Trends in Incidence of Stroke and Transition of Stroke Subtypes in Rural Tianjin China: A Population-Based Study from 1992 to 2012

• Published in: PloS one Vol. 10; no. 10; p. e0139461
• Main Authors: Li, Bin, Lou, Yongzhong, Gu, Hongfei, Long, Xue, Wang, Tao, Wei, Jian, Wang, Jinghua, Tu, Jun, Ning, Xianjia
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 01.10.2015; Public Library of Science (PLoS)
• Subjects: Adult; Age; Age Factors; Aged; Alcohol use; Brain; Cardiovascular disease; Cardiovascular Diseases - epidemiology; China - epidemiology; Collaboration; Demographic aspects; Diabetes; Diagnosis; Epidemiology; Fatalities; Female; Follow-Up Studies; Health risks; Hemorrhage; Hospitals; Humans; Hypertension; Incidence; Ischemia; Low income groups; Male; Medical imaging; Men; Middle Aged; Mortality; Neuroimaging; Neurology; Physicians; Population; Population studies; Population Surveillance; Population-based studies; Prognosis; Registries; Research Design; Risk analysis; Risk Factors; Risk management; Rural areas; Rural Population; Socioeconomic factors; Stroke; Stroke - classification; Stroke - epidemiology; Studies; Time Factors; Trends; China; Beijing China; Taiwan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0139461

The incidence of ischemic stroke has increased and that of hemorrhagic stroke has decreased in urban China; however, the trends in rural areas are unknown. We aimed to explore the secular trends in incidence and transition of stroke subtypes among rural Chinese. This was a population-based stroke surveillance through the Tianjin Brain Study. A total of 14,538 residents in a township of Ji County in Tianjin, China participated in the study since 1985. We investigated the age-standardized stroke incidence (sex-specific, type-specific, and age-specific), the annual proportion of change in the incidence of stroke, and the proportion of intracerebral hemorrhage in the periods 1992-1998, 1999-2005, and 2006-2012, because the neuroimaging technique was available since 1992 in this area. The age-standardized incidence per 100,000 person-years increased significantly for both intracerebral hemorrhage (37.8 in 1992-1998, 46.5 in 1999-2005, and 76.5 in 2006-2012) and ischemic stroke (83.9 in 1992-1998, 135.3 in 1999-2005, and 238.0 in 2006-2012). The age-standardized incidence of first-ever stroke increased annually by 4.9% for intracerebral hemorrhage and by 7.3% for ischemic stroke. The greatest increase was observed in men aged 45-64 years for both stroke types (P < 0.001). The proportion of intracerebral hemorrhage was stable overall, increased among men aged 45-64 years, and decreased among men aged ≥65 years. The average age of intracerebral hemorrhage in men reduced by 7.5 years from 1992 to 2012. The age-standardized incidence of main stroke subtypes increased significantly in rural China over the past 21 years; the overall proportion of intracerebral hemorrhage was stable, but the incidence increased significantly among middle-aged men. These findings imply that it is crucial to control stroke risk factors in middle-aged men for stroke prevention in future decades.