Elsevier

The Lancet Neurology

Volume 6, Issue 5, May 2007, Pages 456-464
The Lancet Neurology

Series
Stroke in China: epidemiology, prevention, and management strategies

https://doi.org/10.1016/S1474-4422(07)70004-2Get rights and content

Summary

In this review, we examine the current status of stroke epidemiology, prevention, and management strategies in mainland China. The main findings suggested that total age-adjusted incidence of first-ever stroke in China is not very different from that in developed countries. Stroke incidence, mortality, and prevalence varied widely among different regions within China, with a noticeable north–south gradient. The proportion of intracerebral haemorrhage was high and reached 55% in one city. Hypertension is the most important risk factor for stroke. The mass approach combined with a high-risk approach for stroke prevention showed encouraging effects, and various unconventional local therapeutic traditions are commonly used to treat stroke in China. Several national guidelines on stroke prevention and treatment have been developed. Because of methodological limitations in the epidemiology studies, data are unreliable in terms of making any firm conclusions. Up-to-date, well-designed, and well-done epidemiological studies and therapeutic trials in China are urgently needed.

Introduction

Stroke is the second commonest cause of death and leading cause of adult disability worldwide.1 Over two-thirds of stroke deaths worldwide are in developing countries.2 Among developing countries, China has the largest population (with one-fifth of the world's population). Chronic diseases now account for an estimated 80% of deaths and 70% of disability-adjusted life-years lost in China. The major causes of death in China are vascular disease, cancer, and chronic respiratory disease.3 Unlike in western countries, cerebrovascular disease predominates; the number of patients who die from stroke is more than three times that from coronary heart disease.4 In the past 20 years, China has experienced a rapid economic development. Over time, the proportion of elderly people in the population will likely increase, life expectancies will lengthen, and, as in some other developing countries, the influence of a westernised lifestyle might shift disease patterns towards a profile more similar to that seen in more developed regions, so that the number of strokes will rise. To provide new insights into the burden and care of stroke in mainland China (not including Hong Kong or Taiwan) and focus future international research and therapeutic efforts, we examined the current status of stroke epidemiology, prevention, and control strategies.

Section snippets

Search strategy and selection criteria

Data were identified by electronic searches of MEDLINE (January 1966 to October 2006), China Biological Medicine Database (CBM-disc 1979 to October 2006), China National Knowledge Infrastructure (CNKI 1996 to October 2006) with the terms “China”, “Chinese”, “epidemiology”, “epidemiological”, “incidence”, “prevalence”, “mortality”, “morbidity”, “fatality”, “case fatality”, “stroke”, “cerebrovascular accident”, “isch(a)emic stroke”, “intracerebral”, “subarachnoid”, “h(a)emorrhage”, “primary

Incidence

Eight studies relevant to stroke incidence were included. The main methodological characteristics and findings of the studies are summarised in table 1. The first multicentre, community-based study on stroke incidence in China was published in 1985.7 Four early studies used similar methods to investigate incidence in various populations.7, 8, 9, 10, 11, 12 The total average age-adjusted incidence of first-ever stroke ranged from 116 to 219 per 100 000 per year. The six-city incidence study7 and

Discussion

In China, epidemiological studies of neurological diseases began in the early 1980s. The most widely cited incidence, mortality, and prevalence data of stroke resulted from two early studies.7, 8, 9 The total incidence of first-ever stroke (115·61–219 per 100 000 per year) was not very different from that in more developed countries (130–410 per 100 000 per year).26 However, more than 20 years have passed and China has changed and developed rapidly during this period, and epidemiological

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