title: Increased Stroke Burdens Among the Low-Income Young and Middle Aged in Rural China.
abstract: Although stroke in the young and middle aged accounts for 31% of all strokes in China, the disease burden is unknown. We aimed to determine the secular trends in stroke incidence and the transition of subtypes in rural China over a 24-year period.
  
  
  
  In 1992, 14 920 residents were recruited to participate in the Tianjin Brain Study. Stroke events and all deaths were registered annually. We assessed the trends in incidence of first-ever stroke, including intracerebral hemorrhage and ischemic stroke, among adults aged 35 to 64 years during 1992 to 1999, 2000 to 2007, and 2008 to 2015. The annual proportion of change in stroke incidence was evaluated from 1992 to 2015.
  
  
  
  The age-standardized incidence of first-ever stroke per 100 000 person-years increased significantly, from 122 in 1992 to 1999, to 215.8 in 2000 to 2007, to 471.8 in 2008 to 2015. The incidence of first-ever stroke increased annually by 11.9% overall (12.4% in men, 9.0% in women, 8.7% for intracerebral hemorrhage, and 10.7% for ischemic stroke; P<0.001). The greatest increases were observed in adults aged 55 to 64 years, with an annual increase of 11.6% for ischemic stroke (10.8% in men and 6.9% in women). However, the proportion of intracerebral hemorrhage has not changed over the past 24 years.
  
  
  
  In contrast with that in developed countries, the burden of stroke in China originates primarily from young and middle-aged adults. Thus, control of risk factors in this population is required to reduce the future burden of stroke in China.
authors.affiliation: From the Centre of Clinical Epidemiology (X.N., J.T., J.W., J.Z.) and Department of Neurosurgery (J.S., R.J.), Tianjin Medical University General Hospital, China; and Department of Epidemiology (X.N., L.B., M.S., J.T., Y.W., J.W.), Department of Neurotrauma (R.J., J.Z.), and Department of Neurology (H.L., L.B., M.S., Y.W.), Tianjin Neurological Institute, China.
authors.forename: Xianjia
authors.initials: X
authors.lastname: Ning
authors.affiliation: From the Centre of Clinical Epidemiology (X.N., J.T., J.W., J.Z.) and Department of Neurosurgery (J.S., R.J.), Tianjin Medical University General Hospital, China; and Department of Epidemiology (X.N., L.B., M.S., J.T., Y.W., J.W.), Department of Neurotrauma (R.J., J.Z.), and Department of Neurology (H.L., L.B., M.S., Y.W.), Tianjin Neurological Institute, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Sun
authors.affiliation: From the Centre of Clinical Epidemiology (X.N., J.T., J.W., J.Z.) and Department of Neurosurgery (J.S., R.J.), Tianjin Medical University General Hospital, China; and Department of Epidemiology (X.N., L.B., M.S., J.T., Y.W., J.W.), Department of Neurotrauma (R.J., J.Z.), and Department of Neurology (H.L., L.B., M.S., Y.W.), Tianjin Neurological Institute, China.
authors.forename: Rongcai
authors.initials: R
authors.lastname: Jiang
authors.affiliation: From the Centre of Clinical Epidemiology (X.N., J.T., J.W., J.Z.) and Department of Neurosurgery (J.S., R.J.), Tianjin Medical University General Hospital, China; and Department of Epidemiology (X.N., L.B., M.S., J.T., Y.W., J.W.), Department of Neurotrauma (R.J., J.Z.), and Department of Neurology (H.L., L.B., M.S., Y.W.), Tianjin Neurological Institute, China.
authors.forename: Hongyan
authors.initials: H
authors.lastname: Lu
authors.affiliation: From the Centre of Clinical Epidemiology (X.N., J.T., J.W., J.Z.) and Department of Neurosurgery (J.S., R.J.), Tianjin Medical University General Hospital, China; and Department of Epidemiology (X.N., L.B., M.S., J.T., Y.W., J.W.), Department of Neurotrauma (R.J., J.Z.), and Department of Neurology (H.L., L.B., M.S., Y.W.), Tianjin Neurological Institute, China.
authors.forename: Lingling
authors.initials: L
authors.lastname: Bai
authors.affiliation: From the Centre of Clinical Epidemiology (X.N., J.T., J.W., J.Z.) and Department of Neurosurgery (J.S., R.J.), Tianjin Medical University General Hospital, China; and Department of Epidemiology (X.N., L.B., M.S., J.T., Y.W., J.W.), Department of Neurotrauma (R.J., J.Z.), and Department of Neurology (H.L., L.B., M.S., Y.W.), Tianjin Neurological Institute, China.
authors.forename: Min
authors.initials: M
authors.lastname: Shi
authors.affiliation: From the Centre of Clinical Epidemiology (X.N., J.T., J.W., J.Z.) and Department of Neurosurgery (J.S., R.J.), Tianjin Medical University General Hospital, China; and Department of Epidemiology (X.N., L.B., M.S., J.T., Y.W., J.W.), Department of Neurotrauma (R.J., J.Z.), and Department of Neurology (H.L., L.B., M.S., Y.W.), Tianjin Neurological Institute, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Tu
authors.affiliation: From the Centre of Clinical Epidemiology (X.N., J.T., J.W., J.Z.) and Department of Neurosurgery (J.S., R.J.), Tianjin Medical University General Hospital, China; and Department of Epidemiology (X.N., L.B., M.S., J.T., Y.W., J.W.), Department of Neurotrauma (R.J., J.Z.), and Department of Neurology (H.L., L.B., M.S., Y.W.), Tianjin Neurological Institute, China.
authors.forename: Yanan
authors.initials: Y
authors.lastname: Wu
authors.affiliation: From the Centre of Clinical Epidemiology (X.N., J.T., J.W., J.Z.) and Department of Neurosurgery (J.S., R.J.), Tianjin Medical University General Hospital, China; and Department of Epidemiology (X.N., L.B., M.S., J.T., Y.W., J.W.), Department of Neurotrauma (R.J., J.Z.), and Department of Neurology (H.L., L.B., M.S., Y.W.), Tianjin Neurological Institute, China. jhw8799@yahoo.com jianningzhang@hotmail.com.
authors.forename: Jinghua
authors.initials: J
authors.lastname: Wang
authors.affiliation: From the Centre of Clinical Epidemiology (X.N., J.T., J.W., J.Z.) and Department of Neurosurgery (J.S., R.J.), Tianjin Medical University General Hospital, China; and Department of Epidemiology (X.N., L.B., M.S., J.T., Y.W., J.W.), Department of Neurotrauma (R.J., J.Z.), and Department of Neurology (H.L., L.B., M.S., Y.W.), Tianjin Neurological Institute, China. jhw8799@yahoo.com jianningzhang@hotmail.com.
authors.forename: Jianning
authors.initials: J
authors.lastname: Zhang
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D017281:Cost of Illness; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011203:Poverty / Q000191:economics* / Q000639:trends*; D012424:Rural Population / Q000639:trends*; D020521:Stroke / Q000191:economics* / Q000453:epidemiology*
keywords: burden; epidemiology; incidence; stroke; subtype; young and middle aged