Epidemiology of stroke and its risk factors in Shandong province, China / 中华神经科杂志

ABSTRACT

Objective@#To investigate the stroke burden (prevalence, incidence, and mortality) and its risk factors for men and women, urban and rural residents at the provincial level in Shandong province.@*Methods@#This study formed part of the National Epidemiological Survey of Stroke in China (NESS-China). This population-based study included 25 190 adults living in Shandong province and was conducted in 2013. The data were derived from eight disease surveillance points (DSPs). They were located in Qingdao Shibei district, Zaozhuang Xuecheng district, Yantai Zhifu district, Laiwu Laicheng district, Yantai Penglai, Weifang Gaomi, Zaozhuang Yiyuan, Linyi Junan. All living subjects who had suffered a stroke by August 31, 2013 were considered as having a prevalent stroke. Incident stroke was defined as a first-ever stroke (both fatal and non-fatal) between September 1, 2012 and August 31, 2013. Fatal cases of incident strokes were used to estimate stroke mortality rate. Stroke cases were subcategorized as follows: ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Stroke cases with no brain imaging within the first week of stroke onset or cases where the results of imaging were not available were classified as stroke of undetermined pathological type (UND).@*Results@#Of the 25 190 participants, 449 had experienced a prevalent stroke, 118 participants were diagnosed as having an incident stroke, 33 fatal cases were identified over the 12-month period. The crude rate of prevalence, incidence and mortality were 1 782.5 per 100 000 people, 468.4 per 100 000 person-years and 131.0 per 100 000 person-years. The age-standard rate of prevalence, incidence and mortality were 1 059.0 per 100 000 people, 279.7 per 100 000 person-years, and 76.0 per 100 000 person-years. Compared to women, the prevalence of stroke was markedly higher among men (1 463.3 per 100 000 people vs 2 265.0 per 100 000 people). Compared to urban residents, the prevalence of stroke was markedly higher among rural residents (563.7 per 100 000 people vs 2 203.6 per 100 000 people). Among all prevalent cases, there were 348 people suffering from IS, 75 cases suffering from ICH, 6 cases suffering from SAH, and 20 cases of UND. The prevalece rates of IS, ICH, SAH and UND were 1 385.5 per 100 000 people, 301.7 per 100 000 people, 23.8 per 100 000 people and 79.4 per 100 000 people, respectively. The three most prevalent risk factors in stroke cases were hypertension (66.4%), current smoking (26.1%), and alcohol drinking (24.9%).@*Conclusions@#Stroke was highly prevalent in Shandong province, China. The prevalence and incidence rates of stroke were significantly greater for men than women. Large geographical variations in the stroke burden were also observed in Shandong province, with a greater stroke burden observed in rural areas.