title: Trends in Incidence of Stroke and Transition of Stroke Subtypes in Rural Tianjin China: A Population-Based Study from 1992 to 2012.
abstract: OBJECTIVE
  The incidence of ischemic stroke has increased and that of hemorrhagic stroke has decreased in urban China; however, the trends in rural areas are unknown. We aimed to explore the secular trends in incidence and transition of stroke subtypes among rural Chinese.
  
  
  METHODS
  This was a population-based stroke surveillance through the Tianjin Brain Study. A total of 14,538 residents in a township of Ji County in Tianjin, China participated in the study since 1985. We investigated the age-standardized stroke incidence (sex-specific, type-specific, and age-specific), the annual proportion of change in the incidence of stroke, and the proportion of intracerebral hemorrhage in the periods 1992-1998, 1999-2005, and 2006-2012, because the neuroimaging technique was available since 1992 in this area.
  
  
  RESULTS
  The age-standardized incidence per 100,000 person-years increased significantly for both intracerebral hemorrhage (37.8 in 1992-1998, 46.5 in 1999-2005, and 76.5 in 2006-2012) and ischemic stroke (83.9 in 1992-1998, 135.3 in 1999-2005, and 238.0 in 2006-2012). The age-standardized incidence of first-ever stroke increased annually by 4.9% for intracerebral hemorrhage and by 7.3% for ischemic stroke. The greatest increase was observed in men aged 45-64 years for both stroke types (P < 0.001). The proportion of intracerebral hemorrhage was stable overall, increased among men aged 45-64 years, and decreased among men aged ≥65 years. The average age of intracerebral hemorrhage in men reduced by 7.5 years from 1992 to 2012.
  
  
  CONCLUSIONS
  The age-standardized incidence of main stroke subtypes increased significantly in rural China over the past 21 years; the overall proportion of intracerebral hemorrhage was stable, but the incidence increased significantly among middle-aged men. These findings imply that it is crucial to control stroke risk factors in middle-aged men for stroke prevention in future decades.
authors.affiliation: Department of Neurology, Tianjin Haibin People's Hospital, Tianjin, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Li
authors.affiliation: Department of Neurology, Tianjin Haibin People's Hospital, Tianjin, China.
authors.forename: Yongzhong
authors.initials: Y
authors.lastname: Lou
authors.affiliation: Department of Neurology, Tianjin Haibin People's Hospital, Tianjin, China.
authors.forename: Hongfei
authors.initials: H
authors.lastname: Gu
authors.affiliation: Department of Neurology, Tianjin Haibin People's Hospital, Tianjin, China.
authors.forename: Xue
authors.initials: X
authors.lastname: Long
authors.affiliation: Department of Neurology, Tianjin Haibin People's Hospital, Tianjin, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Wang
authors.affiliation: Department of Neurology, Tianjin Haibin People's Hospital, Tianjin, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Wei
authors.affiliation: Department of Neurology, Tianjin Medical University General Hospital & Department of Epidemiology, Tianjin Neurological Institute, Tianjin, China.
authors.forename: Jinghua
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Neurology, Tianjin Medical University General Hospital & Department of Epidemiology, Tianjin Neurological Institute, Tianjin, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Tu
authors.affiliation: Department of Neurology, Tianjin Medical University General Hospital & Department of Epidemiology, Tianjin Neurological Institute, Tianjin, China.
authors.forename: Xianjia
authors.initials: X
authors.lastname: Ning
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002681:China / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011379:Prognosis; D012042:Registries; D012107:Research Design; D012307:Risk Factors; D012424:Rural Population; D020521:Stroke / Q000145:classification* / Q000453:epidemiology*; D013997:Time Factors