Estimated Burden of Stroke in China in 2020

This cross-sectional study investigates the prevalence, incidence, and mortality rate of stroke in China in 2020 using data from a nationally representative sample of rural and urban populations. Key Points Question What was the burden of prevalence, incidence, and mortality rate of stroke in China? Findings In this cross-sectional study of 676394 participants aged 40 years and older, the estimated overall prevalence, incidence, and mortality rate of stroke in mainland China in 2020 were 2.6%, 505.2 per 100000 person-years, and 343.4 per 100000 person-years, respectively. The prevalence of stroke was higher in urban areas than rural areas, but the incidence rate and mortality rate of stroke were higher in rural areas than urban areas. Meaning These findings suggest that there may be an urban-rural disparity in the burden of stroke in China, and an improved stroke prevention strategy is needed. Importance roke is the leading cause of death in China. However, recent data about the up-to-date stroke burden in China are limited. Objective To investigate the urban-rural disparity of stroke burden in the Chinese adult population, including prevalence, incidence, and mortality rate, and disparities between urban and rural populations. Design, Setting, and Participants This cross-sectional study was based on a nationally representative survey that included 676394 participants aged 40 years and older. It was conducted from July 2020 to December 2020 in 31 provinces in mainland China. Main Outcomes and Measures Primary outcome was self-reported stroke verified by trained neurologists during a face-to-face interviews using a standardized protocol. Stroke incidence were assessed by defining first-ever strokes that occurred during 1 year preceding the survey. Strokes causing death that occurred during the 1 year preceding the survey were considered as death cases. Results The study included 676394 Chinese adults (395122 [58.4%] females; mean [SD] age, 59.7 [11.0] years). In 2020, the weighted prevalence, incidence, and mortality rates of stroke in China were 2.6% (95% CI, 2.6%-2.6%), 505.2 (95% CI, 488.5-522.0) per 100000 person-years, and 343.4 (95% CI, 329.6-357.2) per 100000 person-years, respectively. It was estimated that among the Chinese population aged 40 years and older in 2020, there were 3.4 (95% CI, 3.3-3.6) million incident cases of stroke, 17.8 (95% CI, 17.5-18.0) million prevalent cases of stroke, and 2.3 (95% CI, 2.2-2.4) million deaths from stroke. Ischemic stroke constituted 15.5 (95% CI, 15.2-15.6) million (86.8%) of all incident strokes in 2020, while intracerebral hemorrhage constituted 2.1 (95% CI, 2.1-2.1) million (11.9%) and subarachnoid hemorrhage constituted 0.2 (95% CI, 0.2-0.2) million (1.3%). The prevalence of stroke was higher in urban than in rural areas (2.7% [95% CI, 2.6%-2.7%] vs 2.5% [95% CI, 2.5%-2.6%]; P=.02), but the incidence rate (485.5 [95% CI, 462.8-508.3] vs 520.8 [95% CI, 496.3-545.2] per 100000 person-years; P<.001) and mortality rate (309.9 [95% CI, 291.7-328.1] vs 369.7 [95% CI, 349.1-390.3] per 100000 person-years; P<.001) were lower in urban areas than in rural areas. In 2020, the leading risk factor for stroke was hypertension (OR, 3.20 [95% CI, 3.09-3.32]). Conclusions and Relevance In a large, nationally representative sample of adults aged 40 years or older, the estimated prevalence, incidence, and mortality rate of stroke in China in 2020 were 2.6%, 505.2 per 100 000 person-years, and 343.4 per 100000 person-years, respectively, indicating the need for an improved stroke prevention strategy in the general Chinese population.