Temporal trend and attributable risk factors of stroke burden in China, 1990–2019: an analysis for the Global Burden of Disease Study 2019

Abstract

Background Understanding the temporal trend of the disease burden of stroke and its attributable risk factors in China, especially at provincial levels, is important for effective prevention strategies and improvement. The aim of this analysis from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) is to investigate the disease burden of stroke and its risk factors at national and provincial levels in China from 1990 to 2019. MethodsFollowing the methodology in the GBD 2019, the incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) of stroke cases in the Chinese population were estimated by sex, age, year, stroke subtypes (ischaemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage), and across 33 provincial administrative units in China from 1990 to 2019. Attributable mortality and DALYs of underlying risk factors were calculated by a comparative risk assessment. Findings In 2019, there were 3•94 million (95% uncertainty interval 3•43-4•58) new stroke cases in China. The incidence rate of stroke increased by 86•0% (73•2-99•0) from 1990, reaching 276•7 (241•3-322•0) per 100 000 population in 2019. The age-standardised incidence rate declined by 9•3% (3•3-15•5) from 1990 to 2019. Among 28•76 million (25•60-32•21) prevalent cases of stroke in 2019, 24•18 million (20•80-27•87) were ischaemic stroke, 4•36 million (3•69-5•05) were intracerebral haemorrhage, and 1•58 million (1•32-1•91) were subarachnoid haemorrhage. The prevalence rate increased by 106•0% (93•7-118•8) and age-standardised prevalence rate increased by 13•2% (7•7-19•1) from 1990 to 2019. In 2019, there were 2•19 million (1•89-2•51) deaths and 45•9 million (39•8-52•3) DALYs due to stroke. The mortality rate increased by 32•3% (8•6-59•0) from 1990 to 2019. Over the same period, the age-standardised mortality rate decreased by 39•8% (28•6-50•7) and the DALY rate decreased by 41•6% (30•7-50•9). High systolic blood pressure, ambient particulate matter pollution exposure, smoking, and diet high in sodium were four major risk factors for stroke burden in 2019. Moreover, we found marked differences of stroke burden and attributable risk factors across provinces in China from 1990 to 2019.Interpretation The disease burden of stroke is still severe in China, although the age-standardised incidence and mortality rates have decreased since 1990. The stroke burden in China might be reduced through blood pressure management, lifestyle interventions, and air pollution control. Moreover, because substantial heterogeneity of stroke burden existed in different provinces, improved health care is needed in provinces with heavy stroke burden.

Increased admission serum total bile acids can be associated with decreased 3-month mortality in patients with acute ischemic stroke

“…However, there are still some limitations: (1) This is only a single-center retrospective study with a small sample size limited to Chinese patients, and some results may vary among different populations. Though studies have shown that the characteristics and prevalence of cerebrovascular and cardiovascular risk factors in the Asian population are similar to those of other large contemporary trials and real-world registries that also include other ethnicities [ 41 – 43 ], further studies involving different populations and more centers are needed to support our findings. (2) Although our model was adjusted for several covariates that might have an impact on the outcomes, there are still some possible influencing factors that have not been collected.…”

China Stroke Statistics: an update on the 2019 report from the National Center for Healthcare Quality Management in Neurological Diseases, China National Clinical Research Center for Neurological Diseases, the Chinese Stroke Association, National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention and Institute for Global Neuroscience and Stroke Collaborations

“…Stroke was the third highest cause of death of China1 and the leading cause of disability-adjusted life-year (DALY) in China in 2019 2. Stroke has imposed an enormous disease burden on the healthcare system in China.…”

Acute glycemic variability and mortality of patients with acute stroke: a meta-analysis

“…Pathophysiologically, stroke is defined as an abrupt neurological outburst caused by impaired perfusion through the blood vessels to the brain [ 5 ]. Despite the continuous efforts in the prevention and treatment of the disease, particularly for the various reperfusion therapies [ 5 ], stroke remains one of the leading causes of morbidity and mortality for people worldwide, particularly in developing countries [ 6 , 7 ]. Accumulating evidence suggests that dysglycemia, including stress-induced hyperglycemia [ 8 ], persistent hyperglycemia [ 9 ], as well as hypoglycemia [ 10 ], are all associated with poor prognosis in patients with acute stroke, which suggests the possible role of glucose fluctuation as a predictor of poor outcomes in patients with acute stroke [ 11 ].…”