a high incidence of stroke in China. Between April 2014 and January 2015, we recruited 3789 stroke-free and cardiovascular disease-free residents aged ≥ 45 years. B-mode ultrasonography was performed to measure CIMT and the presence of carotid plaque. Traditional risk factors were compared between the increased CIMT group and normal CIMT group, and between those with and without carotid plaque. A total of 3789 participants were assessed in this study, with a mean age (standard deviation) of 59.92 (9.70) years. The prevalence of increased CIMT and carotid plaque increased with older age and higher education levels. Age, hypertension, diabetes, and high low-density lipoprotein cholesterol levels were risk factors for increased CIMT and carotid plaque. Furthermore, compared to never smoking, passive smoking was positively associated with increased CIMT, with an odds ratio (95% confidence interval) of 1.26 (1.05, 1.53; P = 0.016); high body mass index was an obvious protective factor against carotid plaque, with an odds ratio (95% confidence interval) of 0.97 (0.95, 0.99; P = 0.004). It is important to identify factors associated with atherosclerosis to prevent cardiovascular disease and stroke and reduce the burden of stroke in this high-risk population.

Hypertension unawareness among Chinese patients with first-ever stroke.

BackgroundThe low rates of hypertension treatment and control, partly due to its unawareness, are the main causes of the high stroke incidence in China. The purpose of this study was to evaluate hypertension unawareness amongst patients with first-ever stroke and to detect factors associated with its unawareness.MethodsWe selected those diagnosed with hypertension from patients with first-ever stroke registered in the Nanjing Stroke Registry Program between 2004 and 2014. These hypertensives were divided as being aware or unaware of their hypertension by using a brief questionnaire conducted shortly after the stroke. Multivariate logistic regression analysis was performed to identify potential factors associated with hypertension unawareness.ResultsOf the 5309 patients with first-ever stroke, 3732 (70.3 %) were diagnosed with hypertension. Among which, 593 (15.9 %) were unaware of their hypertension at the time of stroke onset. Lower-level of education (primary school or illiteracy) and smoking were associated positively with hypertension unawareness; while advanced age, overweight, diabetes mellitus, heart diseases and family history of stroke were associated negatively with hypertension unawareness. Annual data analyzed indicated that the rate of hypertension awareness increased during the past 11 years (r = 0.613, P = 0.045 for trends).ConclusionsA substantial proportion (15.9 %) of Chinese patients with hypertension had not been aware of this covert risk until an overt stroke occurred. Hypertension unawareness was associated with lower educational levels and smoking, which address the importance of health education especially in these individuals.

Is There a Stroke Belt in China and Why?

In 1960s, a stroke belt with high stroke mortality was discovered in the southeast United States. In China, where stroke is the leading cause of death, we aimed to determine whether a focal region of high stroke incidence (stroke belt) exits and, if so, the possible causal and modifiable factors. We systematically reviewed all studies of stroke incidence in China between 1980 and 2010, and included those which met our criteria for a high-quality study. Criteria for a provincial region of high stroke incidence were ranking in the top one third of all provinces for stroke incidence and ranking of more than one third of prefectural regions within the province in the top two sevenths of all prefectural regions for stroke incidence. We also reviewed regional distribution of major vascular risk factors, socioeconomic status, and demographic profiles in China. Nine eligible studies provided data on the incidence of stroke in 32 of 34 provincial regions of China (with Hong Kong and Macao as exceptions) and 52% of the 347 prefectural regions. Nine provincial regions (Heilongjiang, Tibet, Jilin, Liaoning, Xinjiang, Hebei, Inner Mongolia, Beijing, and Ningxia) met our criteria for a region of high stroke incidence and constitute a stroke belt in north and west China. The incidence of stroke in the stroke belt was 236.2 per 100 000 population compared with 109.7 in regions outside the belt (rate ratio, 2.16; 95% confidence interval, 2.10-2.22). The mean population prevalence of hypertension and overweight (body mass index, >25) was greater in the stroke belt than that in other regions (15.3% versus 10.3%, P<0.001; 21.1% versus 12.3%, P=0.013, respectively). The prevalence of hypertension and overweight also correlated significantly with regional stroke incidence (R=0.642, P<0.001; R=0.438, P=0.014, respectively, by Spearman rank correlation). A stroke belt of high stroke incidence exists in 9 provincial regions of north and west China. The stroke belt may be caused, at least in part, by a higher population prevalence of hypertension and excess body weight. Lowering blood pressure and body weight in the stroke belt may reduce the geographic disparity in stroke risk and incidence in China.

Association of a 27-bp repeat polymorphism in ecNOS gene with ischemic stroke in Chinese patients.

To investigate the association between a 27-bp repeat polymorphism of the ecNOS gene in 364 patients with ischemic stroke and 516 control subjects. The incidence of stroke in China is higher than that of coronary artery disease. Furthermore, ischemic stroke is more prevalent than hemorrhagic stroke. A 27-bp repeat polymorphism in intron 4 of the endothelial constitutive nitric oxide synthase (ecNOS) gene has been reported to associate with coronary artery disease in an Australian population, but no association was found between this polymorphism and ischemic stroke in a Japanese population. All patients and unrelated control subjects were screened by CT. All participants lived in central China. Multivariate logistic regression analysis was used to determine the independent roles of this ecNOS gene polymorphism and covariates in ischemic stroke. These results indicated an association between the ecNOS a allele and ischemic stroke in the Chinese patients studied (7.8 versus 17.0%; OR = 2.44; 95% CI = 1.60 to 3.71, p < 0.0001). The ecNOS a allele in intron 4 may be an independent risk factor for ischemic stroke in the Chinese population studied, especially in those lacking other conventional risk factors.

Chinese‐white differences in the distribution of occlusive cerebrovascular disease

The distribution of cerebrovascular lesions is affected by race. Blacks and Japanese have more intracranial occlusive cerebrovascular disease, while whites have more extracranial disease. Despite a high incidence of stroke in China, there are few formal studies of the distribution of vascular occlusive disease in Chinese populations. We compared clinical and angiographic features of 24 white and 24 Chinese patients with symptomatic occlusive cerebrovascular disease. In symptomatic vascular territories, whites had more severe (greater than or equal to 50% stenosis) extracranial lesions, while Chinese had more severe intracranial lesions. When we counted mild and severe lesions in a symptomatic territory, whites had more extracranial lesions while Chinese had more intracranial lesions. When we combined symptomatic and asymptomatic territories, whites had more extracranial lesions, while Chinese had more intracranial lesions. White patients reported more transient ischemic attacks. The distribution of lesions, however, was not explained by differences in incidence of transient ischemia, hypertension, diabetes, hypercholesterolemia, or ischemic heart disease between the groups. The preponderance of intracranial vascular lesions in Chinese patients is similar to that seen in blacks and Japanese. Racial differences in the occurrence of extracranial and intracranial lesions raise the possibility of a different underlying pathophysiology for the 2 locations.