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Epidemiological Study
China Stroke Statistics 2019: A 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
  1. Yong-Jun Wang1,2,
  2. Zi-Xiao Li1,2,
  3. Hong-Qiu Gu1,2,
  4. Yi Zhai1,
  5. Yong Jiang1,
  6. Xing-Quan Zhao1,
  7. Yi-Long Wang1,
  8. Xin Yang1,2,
  9. Chun-Juan Wang1,2,
  10. Xia Meng1,
  11. Hao Li1,
  12. Li-Ping Liu1,
  13. Jing Jing1,
  14. Jing Wu3,
  15. An-Ding Xu4,
  16. Qiang Dong5,
  17. David Wang6,
  18. Ji-Zong Zhao1
  19. On behalf of China Stroke Statistics 2019 Writing Committee
    1. 1 China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
    2. 2 National Center for Healthcare Quality Management in Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
    3. 3 National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
    4. 4 Department of Neurology and Stroke Center, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong, China
    5. 5 Department of Neurology, Huashan Hospital,Fudan University, Shanghai, China
    6. 6 Neurovascular Division, Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
    1. Correspondence to Dr Yong-Jun Wang; yongjunwang{at}ncrcnd.org.cn; Dr Ji-Zong Zhao; zhaojz205{at}163.com

    Abstract

    China faces the greatest challenge from stroke in the world. The death rate for cerebrovascular diseases in China was 149.49 per 100 000, accounting for 1.57 million deaths in 2018. It ranked third among the leading causes of death behind malignant tumours and heart disease. The age-standardised prevalence and incidence of stroke in 2013 were 1114.8 per 100 000 population and 246.8 per 100 000 person-years, respectively. According to the Global Burden of Disease Study 2017, the years of life lost (YLLs) per 100 000 population for stroke increased by 14.6%; YLLs due to stroke rose from third highest among all causes in 1990 to the highest in 2017. The absolute numbers and rates per 100 000 population for all-age disability-adjusted life years (DALYs) for stroke increased substantially between 1990 and 2017, and stroke was the leading cause of all-age DALYs in 2017. The main contributors to cerebrovascular diseases include behavioural risk factors (smoking and alcohol use) and pre-existing conditions (hypertension, diabetes mellitus, dyslipidaemia and atrial fibrillation (AF)). The most prevalent risk factors among stroke survivors were hypertension (63.0%-84.2%) and smoking (31.7%-47.6%). The least prevalent was AF (2.7%-7.4%). The prevalences for major risk factors for stroke are high and most have increased over time. Based on the latest national epidemiological data, 26.6% of adults aged ≥15 years (307.6 million adults) smoked tobacco products. For those aged ≥18 years, age-adjusted prevalence of hypertension was 25.2%; adjusted prevalence of hypercholesterolaemia was 5.8%; and the standardised prevalence of diabetes was 10.9%. For those aged ≥40 years, the standardised prevalence of AF was 2.31%. Data from the Hospital Quality Monitoring System showed that 3 010 204 inpatients with stroke were admitted to 1853 tertiary care hospitals during 2018. Of those, 2 466 785 (81.9%) were ischaemic strokes (ISs); 447 609 (14.9%) were intracerebral haemorrhages (ICHs); and 95 810 (3.2%) were subarachnoid haemorrhages (SAHs). The average age of patients admitted was 66 years old, and nearly 60% were male. A total of 1555 (0.1%), 2774 (0.6%) and 1347 (1.4%) paediatric strokes (age <18 years) were identified among IS, ICH and SAH, respectively. Over one-third (1 063 892 (35.3%)) of the patients were covered by urban resident basic medical insurance, followed by urban employee basic medical insurance (699 513 (23.2%)) and new rural cooperative medical schema (489 361 (16.3%)). The leading risk factor was hypertension (67.4% for IS, 77.2% for ICH and 49.1% for SAH), and the leading comorbidity was pneumonia or pulmonary infection (10.1% for IS, 31.4% for ICH and 25.2% for SAH). In-hospital death/discharge against medical advice rate was 8.3% for stroke inpatients, ranging from 5.8% for IS to 19.5% for ICH. The median and IQR of length of stay was 10.0 (7.0–14.0) days, ranging from 10.0 (7.0–13.0) in IS to 14.0 (8.0–22.0) in SAH. Data from the Chinese Stroke Center Alliance demonstrated that the composite scores of guideline-recommended key performance indicators for patients with IS, ICH and SAH were 0.77±0.21, 0.72±0.28 and 0.59±0.32, respectively.

    • stroke
    • statistics
    http://creativecommons.org/licenses/by-nc/4.0/

    This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

    https://doi.org/10.1136/svn-2020-000457

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      Footnotes

      • Twitter @yilong

      • Y-JW, Z-XL, H-QG and YZ contributed equally.

      • Collaborators China Stroke Statistics 2019 Writing Committee (ordered alphabetically by First name): Beisha Tang (bstang7398@ 163. com, Department of Neurology, Xiangya Hospital, Central South University, Changsha, China), Caiyun Wang (wangcaiyun@chinastroke.net，Beijing Tiantan Hospital, Capital Medical University, Beijing, China), Chen Wang (wangchen-tr2002@163.com, Beijing Tiantan Hospital, Capital Medical University, Beijing, China), Bo Hu (hubo@ hust. edu. cn, Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (HUST), Wuhan, China), Chang Yin (yinchang@niha.org.cn, Dept. of Healthcare Quality Monitoring and Control Research; National Institute of Hospital Administration, NHC; Beijing, China), Chuan-Qiang Pu(david.wang@chinastroke.net, Neurovascular Division, Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013 USA), Dong-Shen Fan (dsfan@sina.com, Peking University Third Hospital), Dong Zhou (zhoudong66@yahoo.de, Department of Neurology, Huaxi Hoappital of Sichuan University), Gang Zhao (zhaogang@fmmu.edu.cn, Department of Neurology, Xijing Hospital, The 4th Military Medical University, Xi’an, China), Hai-Bo Wang (Haibo@mail.harvard.edu, Clinical Trial Unit, First Affiliated Hospital of Sun Yat-Sen University), Hao Wang (Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China), Jing Wu (wujing@chinacdc.cn, National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention), Jin-Sheng Zeng (zengjs@pub.guangzhou.gd.cn, The First Affiliated Hospital of Zhongshan University), Lan-Xia Gan (lanxia.gan@cltr.org, China Standard Medical Information Research Center, Shenzhen, China), Li Guo (guoli6@163.com, Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China), Li-Min Wang (wanglimin@ncncd.chinacdc.cn, National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention), Lin-Hong Wang (linhong@chinawch.org.cn, National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention), Li-Ying Cui (pumchcuily@sina.com, Peking Union Medical College Hospital), Mei-Jia Zhu (zhumeijia1818@163.com, Shandong Hospital of Thousand Buddha Mountain Affiliated to Shandong University), Ming Lou (loumingxc@vip.sina.com, Department of Neurology, The Second Affiliated Hospital of Zhejiang University School of Medicine), Ning Wang (nwang900@yahoo.com, Department of Neurology and Institute of Neurology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China), Peng Xie (xiepeng@cqmu.edu.cn, Chongqing Medical University, Chongqing, China), Shuo Wang (captain9858@vip.sina.com, Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China), Tao Feng (happyft@sina.com, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China), Tong Zhang (zt61611@sohu.com, Capital Medical University School of Rehabilitation Medicine, China Rehabilitation Research Center, Beijing, China), Wen-Hua Zhao (zhaowh@chinacdc.cn, National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention), Xu-Dong Ma (13910092912@163.com, National Health Commission of The People's Republic of China), Xun-Ming Ji （robertjixm@hotmail.com/jixunming@vip.163.com, Department of Neurosurgery, Xuanwu Hospital, Capital University of Medicine, Beijing, China), Yi-Ming Deng (parkerdeng@163.com, Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University), Yi Yang (doctoryangyi@163.com/doctor_yangyi@hotmail.com, Department of Neurology, the First Hospital of Jilin University, Changchun, China), Ying Shi (ying.shi@cltr.org, China Standard Medical Information Research Center, Shenzhen, China), Yu-Ming Xu (13903711125@126.com/xym13903711125@126.com, Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China), Yu-Ping Wang (wangyuping01@sina.cn, Xuanwu Hospital of Capital Medical University), Zhong-Rong Miao (zhongrongm@163.com, Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China), Xiao-Yuan Niu (niuxiaoyuan1958@163.com, Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, China).

      • Contributors Y-JW, Z-XL, H-QG and YZ contributed equally to this work. J-ZZ, Y-JW, A-DX, QD and DW designed the protocol and framework and also participated in the revision. YZ, YJ, HL and JW drafted the sections of stroke-related risk factors. H-QG, X-QZ, Y-LW, L-PL and Z-XL drafted the section of stroke care quality and revised the whole manuscript. H-QG performed the statistical analysis based on data from the Hospital Quality Monitoring System and Chinese Stroke Center Alliance project. XY, XM, JJ and C-JW collected the data of stroke care quality.

      • Funding This study was funded by Ministry of Science and Technology of the People’s Republic of China, National Key R&D Programme of China (2017YFC1310901, 2016YFC0901002, 2017YFC1307905,and 2015BAI12B00), the Youth Programme (QML20180501), National Natural Science Foundation of China (81801152) and Beijing Talents Project (2018000021223ZK03 and 2018A13).

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      • Competing interests All authors declared that they have no financial and personal relationships with other people or organizations that can inappropriately influence their works.

      • Patient consent for publication Not required.

      • Provenance and peer review Commissioned; externally peer reviewed.

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