Date Published: March 31, 2019
Publisher: Impact Journals
Author(s): Wenjuan Zhao, Jialing Wu, Jie Liu, Yanan Wu, Jingxian Ni, Hongfei Gu, Jun Tu, Jinghua Wang, Zhongping An, Xianjia Ning.
Recent data on the incidence and trends for recurrent strokes in China are scarce. We assessed the temporal trends in recurrent stroke incidence using in rural China. The age-standardized incidences of recurrent stroke, within 5 years of the incident stroke event, were estimated for 3 time periods: 1992–1998, 1999–2005, and 2006–2012. Among the 768 documented incident stroke cases, 26.3% of the patients experienced recurrent stroke within 5 years. The overall age-adjusted recurrent stroke incidence was 43.93 per 100,000 person-years (1992–2012). During the 2006–2012 period, the recurrent stroke incidence per 100,000 person-years was 107.79 in men, and 557.76 in individuals ≥65 years old. There were significant upward tendencies observed in this population across sex, age, or type of stroke (except for among individuals ≥65 years old with incident intracerebral hemorrhages). Compared with the recurrent stroke incidence observed in the 1992–1998 period, that observed during the 2006–2012 period was more than 3-fold higher; the greatest increase (6.8-fold) was observed in women. These findings suggest an urgent need to improve risk factor management and implement appropriate medical resources to contain this upward trend in recurrent stroke incidence and reduce the overall stroke burden in China.
Recurrent strokes are more likely to be disabling or fatal than incident strokes, and population-based studies have documented that recurrent strokes account for more than 30% of all strokes . Therefore, the prevention of recurrent strokes is important to both patients and society. Strokes are one of the leading causes of death and disability, worldwide , accounting for 9% (almost 4.4 million) of all deaths each year . Over the past 2 decades, there has been a notable increase (84%) in the absolute number of stroke survivors globally, despite a decreasing incidence of strokes in high-income countries . However, the number of stroke survivors <75 years old is approximately 30% higher in low- and middle-income countries than in high-income countries . To our knowledge, this is the first report describing the temporal trends in recurrent stroke incidence in China based on a prospective, population-based study. In this study, we assessed the age-standardized recurrent stroke incidence within 5 years of the incident stroke in a rural population in China. Of those experiencing a documented incident stroke within the study period, 26.3% experienced a recurrent stroke within 5 years. This yielded an overall age-adjusted recurrent stroke incidence of 43.93/100,000 person-years. During the 2006–2012 period, the incidence was as high as 107.79/100,000 person-years in men and 557.76/100,000 person-years in individuals ≥65 years old. The recurrent stroke incidence demonstrated a significant upward trend during the 3study periods, regardless of sex, age, or incident stroke subtype (except for recurrent strokes among individuals ≥65 years old who experienced ICH as their incident stroke event). Compared with the recurrent stroke incidence during the 1992–1998 period, the incidence during the 2006–2012 period was >3-fold higher, with the greatest increase (6.8-fold) observed in women.
This report describes the temporal trends in the incidence of recurrent strokes in a rural, low-income population in China. Among individuals suffering from an incident stroke, 26.3% experienced recurrent strokes within 5 years. Further, the incidence of recurrent strokes increased in each of the 6-year study stages, regardless of patient age, sex, or incident stroke subtype (except within the oldest age group who experienced incident ICH). The high incidence of first-ever strokes and poor risk factor management in the study population may explain the upward trend in recurrent stroke incidence. These findings suggest an urgent need to improve risk factor management and implement appropriate medical resources to control the upward trend in recurrent stroke incidence and the overall burden of strokes in China’s low-income population.