Geographic Variations of Stroke Incidence in Chinese Communities: An 18-Year Prospective Cohort Study from 1997 to 2015
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background and Purpose As a leading cause of disability and death in China, stroke as well as its epidemiologic features have gained increasing attention. Prior studies, however, have overgeneralized the north-to-south gradient in China. Whether the differences exist across urban and rural areas remains unexplored. This study therefore aims to investigate the north-to-south gradient in stroke incidence across urban and rural China. Methods The present prospective cohort study analyzed data from the China Health and Nutrition Survey 1997 to 2015. By including 16,917 individuals from diverse social contexts, we calculated the age-standardized incidence of stroke across regions and the age-adjusted risk ratio (aRR). Cox proportional hazards models with time-varying covariates were employed to analyze variations in incident stroke. Results During the follow-up, age-standardized incidence of stroke ranged from 4.17 per 1,000 person-years (95% confidence interval [CI], 3.38 to 4.96) in the north region to 1.95 (95% CI, 1.60 to 2.30) in the south region (aRR, 2.04; 95% CI, 1.58 to 2.64; P<0.001). The north-to-south gradient of stroke incidence was observed only in rural areas, but not in urban areas. Hierarchical modelling analyses further indicated that the regional differences could be mostly explained by the disparities in the prevalence of hypertension. Conclusions The present study extends the current evidence on the north-to-south gradient by demonstrating that the difference varied across urban and rural China. Our findings highlight the importance of hypertension management as the measure for alleviating regional differences in stroke incidence.
Abstract
Background and Purpose As a leading cause of disability and death in China, stroke as well as its epidemiologic features have gained increasing attention. Prior studies, however, have overgeneralized the north-to-south gradient in China. Whether the differences exist across urban and rural areas remains unexplored. This study therefore aims to investigate the north-to-south gradient in stroke incidence across urban and rural China. Methods The present prospective cohort study analyzed data from the China Health and Nutrition Survey 1997 to 2015. By including 16,917 individuals from diverse social contexts, we calculated the age-standardized incidence of stroke across regions and the age-adjusted risk ratio (aRR). Cox proportional hazards models with time-varying covariates were employed to analyze variations in incident stroke. Results During the follow-up, age-standardized incidence of stroke ranged from 4.17 per 1,000 person-years (95% confidence interval [CI], 3.38 to 4.96) in the north region to 1.95 (95% CI, 1.60 to 2.30) in the south region (aRR, 2.04; 95% CI, 1.58 to 2.64; P<0.001). The north-to-south gradient of stroke incidence was observed only in rural areas, but not in urban areas. Hierarchical modelling analyses further indicated that the regional differences could be mostly explained by the disparities in the prevalence of hypertension. Conclusions The present study extends the current evidence on the north-to-south gradient by demonstrating that the difference varied across urban and rural China. Our findings highlight the importance of hypertension management as the measure for alleviating regional differences in stroke incidence.
참고문헌 (33)
- Zhou M, "Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017", Lancet, 394, pp.1145~1158 (2019)
- Boot E, "Ischaemic stroke in young adults : a global perspective", J Neurol Neurosurg Psychiatry, 91, pp.411~417 (2020)
- Narayanaswamy Venketasubramanian, "Stroke Epidemiology in South, East, and South-East Asia: A Review", 대한뇌졸중영문학회지, 19(3), pp.286~294 (2017), 대한뇌졸중학회
- Feigin VL, "Global and regional burden of stroke during 1990-2010 : findings from the Global Burden of Disease Study 2010", Lancet, 383, pp.245~254 (2014)
- Wu S, "Stroke in China: advances and challenges in epidemiology, prevention, and management", Lancet Neurol, 18, pp.394~405 (2019)
- He J, "Stroke in the People’s Republic of China. I. Geographic variations in incidence and risk factors", Stroke, 26, pp.2222~2227 (1995)
- Wang W, "Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480 687 adults", Circulation, 135, pp.759~771 (2017)
- Geiss LS, "Prevalence and incidence trends for diagnosed diabetes among adults aged 20 to 79 years, United States, 1980-2012", JAMA, 312, pp.1218~1226 (2014)
- Magliano DJ, "Trends in incidence of total or type 2 diabetes : systematic review", BMJ, 366, pp.l5003~ (2019)
- "Life expectancy at birth, total (years): China"[URL]
- "Population ages 65 and above (% of total population): China"[URL]
- Yu X, "All-cause mortality rate in China: do residents in economically developed regions have better health?", Int J Equity Health, 19, pp.12~ (2020)
- Guan T, "Rapid transitions in the epidemiology of stroke and its risk factors in China from 2002 to 2013", Neurology, 89, pp.53~61 (2017)
- Popkin BM, "Cohort profile: The China Health and Nutrition Survey: monitoring and understanding socio-economic and health change in China, 1989-2011", Int J Epidemiol, 39, pp.1435~1440 (2010)
- Ferriero DM, "Management of stroke in neonates and children : a scientific statement from the American Heart Association", American Stroke Association, 2019, pp.50, e51~e96
- Wang CC, "Epidemiological survey of neurological disorders in six urban areas of the People’s Republic of China", Chin J Neurosurg, 1, pp.2~7 (1985)
- McNutt LA, "Estimating the relative risk in cohort studies and clinical trials of common outcomes", Am J Epidemiol, 157, pp.940~943 (2003)
- Howard G, "Twenty years of progress toward understanding the stroke belt", Stroke, 51, pp.742~750 (2020)
- Lanska DJ, "The geography of stroke mortality in the United States and the concept of a stroke belt", Stroke, 26, pp.1145~1149 (1995)
- Labarthe DR, "Incidence and case fatality at the county level as contributors to geographic disparities in stroke mortality", Neuroepidemiology, 47, pp.96~102 (2016)
- Koton S, "Stroke incidence and mortality trends in US communities, 1987 to 2011", JAMA, 312, pp.259~268 (2014)
- El-Saed A, "Geographic variations in stroke incidence and mortality among older populations in four US communities", Stroke, 37, pp.1975~1979 (2006)
- Howard VJ, "The reasons for geographic and racial differences in stroke study : objectives and design", Neuroepidemiology, 25, pp.135~143 (2005)
- Anderson CA, "Dietary sources of sodium in China, Japan, the United Kingdom, and the United States, women and men aged 40 to 59years: the INTERMAP study", J Am Diet Assoc, 110, pp.736~745 (2010)
- Li Y, "Dietary patterns are associated with stroke in Chinese adults", J Nutr, 141, pp.1834~1839 (2011)
- Xing L, "Epidemiology of stroke in urban northeast China : a population-based study 2018-2019", Int J Stroke (2020)[DOI]
- 김영대, "Traditional Risk Factors for Stroke in East Asia", 대한뇌졸중영문학회지, 18(3), pp.273~285 (2016), 대한뇌졸중학회
- Xing L, "High prevalence of stroke and uncontrolled associated risk factors are major public health challenges in rural northeast China : a population-based study", Int J Stroke, 15, pp.399~411 (2020)
- Ay H, "An evidence-based causative classification system for acute ischemic stroke", Ann Neurol, 58, pp.688~697 (2005)
- Doufekias E, "Cardiogenic and aortogenic brain embolism", J Am Coll Cardiol, 51, pp.1049~1059 (2008)
- Arsava EM, "The causative classification of stroke system : an international reliability and optimization study", Neurology, 75, pp.1277~1284 (2010)
- Kernan WN, "Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack : a guideline for healthcare professionals from the American Heart Association", American Stroke Association, 2014, pp.45, 2160~2236
- GBD 2016 Healthcare Access and Quality Collaborators, "Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016", Lancet, 391, pp.2236~2271 (2018)