title: Increasing stroke incidence and prevalence of risk factors in a low-income Chinese population.
abstract: OBJECTIVE
  We investigated secular trends in incidence of first-ever stroke and the prevalence of stroke risk factors within the same population in rural China.
  
  
  METHODS
  In 1985, 15,438 residents from a township of Tianjin, China, were recruited to the Tianjin Brain Study, a population-based stroke surveillance study. Stroke events and all deaths were registered annually. Because imaging technology was first available in 1992, we analyzed the incidence of first-ever stroke over 3 study periods-1992-1998, 1999-2005, and 2006-2012-from 1992 to 2012. Risk factor surveys were conducted in 1991 and 2011.
  
  
  RESULTS
  The age-standardized incidence of first-ever stroke per 100,000 person-years increased rapidly from 124.5 in 1992-1998 to 190.0 in 1999-2005 and to 318.2 in 2006-2012; incidence increased annually by 6.5% overall and by 12% among men aged 45-64 years (p < 0.05). From 1992 to 2012, the age at first-ever stroke in men was earlier by 3.3 years overall, but a similar trend was not observed in women. Concurrently, the prevalence of high fasting glucose and alcohol consumption increased significantly in both men and women, especially in men aged <45 years; the prevalence of obesity and high fasting glucose increased by 8.8-fold and 11-fold, respectively, from 1992 to 2012.
  
  
  CONCLUSIONS
  The incidence of stroke in rural China increased rapidly, particularly among middle-aged adults, along with a concurrent increase in risk factor prevalence. These findings suggest that without controlling these risk factors, stroke incidence will continue to increase over future decades in China.
authors.affiliation: From the Department of Epidemiology (J.W., J.T., C.Z., X.N.), Tianjin Neurological Institute; the Department of Neurology (J.W., L.Y., J.T., C.Z., X.N.), Tianjin Medical University General Hospital; the Departments of Neurology (Z.A.) and Ultrasound (B.L.), Tianjin Huanhu Hospital; the Department of Neurology (B.L., H.G.), Tianjin Dagang Oilfield General Hospital; the Department of Neuro-Immunology (L.Y.), Tianjin Neurological Institute; and the Department of Internal Medicine and Cardiovascular Center (T.-C.S.), National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Jinghua
authors.initials: J
authors.lastname: Wang
authors.affiliation: From the Department of Epidemiology (J.W., J.T., C.Z., X.N.), Tianjin Neurological Institute; the Department of Neurology (J.W., L.Y., J.T., C.Z., X.N.), Tianjin Medical University General Hospital; the Departments of Neurology (Z.A.) and Ultrasound (B.L.), Tianjin Huanhu Hospital; the Department of Neurology (B.L., H.G.), Tianjin Dagang Oilfield General Hospital; the Department of Neuro-Immunology (L.Y.), Tianjin Neurological Institute; and the Department of Internal Medicine and Cardiovascular Center (T.-C.S.), National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Zhongping
authors.initials: Z
authors.lastname: An
authors.affiliation: From the Department of Epidemiology (J.W., J.T., C.Z., X.N.), Tianjin Neurological Institute; the Department of Neurology (J.W., L.Y., J.T., C.Z., X.N.), Tianjin Medical University General Hospital; the Departments of Neurology (Z.A.) and Ultrasound (B.L.), Tianjin Huanhu Hospital; the Department of Neurology (B.L., H.G.), Tianjin Dagang Oilfield General Hospital; the Department of Neuro-Immunology (L.Y.), Tianjin Neurological Institute; and the Department of Internal Medicine and Cardiovascular Center (T.-C.S.), National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Bin
authors.initials: B
authors.lastname: Li
authors.affiliation: From the Department of Epidemiology (J.W., J.T., C.Z., X.N.), Tianjin Neurological Institute; the Department of Neurology (J.W., L.Y., J.T., C.Z., X.N.), Tianjin Medical University General Hospital; the Departments of Neurology (Z.A.) and Ultrasound (B.L.), Tianjin Huanhu Hospital; the Department of Neurology (B.L., H.G.), Tianjin Dagang Oilfield General Hospital; the Department of Neuro-Immunology (L.Y.), Tianjin Neurological Institute; and the Department of Internal Medicine and Cardiovascular Center (T.-C.S.), National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Li
authors.initials: L
authors.lastname: Yang
authors.affiliation: From the Department of Epidemiology (J.W., J.T., C.Z., X.N.), Tianjin Neurological Institute; the Department of Neurology (J.W., L.Y., J.T., C.Z., X.N.), Tianjin Medical University General Hospital; the Departments of Neurology (Z.A.) and Ultrasound (B.L.), Tianjin Huanhu Hospital; the Department of Neurology (B.L., H.G.), Tianjin Dagang Oilfield General Hospital; the Department of Neuro-Immunology (L.Y.), Tianjin Neurological Institute; and the Department of Internal Medicine and Cardiovascular Center (T.-C.S.), National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Jun
authors.initials: J
authors.lastname: Tu
authors.affiliation: From the Department of Epidemiology (J.W., J.T., C.Z., X.N.), Tianjin Neurological Institute; the Department of Neurology (J.W., L.Y., J.T., C.Z., X.N.), Tianjin Medical University General Hospital; the Departments of Neurology (Z.A.) and Ultrasound (B.L.), Tianjin Huanhu Hospital; the Department of Neurology (B.L., H.G.), Tianjin Dagang Oilfield General Hospital; the Department of Neuro-Immunology (L.Y.), Tianjin Neurological Institute; and the Department of Internal Medicine and Cardiovascular Center (T.-C.S.), National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Hongfei
authors.initials: H
authors.lastname: Gu
authors.affiliation: From the Department of Epidemiology (J.W., J.T., C.Z., X.N.), Tianjin Neurological Institute; the Department of Neurology (J.W., L.Y., J.T., C.Z., X.N.), Tianjin Medical University General Hospital; the Departments of Neurology (Z.A.) and Ultrasound (B.L.), Tianjin Huanhu Hospital; the Department of Neurology (B.L., H.G.), Tianjin Dagang Oilfield General Hospital; the Department of Neuro-Immunology (L.Y.), Tianjin Neurological Institute; and the Department of Internal Medicine and Cardiovascular Center (T.-C.S.), National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Changqing
authors.initials: C
authors.lastname: Zhan
authors.affiliation: From the Department of Epidemiology (J.W., J.T., C.Z., X.N.), Tianjin Neurological Institute; the Department of Neurology (J.W., L.Y., J.T., C.Z., X.N.), Tianjin Medical University General Hospital; the Departments of Neurology (Z.A.) and Ultrasound (B.L.), Tianjin Huanhu Hospital; the Department of Neurology (B.L., H.G.), Tianjin Dagang Oilfield General Hospital; the Department of Neuro-Immunology (L.Y.), Tianjin Neurological Institute; and the Department of Internal Medicine and Cardiovascular Center (T.-C.S.), National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Bin
authors.initials: B
authors.lastname: Liu
authors.affiliation: From the Department of Epidemiology (J.W., J.T., C.Z., X.N.), Tianjin Neurological Institute; the Department of Neurology (J.W., L.Y., J.T., C.Z., X.N.), Tianjin Medical University General Hospital; the Departments of Neurology (Z.A.) and Ultrasound (B.L.), Tianjin Huanhu Hospital; the Department of Neurology (B.L., H.G.), Tianjin Dagang Oilfield General Hospital; the Department of Neuro-Immunology (L.Y.), Tianjin Neurological Institute; and the Department of Internal Medicine and Cardiovascular Center (T.-C.S.), National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Ta-Chen
authors.initials: TC
authors.lastname: Su
authors.affiliation: From the Department of Epidemiology (J.W., J.T., C.Z., X.N.), Tianjin Neurological Institute; the Department of Neurology (J.W., L.Y., J.T., C.Z., X.N.), Tianjin Medical University General Hospital; the Departments of Neurology (Z.A.) and Ultrasound (B.L.), Tianjin Huanhu Hospital; the Department of Neurology (B.L., H.G.), Tianjin Dagang Oilfield General Hospital; the Department of Neuro-Immunology (L.Y.), Tianjin Neurological Institute; and the Department of Internal Medicine and Cardiovascular Center (T.-C.S.), National Taiwan University Hospital, Taipei, Taiwan. xjn0906@gmail.com.
authors.forename: Xianjia
authors.initials: X
authors.lastname: Ning
mesh_terms: D000328:Adult; D017668:Age of Onset; D000368:Aged; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011203:Poverty / Q000706:statistics & numerical data*; D015995:Prevalence; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D020521:Stroke / Q000453:epidemiology* / Q000401:mortality