Incidence of First-Ever Stroke, Stroke Events, and Early Case Fatality Rate in China: Results from a National Population-Based Survey

Background: In recent years, stroke has become the leading cause of death in the Chinese population, and the burden of stroke is huge. The aim of this study was to describe the epidemiological characteristics of population-based stroke incidence and case fatality rates in China, which are nationally representative. Methods: In 2013, a nationally representative household survey was conducted at 155 survey sites in 31 provinces. All stroke cases occurring within 1 year before the start of the survey period, including first-ever and recurrent strokes, were considered event cases. According to computed tomography, magnetic resonance imaging, and autopsy results, stroke was classified as ischemic, hemorrhagic, subarachnoid hemorrhagic, or difficult-to-classify stroke. The 7- and 30-day case fatality rates after stroke onset were investigated. Results: A total of 595,711 people were surveyed, with 2,164 diagnosed stroke events and 1,645 first-ever strokes. The age-standardized incidence of first-ever stroke and stroke event incidence in the Chinese population were 229.5 and 300.61 per 100,000 person-years, respectively. The world population age-standardized incidence of first-ever stroke and stroke events by the World Health Organization were 188.5 and 246.3 per 100,000 person-years, respectively. Among the 31 provinces, the top five incidence rates of first-ever stroke were recorded in Shaanxi, Heilongjiang, Ningxia, Henan, and Tianjin (518.0, 400.8, 389.5, 366.6, and 344.0 per 100,000 person-years, respectively). The top five incidence rates of stroke events were documented in Heilongjiang, Shaanxi, Henan, Tianjin, and Ningxia (672.7, 603.1, 580.2, 469.0, and 456.2 per 100,000 person-years, respectively). The 7- and 30-day case fatality rates were 14.3% and 17.8% for patients with first-ever stroke, respectively. Significant differences in the 30-day mortality rate of different stroke subtypes were recorded: 8.3% (95% confidence interval [CI], 8.2-8.5) for ischemic stroke, 44.4% (95% CI, 42.2-46.5) for cerebral hemorrhage, and 3.1% (95% CI, 3.0-3.3) for subarachnoid hemorrhage (p < 0.0001). Compared with the area of residence, the 30-day mortality rate of first-ever stroke in rural areas was 19.8% (95% CI, 19.3-20.3), which was higher than that in urban areas (14.9% [95% CI, 14.5-15.3]) (p = 0.011). Conclusion: In China, the incidences of first-ever stroke and stroke events are increasing, whereas the early case fatality rate is declining, which will inevitably lead to a higher stroke prevalence and a greater stroke burden. Therefore, the primary and secondary prevention strategies should be strengthened to reduce the incidence and burden of stroke.