Pay attention to the regional differences of stroke burden in China and the status in Southwest China_West China Medical Journal

Authors：

YUAN Ruozhen , WU Simiao , WU Bo ,  LIU Ming

Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LIU Ming, Email: wyplmh@hotmail.com

Keywords：

Stroke; Disease burden; Southwest China; Reginal differences

DOI：

10.7507/1002-0179.201909145

Video：

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In China, there are more than 2 million new strokes annually, and the disability-adjusted life-years due to stroke were higher than any other disease. With aging of the population, inadequate control of vascular risk factors such as hypertension, and uneven distribution of specialized stroke care, the burden of stroke will continue to increase. Despite improved health care quality in China, the availability of specialized stroke care varies across the country, especially in rural areas. Stroke prevention, management and research face unique and severe challenges due to rough terrain and economic underdevelopment in Southwest China. In the future, efforts should be made to provide more balanced availability of specialized stroke care services across China, promote generalization of evidence-based practice, and carry out more high-quality research to improve outcomes of stroke patients, with special attention to the rural population and Southwest China.

Citation： YUAN Ruozhen, WU Simiao, WU Bo, LIU Ming. Pay attention to the regional differences of stroke burden in China and the status in Southwest China. West China Medical Journal, 2019, 34(10): 1083-1086. doi: 10.7507/1002-0179.201909145 Copy

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11.	Wang Y, Wang Y, Zhao X, et al. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med, 2013, 369(1): 11-19.
12.	Zhang S, Wu B, Liu M, et al. Acupuncture efficacy on ischemic stroke recovery: multicenter randomized controlled trial in China. Stroke, 2015, 46(5): 1301-1306.
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16.	Li Y, Yang L, Wang L, et al. Burden of hypertension in China: a nationally representative survey of 174,621 adults. Int J Cardiol, 2017, 227: 516-523.
17.	Wang Z, Chen Z, Zhang L, et al. Status of hypertension in China: results from the China hypertension survey, 2012-2015. Circulation, 2018, 137(22): 2344-2356.
18.	Lu Y, Wang P, Zhou T, et al. Comparison of prevalence, awareness, treatment, and control of cardiovascular risk factors in China and the United States. J Am Heart Assoc, 2018, 26, 7(3): e007462.
19.	Falaschetti E, Mindell J, Knott C, et al. Hypertension management in England: a serial cross-sectional study from 1994 to 2011. Lancet, 2014, 383(9932): 1912-1919.
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21.	Wang L, Gao P, Zhang M, et al. Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013. JAMA, 2017, 317(24): 2515-2523.
22.	Wang M, Luo X, Xu S, et al. Trends in smoking prevalence and implication for chronic diseases in China: serial national cross-sectional surveys from 2003 to 2013. Lancet Respir Med, 2019, 7(1): 35-45.
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26.	Li Y, He Y, Lai J, et al. Dietary patterns are associated with stroke in Chinese adults. J Nutr, 2011, 141(10): 1834-1839.
27.	Wang X, Wu Y, Zhang X, et al. Dietary changes over 25 years in Tianjin residents: findings from the 1986-1988, 2000-2004, and 2008-2011 nutrition surveys. Nutrients, 2016, 8(2): 62.
28.	Anderson CA, Appel LJ, Okuda N, et al. Dietary sources of sodium in China, Japan, the United Kingdom, and the United States, women and men aged 40 to 59 years: the INTERMAP study. J Am Diet Assoc, 2010, 110(5): 736-745.
29.	Li J, Liu J, Ma Y, et al. Imbalanced regional development of acute ischemic stroke care in emergency departments in China. Emerg Med Int, 2019, 2019: 3747910.
30.	Lin S, Wu B, Hao ZL, et al. Characteristics, treatment and outcome of ischemic stroke with atrial fibrillation in a Chinese hospital-based stroke study. Cerebrovasc Dis, 2011, 31(5): 419-426.
31.	Tao WD, Liu M, Fisher M, et al. Posterior versus anterior circulation infarction: how different are the neurological deficits?. Stroke, 2012, 43(8): 2060-2065.
32.	Hao Z, Chang X, Zhou H, et al. A cohort study of decompressive craniectomy for malignant middle cerebral artery infarction: a real-world experience in clinical practice. Medicine (Baltimore), 2015, 94(25): e1039.
33.	Wu S, Yuan R, Xiong Y, et al. Clinical features, management and outcomes of severe ischaemic stroke in tertiary hospitals in China: protocol for a prospective multicentre registry-based observational study. BMJ Open, 2018, 8(10): e024900.

1. Zhou M, Wang H, Zhu J, et al. Cause-specific mortality for 240 causes in China during 1990-2013: a systematic subnational analysis for the global burden of disease study 2013. Lancet, 2016, 387(10015): 251-272.
2. Feigin VL, Forouzanfar MH, Krishnamurthi R, et al. Global and regional burden of stroke during 1990-2010: findings from the global burden of disease study 2010. Lancet, 2014, 383(9913): 245-254.
3. GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the global burden of disease study 2016. Lancet, 2017, 390(10100): 1151-1210.
4. Liu M, Wu B, Wang WZ, et al. Stroke in China: epidemiology, prevention, and management strategies. Lancet Neurol, 2007, 6(5): 456-464.
5. Guan T, Ma J, Li M, et al. Rapid transitions in the epidemiology of stroke and its risk factors in China from 2002 to 2013. Neurology, 2017, 89(1): 53-61.
6. Wang W, Jiang B, Sun H, et al. Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480687 adults. Circulation, 2017, 135(8): 759-771.
7. Chen Z, Peto R, Zhou M, et al. Contrasting male and female trends in tobacco-attributed mortality in China: evidence from successive nationwide prospective cohort studies. Lancet, 2015, 386(10002): 1447-1456.
8. Millwood IY, Li L, Smith M, et al. Alcohol consumption in 0.5 million people from 10 diverse regions of China: prevalence, patterns and socio-demographic and health-related correlates. Int J Epidemiol, 2013, 42(3): 816-827.
9. Huo Y, Li J1, Qin X, et al. Efficacy of folic acid therapy in primary prevention of stroke among adults with hypertension in China: the CSPPT randomized clinical trial. JAMA, 2015, 313(13): 1325-1335.
10. He J, Zhang Y, Xu T, et al. Effects of immediate blood pressure reduction on death and major disability in patients with acute ischemic stroke: the CATIS randomized clinical trial. JAMA, 2014, 311(5): 479-489.
11. Wang Y, Wang Y, Zhao X, et al. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med, 2013, 369(1): 11-19.
12. Zhang S, Wu B, Liu M, et al. Acupuncture efficacy on ischemic stroke recovery: multicenter randomized controlled trial in China. Stroke, 2015, 46(5): 1301-1306.
13. Wu S, Wu B, Liu M, et al. Stroke in China: advances and challenges in epidemiology, prevention, and management. Lancet Neurol, 2019, 18(4): 394-405.
14. 国家卫生计生委统计信息中心. 2013第五次国家卫生服务调查分析报告. 北京: 中国协和医科大学出版社, 2015.
15. 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, 2018, 391(10136): 2236-2271.
16. Li Y, Yang L, Wang L, et al. Burden of hypertension in China: a nationally representative survey of 174,621 adults. Int J Cardiol, 2017, 227: 516-523.
17. Wang Z, Chen Z, Zhang L, et al. Status of hypertension in China: results from the China hypertension survey, 2012-2015. Circulation, 2018, 137(22): 2344-2356.
18. Lu Y, Wang P, Zhou T, et al. Comparison of prevalence, awareness, treatment, and control of cardiovascular risk factors in China and the United States. J Am Heart Assoc, 2018, 26, 7(3): e007462.
19. Falaschetti E, Mindell J, Knott C, et al. Hypertension management in England: a serial cross-sectional study from 1994 to 2011. Lancet, 2014, 383(9932): 1912-1919.
20. Pan L, Yang Z, Wu Y, et al. The prevalence, awareness, treatment and control of dyslipidemia among adults in China. Atherosclerosis, 2016, 248: 2-9.
21. Wang L, Gao P, Zhang M, et al. Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013. JAMA, 2017, 317(24): 2515-2523.
22. Wang M, Luo X, Xu S, et al. Trends in smoking prevalence and implication for chronic diseases in China: serial national cross-sectional surveys from 2003 to 2013. Lancet Respir Med, 2019, 7(1): 35-45.
23. Brauer M, Freedman G, Frostad J, et al. Ambient air pollution exposure estimation for the global burden of disease 2013. Environ Sci Technol, 2016, 50(1): 79-88.
24. Yu K, Qiu G, Chan KH, et al. Association of solid fuel use with risk of cardiovascular and all-cause mortality in rural china. JAMA, 2018, 319(13): 1351-1361.
25. Luo L, Jiang J, Zhang G, et al. Stroke mortality attributable to ambient particulate matter pollution from 1990 to 2015 in China: an age-period-cohort and spatial autocorrelation analysis. Int J Environ Res Public Health, 2017, 14(7): 772.
26. Li Y, He Y, Lai J, et al. Dietary patterns are associated with stroke in Chinese adults. J Nutr, 2011, 141(10): 1834-1839.
27. Wang X, Wu Y, Zhang X, et al. Dietary changes over 25 years in Tianjin residents: findings from the 1986-1988, 2000-2004, and 2008-2011 nutrition surveys. Nutrients, 2016, 8(2): 62.
28. Anderson CA, Appel LJ, Okuda N, et al. Dietary sources of sodium in China, Japan, the United Kingdom, and the United States, women and men aged 40 to 59 years: the INTERMAP study. J Am Diet Assoc, 2010, 110(5): 736-745.
29. Li J, Liu J, Ma Y, et al. Imbalanced regional development of acute ischemic stroke care in emergency departments in China. Emerg Med Int, 2019, 2019: 3747910.
30. Lin S, Wu B, Hao ZL, et al. Characteristics, treatment and outcome of ischemic stroke with atrial fibrillation in a Chinese hospital-based stroke study. Cerebrovasc Dis, 2011, 31(5): 419-426.
31. Tao WD, Liu M, Fisher M, et al. Posterior versus anterior circulation infarction: how different are the neurological deficits?. Stroke, 2012, 43(8): 2060-2065.
32. Hao Z, Chang X, Zhou H, et al. A cohort study of decompressive craniectomy for malignant middle cerebral artery infarction: a real-world experience in clinical practice. Medicine (Baltimore), 2015, 94(25): e1039.
33. Wu S, Yuan R, Xiong Y, et al. Clinical features, management and outcomes of severe ischaemic stroke in tertiary hospitals in China: protocol for a prospective multicentre registry-based observational study. BMJ Open, 2018, 8(10): e024900.

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