Trends in Incidence of Stroke and Transition of Stroke Subtypes in Rural Tianjin China: A Population-Based Study from 1992 to 2012

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2015 Oct 2

PMID 26426803

Citations 14

Authors

Bin Li

Yongzhong Lou

Hongfei Gu

Xue Long

Tao Wang

Jian Wei

Jinghua Wang

Jun Tu

Xianjia Ning

Affiliations

Soon will be listed here.

Abstract

Objectives: The incidence of ischemic stroke has increased and that of hemorrhagic stroke has decreased in urban China; however, the trends in rural areas are unknown. We aimed to explore the secular trends in incidence and transition of stroke subtypes among rural Chinese.

Methods: This was a population-based stroke surveillance through the Tianjin Brain Study. A total of 14,538 residents in a township of Ji County in Tianjin, China participated in the study since 1985. We investigated the age-standardized stroke incidence (sex-specific, type-specific, and age-specific), the annual proportion of change in the incidence of stroke, and the proportion of intracerebral hemorrhage in the periods 1992-1998, 1999-2005, and 2006-2012, because the neuroimaging technique was available since 1992 in this area.

Results: The age-standardized incidence per 100,000 person-years increased significantly for both intracerebral hemorrhage (37.8 in 1992-1998, 46.5 in 1999-2005, and 76.5 in 2006-2012) and ischemic stroke (83.9 in 1992-1998, 135.3 in 1999-2005, and 238.0 in 2006-2012). The age-standardized incidence of first-ever stroke increased annually by 4.9% for intracerebral hemorrhage and by 7.3% for ischemic stroke. The greatest increase was observed in men aged 45-64 years for both stroke types (P < 0.001). The proportion of intracerebral hemorrhage was stable overall, increased among men aged 45-64 years, and decreased among men aged ≥65 years. The average age of intracerebral hemorrhage in men reduced by 7.5 years from 1992 to 2012.

Conclusion: The age-standardized incidence of main stroke subtypes increased significantly in rural China over the past 21 years; the overall proportion of intracerebral hemorrhage was stable, but the incidence increased significantly among middle-aged men. These findings imply that it is crucial to control stroke risk factors in middle-aged men for stroke prevention in future decades.

Citing Articles

Incidence, case fatality, and functional outcome of intracerebral haemorrhage, according to age, sex, and country income level: a systematic review and meta-analysis.

Wolsink A, Cliteur M, van Asch C, Boogaarts H, Dammers R, Hannink G Lancet Reg Health Eur. 2025; 49:101180.

PMID: 39759582 PMC: 11699750. DOI: 10.1016/j.lanepe.2024.101180.

Botulinum toxin A injection for post-stroke upper limb spasticity and rehabilitation practices from centers across Asian countries.

Rosales R, Chia N, Kumthornthip W, Goh K, Mak C, Kong K Front Neurol. 2024; 15:1335365.

PMID: 38651107 PMC: 11034516. DOI: 10.3389/fneur.2024.1335365.

Trends in hemorrhagic stroke incidence and mortality in a National Stroke Registry of a multi-ethnic Asian population.

Lim M, Zheng H, Zhang Z, Sia C, Tan B, Ong M Eur Stroke J. 2023; 9(1):189-199.

PMID: 37776052 PMC: 10916808. DOI: 10.1177/23969873231202392.

Incidence, subtypes, sex differences and trends of stroke in Taiwan.

Tsai C, Wang Y, Teng N, Yip P, Chen L PLoS One. 2022; 17(11):e0277296.

PMID: 36383604 PMC: 9668115. DOI: 10.1371/journal.pone.0277296.

Pooled incidence and case-fatality of acute stroke in Mainland China, Hong Kong, and Macao: A systematic review and meta-analysis.

He F, Blackberry I, Yao L, Xie H, Rasekaba T, Mnatzaganian G PLoS One. 2022; 17(6):e0270554.

PMID: 35759497 PMC: 9236238. DOI: 10.1371/journal.pone.0270554.

References

Coull A, Silver L, Bull L, Giles M, Rothwell P . Direct assessment of completeness of ascertainment in a stroke incidence study. Stroke. 2004; 35(9):2041-5. DOI: 10.1161/01.STR.0000137605.48864.2f. View

Zhang L, Yang J, Hong Z, Yuan G, Zhou B, Zhao L . Proportion of different subtypes of stroke in China. Stroke. 2003; 34(9):2091-6. DOI: 10.1161/01.STR.0000087149.42294.8C. View

Reynolds K, Lewis B, Nolen J, Kinney G, Sathya B, He J . Alcohol consumption and risk of stroke: a meta-analysis. JAMA. 2003; 289(5):579-88. DOI: 10.1001/jama.289.5.579. View

Chau P, Woo J, Goggins W, Tse Y, Chan K, Lo S . Trends in stroke incidence in Hong Kong differ by stroke subtype. Cerebrovasc Dis. 2010; 31(2):138-46. DOI: 10.1159/000321734. View

Sivenius J, Tuomilehto J, Immonen-Raiha P, Kaarisalo M, Sarti C, Torppa J . Continuous 15-year decrease in incidence and mortality of stroke in Finland: the FINSTROKE study. Stroke. 2004; 35(2):420-5. DOI: 10.1161/01.STR.0000110220.63212.59. View

Rothwell P, Coull A, Giles M, Howard S, Silver L, Bull L . Change in stroke incidence, mortality, case-fatality, severity, and risk factors in Oxfordshire, UK from 1981 to 2004 (Oxford Vascular Study). Lancet. 2004; 363(9425):1925-33. DOI: 10.1016/S0140-6736(04)16405-2. View

Feldmann E, Daneault N, Kwan E, Ho K, Pessin M, Langenberg P . Chinese-white differences in the distribution of occlusive cerebrovascular disease. Neurology. 1990; 40(10):1541-5. DOI: 10.1212/wnl.40.10.1540. View

Kay R, Woo J, Kreel L, Wong H, Teoh R, Nicholls M . Stroke subtypes among Chinese living in Hong Kong: the Shatin Stroke Registry. Neurology. 1992; 42(5):985-7. DOI: 10.1212/wnl.42.5.985. View

Wang L, Kong L, Wu F, Bai Y, Burton R . Preventing chronic diseases in China. Lancet. 2005; 366(9499):1821-4. DOI: 10.1016/S0140-6736(05)67344-8. View

10.

Jiang B, Wang W, Chen H, Hong Z, Yang Q, Wu S . Incidence and trends of stroke and its subtypes in China: results from three large cities. Stroke. 2005; 37(1):63-8. DOI: 10.1161/01.STR.0000194955.34820.78. View

11.

Grimaud O, Bejot Y, Heritage Z, Vallee J, Durier J, Cadot E . Incidence of stroke and socioeconomic neighborhood characteristics: an ecological analysis of Dijon stroke registry. Stroke. 2011; 42(5):1201-6. DOI: 10.1161/STROKEAHA.110.596429. View

12.

Redon J, Olsen M, Cooper R, Zurriaga O, Martinez-Beneito M, Laurent S . Stroke mortality and trends from 1990 to 2006 in 39 countries from Europe and Central Asia: implications for control of high blood pressure. Eur Heart J. 2011; 32(11):1424-31. DOI: 10.1093/eurheartj/ehr045. View

13.

Zhang L, Qin L, Cui H, Liu A, Wang P . Prevalence of cardiovascular risk factors clustering among suburban residents in Beijing, China. Int J Cardiol. 2010; 151(1):46-9. DOI: 10.1016/j.ijcard.2010.04.056. View

14.

Zhang Y, Tuomilehto J, Jousilahti P, Wang Y, Antikainen R, Hu G . Lifestyle factors on the risks of ischemic and hemorrhagic stroke. Arch Intern Med. 2011; 171(20):1811-8. DOI: 10.1001/archinternmed.2011.443. View

15.

Wieberdink R, Ikram M, Hofman A, Koudstaal P, Breteler M . Trends in stroke incidence rates and stroke risk factors in Rotterdam, the Netherlands from 1990 to 2008. Eur J Epidemiol. 2012; 27(4):287-95. PMC: 3370158. DOI: 10.1007/s10654-012-9673-y. View

16.

Ikram M, Wieberdink R, Koudstaal P . International epidemiology of intracerebral hemorrhage. Curr Atheroscler Rep. 2012; 14(4):300-6. PMC: 3388250. DOI: 10.1007/s11883-012-0252-1. View

17.

Kim R, Kim B, Kim Y, Seo J, Lim Y, Kim H . Trends in the incidence of hospitalized acute myocardial infarction and stroke in Korea, 2006-2010. J Korean Med Sci. 2013; 28(1):16-24. PMC: 3546096. DOI: 10.3346/jkms.2013.28.1.16. View

18.

Pezzini A, Grassi M, Paciaroni M, Zini A, Silvestrelli G, Iacoviello L . Obesity and the risk of intracerebral hemorrhage: the multicenter study on cerebral hemorrhage in Italy. Stroke. 2013; 44(6):1584-9. DOI: 10.1161/STROKEAHA.111.000069. View

19.

Tsai C, Thomas B, Sudlow C . Epidemiology of stroke and its subtypes in Chinese vs white populations: a systematic review. Neurology. 2013; 81(3):264-72. PMC: 3770160. DOI: 10.1212/WNL.0b013e31829bfde3. View

20.

Sugama C, Isa K, Okumura K, Iseki K, Kinjo K, Ohya Y . Trends in the incidence of stroke and cardiovascular risk factors on the isolated island of Okinawa: the Miyakojima study. J Stroke Cerebrovasc Dis. 2012; 22(7):e118-23. DOI: 10.1016/j.jstrokecerebrovasdis.2012.08.016. View