Stroke incidence and mortality in rural and urban Shanghai from 1984 through 1991. Findings from a community-based registry

The Epidemiological Characteristics of Stroke in Hunan Province, China

Previous studies have shown that Hunan Province has a high incidence of stroke and a high proportion of intracerebral hemorrhage (ICH). Considering the changes over the past three decades, little is known about the current epidemiological characteristics of stroke in Hunan Province. In 2013, a cross-sectional study was conducted at seven national disease surveillance points (DSPs) in Hunan Province. A multistage cluster sampling method was used to select a representative sample. A total of 21,156 participants aged 20 years and older were examined. Among the 21,156 participants, the number of prevalent strokes, incident strokes and deaths was 307, 87, and 36, respectively. The 2010 China census-standardized prevalence, incidence and mortality were 1191.0 per 100,000 people [95% confidence interval (CI) 1044.8-1337.2], 333.6 per 100,000 person-years (95% CI 255.7-411.5) and 129.7 per 100,000 person-years (95% CI 81.1-178.3), respectively. Ischemic stroke (IS), ICH, subarachnoid hemorrhage (SAH), and stroke of undetermined type (UND) constituted 50.6, 41.4, 5.7, and 2.3% of all incident stroke cases, respectively. Tianxin, Liuyang, Wuling, and Hongjiang have high proportions of ICH (61.5, 58.3, 60, and 50%, respectively). Hypertension is the most common risk factor for prevalent stroke (71.34%), followed by smoking (30.62%) and alcohol use (25.73%). In conclusion, Hunan Province has an extremely heavy stroke burden. The high proportion of ICH is not limited to the Changsha community; it represents an important issue for all of Hunan Province.

The Epidemiology of Stroke in the East Asian Region: A Literature-Based Review

Stroke is a leading cause of morbidity and mortality in the developed world. Our objective was to review comparable studies of stroke incidence, prevalence, and subtypes in the East Asian region. English language epidemiologic studies of stroke published from 1984 through 2004 were identified for the East Asian region (China, Hong Kong, Taiwan, Japan, North and South Korea and the ASEAN countries). The Sudlow–Warlow criteria were modified to identify comparable studies. Stroke epidemiology is relatively well characterized in China, Taiwan, and Japan; however, little information is available for other countries. Four studies of stroke incidence, from China, Taiwan, and Japan, were identified, which reported a total of 4995 first-ever stroke events. There was an over twofold difference in the age-adjusted incidence of stroke between the Chinese Seven Cities and Okinawa study (483 vs 201 per 100 000). The 1-month case fatality rate ranged from 12·7% to 17·3%. Only one population-based study on stroke prevalence, from Taiwan, was identified: Studies show the relatively high proportion of hemorrhagic stroke (30%). Stroke epidemiology is relatively well characterized in China, Japan, and Taiwan but not in other countries in the region. More recent data are needed to monitor stroke prevention efforts and guide planning of health care resources in the region.

Polymorphisms in three genes are associated with hemorrhagic stroke

BACKGROUND

Multiligand receptor for advanced glycation end products (RAGE), osteoprotegerin, and Golgb1 genes may be implicated in atherosclerosis and vascular diseases. Single nucleotide polymorphisms (SNPs) rs1035798 in RAGE gene, rs2073617 and rs2073618 in TNFRSF11B, and rs3732410 in Golgb1 will be investigated on whether there is an association with hemorrhagic stroke (HS) in Chinese population.

METHODS

A total of 600 subjects including 199 HS patients and 401 controls were assayed. These samples were divided into two groups: the ≤50 year and >50 year groups. Genotyping of SNPs was determined using the SEQUENOM MassARRAY matrix-assisted laser desorption ionization-time-of-flight-mass spectrometry. The association between genotype and HS risk was evaluated by computing the odds ratio (OR) and 95% confidence interval (CI) with multivariate unconditional logistic regression analyses.

RESULTS

Our data showed that in the ≤50 year group, the rs1035798 major allele homozygote C/C in RAGE gene was associated with an increased risk of HS, while Golgb1 rs3732410 minor allele homozygote G/G was associated with a decreased risk of HS. In the >50 year group, the major allele homozygote G/G of rs2073618 was found to be associated with an increased risk of HS.

CONCLUSIONS

The polymorphisms rs1035798 of RAGE gene, rs2073618 of TNFRSF11B, and rs3732410 of Golgb1 might be involved in the risk of HS at different stage of ages.

The rs10947803 SNP of KCNK17 is associated with cerebral hemorrhage but not ischemic stroke in a Chinese population

KCNK17 (potassium channel, subfamily K, member17) was first discovered to associate with the pathogenesis of ischemic stroke in the first genome-wide association study. The rs10947803 SNP in KCNK17 is significantly associated with ischemic stroke in Caucasian populations. The aim of the present study was to investigate the association with strokes in the Chinese population. A total of 1364 stroke patients and 1293 controls were examined using a case-control methodology. The rs10947803 SNP in KCNK17 was genotyped by a TaqMan real-time PCR assay. The rs10947803 SNP (A allele) of KCNK17 was significantly associated with cerebral hemorrhage (for AA+AC versus CC, unadjusted odds ratio [OR]=1.70; 95% confidence interval [CI], 1.08-2.69; P=0.020). After adjustment for age and sex, the association remained significant for AA+AC versus CC, OR=1.65; 95% CI, 1.04-2.62; P=0.033. In addition, the rs10947803 SNP in KCNK17 was not associated with ischemic stroke (for AA+AC versus CC, unadjusted OR=0.92; 95% CI, 0.81-1.05; P=0.212, after age- and sex-adjustment, OR=0.87; 95% CI, 0.72-1.05; P=0.143). The rs10947803 SNP (A allele) in KCNK17 increases the risk of cerebral hemorrhage but not ischemic stroke in the Chinese population.

Ten-year clinical epidemiological trends of intracerebral hemorrhage in Chongqing, China

BACKGROUND

The combination of an increase in aged population and adaptation of Western lifestyle is modifying the epidemiological status of intracerebral hemorrhage in China. The purpose of this study is to analyse and characterize the changing trends of intracerebral hemorrhage in Chongqing, the largest city in Southwest China, over the past 10 years.

METHODS

We retrospectively reviewed the medical records of patients diagnosed with intracerebral hemorrhage who visited the First Affiliated Hospital of Chongqing Medical University from 1 January 1998 to 31 December 1998 and from 1 January 2008 to 31 December 2008, respectively. Relevant variable information of these two populations for the two time periods was compared and discussed.

RESULTS

There were a total of 404 intracerebral hemorrhage patients who met the study criteria and registered in the First Affiliated Hospital in 1998 (128 cases) and 2008 (276 cases). The highest incidence of intracerebral hemorrhage was noted in the 1960s and 1970s age groups. The mean onset age of intracerebral hemorrhage was 2·65 years older in 2008 compared to 1998, specifically 2·10 years older for men and 3·38 years for women. In 1998, male intracerebral hemorrhage patients outnumbered female patients (1·42:1). This gender disproportion became higher in 2008 (1·63:1). Hypertension accounts for the highest proportion of all risk factors. The number of patients had minimally invasive interventions (intracranial hematoma drainage) was increased, and the in-hospital mortality rate decreased to 14·13% in 2008 from 19·53% in 1998.

CONCLUSIONS

We identified changes in population characteristics of patients with intracerebral hemorrhage during a period of economic development in China. These changes in patterns of intracerebral hemorrhage have raised new challenges and the needs for priority adjustment in the campaign for intracerebral hemorrhage prevention in China and other developing countries.

Baseline cardiovascular risk factors and stroke mortality by municipality population size in a 19-year follow-up study-NIPPON DATA80

The urban-rural difference in cardiovascular risk factors and stroke mortality throughout Japan was examined in a cohort by using hierarchical data structure. The subjects were 9,309 men and women aged ≥ 30 years who were residents of 294 areas in 211 municipalities of Japan in 1980; they were followed up until 1999. The population sizes of the municipalities in which the aforementioned areas were located were used to distinguish between urban and rural areas. We applied multilevel modeling to take into account the hierarchical data structure of individuals (subjects) (level 1) nested within areas (level 2). Statistically significant differences were observed in the case of medium (30,000-300,000) and small (<30,000) municipality populations compared with large (≥300,000) municipality populations with regard to the following parameters: body mass index in men, serum total cholesterol in both men and women, and daily alcohol drinking in women. The values or frequencies of these cardiovascular risk factors were significantly higher in large populations. Meanwhile, age-adjusted odds ratios for stroke mortality in the areas in the medium and small municipalities compared with those in the areas in the large municipalities were 1.31 (95% confidence interval (CI) 0.81-2.13) and 1.40 (95% CI 0.87-2.24) in men, and 1.32 (95% CI 0.79-2.20) and 1.62 (95% CI 0.99-2.65) in women, respectively. The results of multivariate analyses adjusted for age, body mass index, total cholesterol, diabetes, hypertension, current smoking, and daily alcohol consumption did not change materially. In conclusion, stroke mortality tended to be higher in rural areas than in urban areas in Japan, especially among women.

Urban–rural difference in stroke mortality from a 19-year cohort study of the Japanese general population: NIPPON DATA80

In Japan, cohort studies on stroke have been mainly conducted in rural areas, with few studies comparing stroke mortality between urban and rural areas. We aimed to explore urban-rural difference in stroke mortality throughout Japan using a representative sample of the general Japanese population, the NIPPON DATA80. This study included 9309 subjects (4080 men and 5229 women) aged 30 years or older who were residents of 294 areas in 211 municipalities of Japan in 1980 and followed-up until 1999. Population size of the municipality in which the aforementioned areas were located was used to distinguish between urban and rural areas, because municipalities in Japan are classified as village, town or city principally by population size. We applied a multilevel logistic regression model to take into account the hierarchical data structure of individuals (subjects) (level 1) nested within areas (level 2), and then calculated odds ratios and 95% confidence intervals (CIs) of deaths from total stroke. Statistically significant variance between areas was not observed in men but was in women. Age-adjusted odds ratios of the areas in the medium (population > or = 30,000 and <300,000) and small municipalities (<30,000) compared with the areas in the large municipalities (> or = 300,000) were 1.31 and 1.40 in men, and 1.32 and 1.62 in women, respectively. Multivariate-adjusted odds ratios (adjusted for age, body mass index, total cholesterol, diabetes, hypertension, current smoking, and daily alcohol consumption) of the areas in the medium and small municipalities compared with the areas in the large municipalities were 1.29 and 1.36 in men, and 1.34 and 1.68 in women, respectively. In conclusion, stroke mortality tended to be higher in rural areas than in urban areas in Japan, especially among women.

Hospital-based prospective registration of acute ischemic stroke and transient ischemic attack in Japan

The purpose of this study was to obtain fundamental information on patients with acute ischemic stroke and transient ischemic attack (TIA) in Japan. We prospectively registered consecutive stroke and TIA patients who visited 156 participating hospitals within 7 days of onset between May 1, 1999 and April 30, 2000. A total of 16,922 patients with 70.6 +/- 11.5 years old (median 71, range 18-107) were enrolled in the study. TIA was seen in 7% of registered patients, lacunar stroke in 36%, atherothrombotic in 31%, cardioembolic stroke in 20%, and other in 6%. Hypertension was present in 61%, diabetes mellitus in 24%, atrial fibrillation (AF) in 21%, smoking in 18%, and hypercholesterolemia in 17%. Overall, 37% of patients arrived at hospital within 3 hours of symptom onset, and 50% within 6 hours. Among those who visited the hospital within 6 hours, 64% used an ambulance service. Mean NIHSS score was 8.0 +/- 7.9 (median, 5). Only 3% were treated with thrombolytic agents in acute phase of stroke. Only 19% of all patients were treated in stroke care unit or intensive care unit. The modified Rankin Scale score of 0 to 2 at discharge was observed in 61% of the patients, 3 to 5 in 32%, and the mortality rate was 7%. More than half of the acute stroke patients arrived at the hospital after 6 hours of onset, and the stroke care unit was used only in one fifth of all patients. Establishment of ideal emergency system and arrangement of stroke units are also awaited for better management and improvement of patients' outcome.

Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century

This overview of population-based studies of incidence, prevalence, mortality, and case-fatality of stroke was based on studies from 1990. Incidence (first stroke in an individual's lifetime) and prevalence were computed by age, sex, and stroke type. Age-standardised incidence and prevalence with the corresponding 95% CI were plotted for each study to facilitate comparisons. The review shows that the burden of stroke is high and is likely to increase in future decades as a result of demographic and epidemiological transitions in populations. The main features of stroke epidemiology include modest geographical variation in incidence, prevalence, and case-fatality among the--predominantly white--populations studied so far, and a stabilisation or reversal in the declining secular trends in the pre-1990s rates, especially in older people. However, further research that uses the best possible methods to study the incidence, risk factors, and outcome of stroke are urgently needed in other populations of the world, especially in less developed countries where the risk of stroke is high, lifestyles are changing rapidly, and population restructuring is occurring.

Stroke epidemiology in Novosibirsk, Russia: a population-based study

OBJECTIVE

To determine first-ever stroke incidence, 30-day case-fatality rates, and frequency of various risk factors among patients with stroke in Novosibirsk, Russia, during 1992.

DESIGN

A population-based study of an administratively defined district of Novosibirsk was conducted to identify residents with a first-ever stroke that occurred between Jan. 1, 1992, and Dec. 31, 1992.

MATERIAL AND METHODS

For case ascertainment, mortality statistics, death certificates, hospital registrations, outpatient clinical data, and all ambulance calls for the study area were reviewed. Patients with stroke or suspected stroke were examined and interviewed by a cerebrovascular neurologist, and the type of stroke was determined.

RESULTS

During the 12-month study period, 366 patients with first-ever stroke were registered. A diagnosis of cerebral infarction or intracerebral hemorrhage was confirmed by computed tomography or autopsy in 42% of cases. The diagnosis of subarachnoid hemorrhage was established by cerebrospinal fluid examination in all 14 cases. The age- and sex-adjusted annual incidence rate for stroke was 232 per 100,000. The distribution of incidence cases by diagnostic category was as follows: cerebral infarction, 87.7%; intracerebral hemorrhage, 8.5%; and subarachnoid hemorrhage, 3.8%. The overall 30-day case-fatality rate for stroke was 22.4%. Hypertension, angina pectoris, and cigarette smoking were the most frequent risk factors in patients with stroke in Novosibirsk.

CONCLUSION

The incidence rate of first-ever stroke in Novosibirsk, Russia, is one of the highest in the world, but the 30-day case-fatality rates are similar to those in other populations.