title: Prevalence, Incidence, and Mortality of Stroke in China: Results from a Nationwide Population-Based Survey of 480 687 Adults.
abstract: China bears the biggest stroke burden in the world. However, little is known about the current prevalence, incidence, and mortality of stroke at the national level, and the trend in the past 30 years.
  
  
  
  In 2013, a nationally representative door-to-door survey was conducted in 155 urban and rural centers in 31 provinces in China, totaling 480 687 adults aged ≥20 years. All stroke survivors were considered as prevalent stroke cases at the prevalent time (August 31, 2013). First-ever strokes that occurred during 1 year preceding the survey point-prevalent time were considered as incident cases. According to computed tomography/MRI/autopsy findings, strokes were categorized into ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and stroke of undetermined type.
  
  
  
  Of 480 687 participants, 7672 were diagnosed with a prevalent stroke (1596.0/100 000 people) and 1643 with incident strokes (345.1/100 000 person-years). The age-standardized prevalence, incidence, and mortality rates were 1114.8/100 000 people, 246.8 and 114.8/100 000 person-years, respectively. Pathological type of stroke was documented by computed tomography/MRI brain scanning in 90% of prevalent and 83% of incident stroke cases. Among incident and prevalent strokes, ischemic stroke constituted 69.6% and 77.8%, intracerebral hemorrhage 23.8% and 15.8%, subarachnoid hemorrhage 4.4% and 4.4%, and undetermined type 2.1% and 2.0%, respectively. Age-specific stroke prevalence in men aged ≥40 years was significantly greater than the prevalence in women (P<0.001). The most prevalent risk factors among stroke survivors were hypertension (88%), smoking (48%), and alcohol use (44%). Stroke prevalence estimates in 2013 were statistically greater than those reported in China 3 decades ago, especially among rural residents (P=0.017). The highest annual incidence and mortality of stroke was in Northeast (365 and 159/100 000 person-years), then Central areas (326 and 154/100 000 person-years), and the lowest incidence was in Southwest China (154/100 000 person-years), and the lowest mortality was in South China (65/100 000 person-years) (P<0.002).
  
  
  
  Stroke burden in China has increased over the past 30 years, and remains particularly high in rural areas. There is a north-to-south gradient in stroke in China, with the greatest stroke burden observed in the northern and central regions.
authors.affiliation: From Department of Neuroepidemiology, Beijing Neurosurgical Institute; Capital Medical University, China (W.W., B.J., H.S., X.R., D.S., Z.C., S.W., Y.Z.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (W.W., B.J., H.S., X.R., D.S., Z.C.); Beijing Tiantan Hospital, Capital Medical University, Beijing Institute for Brain Disorders, China (Y.J., Yilong Wang, Yongjun Wang); National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing (Y.L., Linhong Wang, Limin Wang); Department of Neurology, OSF/INI Comprehensive Stroke Center at SFMC, University of Illinois College of Medicine at Peoria (D.W.); and National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, New Zealand (V.L.F.). qgnfbwwz@163.com Yongjunwang1962@gmail.com valery.feigin@aut.ac.nz.
authors.forename: Wenzhi
authors.initials: W
authors.lastname: Wang
authors.affiliation: From Department of Neuroepidemiology, Beijing Neurosurgical Institute; Capital Medical University, China (W.W., B.J., H.S., X.R., D.S., Z.C., S.W., Y.Z.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (W.W., B.J., H.S., X.R., D.S., Z.C.); Beijing Tiantan Hospital, Capital Medical University, Beijing Institute for Brain Disorders, China (Y.J., Yilong Wang, Yongjun Wang); National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing (Y.L., Linhong Wang, Limin Wang); Department of Neurology, OSF/INI Comprehensive Stroke Center at SFMC, University of Illinois College of Medicine at Peoria (D.W.); and National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, New Zealand (V.L.F.).
authors.forename: Bin
authors.initials: B
authors.lastname: Jiang
authors.affiliation: From Department of Neuroepidemiology, Beijing Neurosurgical Institute; Capital Medical University, China (W.W., B.J., H.S., X.R., D.S., Z.C., S.W., Y.Z.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (W.W., B.J., H.S., X.R., D.S., Z.C.); Beijing Tiantan Hospital, Capital Medical University, Beijing Institute for Brain Disorders, China (Y.J., Yilong Wang, Yongjun Wang); National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing (Y.L., Linhong Wang, Limin Wang); Department of Neurology, OSF/INI Comprehensive Stroke Center at SFMC, University of Illinois College of Medicine at Peoria (D.W.); and National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, New Zealand (V.L.F.).
authors.forename: Haixin
authors.initials: H
authors.lastname: Sun
authors.affiliation: From Department of Neuroepidemiology, Beijing Neurosurgical Institute; Capital Medical University, China (W.W., B.J., H.S., X.R., D.S., Z.C., S.W., Y.Z.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (W.W., B.J., H.S., X.R., D.S., Z.C.); Beijing Tiantan Hospital, Capital Medical University, Beijing Institute for Brain Disorders, China (Y.J., Yilong Wang, Yongjun Wang); National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing (Y.L., Linhong Wang, Limin Wang); Department of Neurology, OSF/INI Comprehensive Stroke Center at SFMC, University of Illinois College of Medicine at Peoria (D.W.); and National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, New Zealand (V.L.F.).
authors.forename: Xiaojuan
authors.initials: X
authors.lastname: Ru
authors.affiliation: From Department of Neuroepidemiology, Beijing Neurosurgical Institute; Capital Medical University, China (W.W., B.J., H.S., X.R., D.S., Z.C., S.W., Y.Z.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (W.W., B.J., H.S., X.R., D.S., Z.C.); Beijing Tiantan Hospital, Capital Medical University, Beijing Institute for Brain Disorders, China (Y.J., Yilong Wang, Yongjun Wang); National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing (Y.L., Linhong Wang, Limin Wang); Department of Neurology, OSF/INI Comprehensive Stroke Center at SFMC, University of Illinois College of Medicine at Peoria (D.W.); and National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, New Zealand (V.L.F.).
authors.forename: Dongling
authors.initials: D
authors.lastname: Sun
authors.affiliation: From Department of Neuroepidemiology, Beijing Neurosurgical Institute; Capital Medical University, China (W.W., B.J., H.S., X.R., D.S., Z.C., S.W., Y.Z.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (W.W., B.J., H.S., X.R., D.S., Z.C.); Beijing Tiantan Hospital, Capital Medical University, Beijing Institute for Brain Disorders, China (Y.J., Yilong Wang, Yongjun Wang); National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing (Y.L., Linhong Wang, Limin Wang); Department of Neurology, OSF/INI Comprehensive Stroke Center at SFMC, University of Illinois College of Medicine at Peoria (D.W.); and National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, New Zealand (V.L.F.).
authors.forename: Linhong
authors.initials: L
authors.lastname: Wang
authors.affiliation: From Department of Neuroepidemiology, Beijing Neurosurgical Institute; Capital Medical University, China (W.W., B.J., H.S., X.R., D.S., Z.C., S.W., Y.Z.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (W.W., B.J., H.S., X.R., D.S., Z.C.); Beijing Tiantan Hospital, Capital Medical University, Beijing Institute for Brain Disorders, China (Y.J., Yilong Wang, Yongjun Wang); National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing (Y.L., Linhong Wang, Limin Wang); Department of Neurology, OSF/INI Comprehensive Stroke Center at SFMC, University of Illinois College of Medicine at Peoria (D.W.); and National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, New Zealand (V.L.F.).
authors.forename: Limin
authors.initials: L
authors.lastname: Wang
authors.affiliation: From Department of Neuroepidemiology, Beijing Neurosurgical Institute; Capital Medical University, China (W.W., B.J., H.S., X.R., D.S., Z.C., S.W., Y.Z.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (W.W., B.J., H.S., X.R., D.S., Z.C.); Beijing Tiantan Hospital, Capital Medical University, Beijing Institute for Brain Disorders, China (Y.J., Yilong Wang, Yongjun Wang); National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing (Y.L., Linhong Wang, Limin Wang); Department of Neurology, OSF/INI Comprehensive Stroke Center at SFMC, University of Illinois College of Medicine at Peoria (D.W.); and National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, New Zealand (V.L.F.).
authors.forename: Yong
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: From Department of Neuroepidemiology, Beijing Neurosurgical Institute; Capital Medical University, China (W.W., B.J., H.S., X.R., D.S., Z.C., S.W., Y.Z.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (W.W., B.J., H.S., X.R., D.S., Z.C.); Beijing Tiantan Hospital, Capital Medical University, Beijing Institute for Brain Disorders, China (Y.J., Yilong Wang, Yongjun Wang); National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing (Y.L., Linhong Wang, Limin Wang); Department of Neurology, OSF/INI Comprehensive Stroke Center at SFMC, University of Illinois College of Medicine at Peoria (D.W.); and National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, New Zealand (V.L.F.).
authors.forename: Yichong
authors.initials: Y
authors.lastname: Li
authors.affiliation: From Department of Neuroepidemiology, Beijing Neurosurgical Institute; Capital Medical University, China (W.W., B.J., H.S., X.R., D.S., Z.C., S.W., Y.Z.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (W.W., B.J., H.S., X.R., D.S., Z.C.); Beijing Tiantan Hospital, Capital Medical University, Beijing Institute for Brain Disorders, China (Y.J., Yilong Wang, Yongjun Wang); National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing (Y.L., Linhong Wang, Limin Wang); Department of Neurology, OSF/INI Comprehensive Stroke Center at SFMC, University of Illinois College of Medicine at Peoria (D.W.); and National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, New Zealand (V.L.F.).
authors.forename: Yilong
authors.initials: Y
authors.lastname: Wang
authors.affiliation: From Department of Neuroepidemiology, Beijing Neurosurgical Institute; Capital Medical University, China (W.W., B.J., H.S., X.R., D.S., Z.C., S.W., Y.Z.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (W.W., B.J., H.S., X.R., D.S., Z.C.); Beijing Tiantan Hospital, Capital Medical University, Beijing Institute for Brain Disorders, China (Y.J., Yilong Wang, Yongjun Wang); National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing (Y.L., Linhong Wang, Limin Wang); Department of Neurology, OSF/INI Comprehensive Stroke Center at SFMC, University of Illinois College of Medicine at Peoria (D.W.); and National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, New Zealand (V.L.F.).
authors.forename: Zhenghong
authors.initials: Z
authors.lastname: Chen
authors.affiliation: From Department of Neuroepidemiology, Beijing Neurosurgical Institute; Capital Medical University, China (W.W., B.J., H.S., X.R., D.S., Z.C., S.W., Y.Z.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (W.W., B.J., H.S., X.R., D.S., Z.C.); Beijing Tiantan Hospital, Capital Medical University, Beijing Institute for Brain Disorders, China (Y.J., Yilong Wang, Yongjun Wang); National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing (Y.L., Linhong Wang, Limin Wang); Department of Neurology, OSF/INI Comprehensive Stroke Center at SFMC, University of Illinois College of Medicine at Peoria (D.W.); and National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, New Zealand (V.L.F.).
authors.forename: Shengping
authors.initials: S
authors.lastname: Wu
authors.affiliation: From Department of Neuroepidemiology, Beijing Neurosurgical Institute; Capital Medical University, China (W.W., B.J., H.S., X.R., D.S., Z.C., S.W., Y.Z.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (W.W., B.J., H.S., X.R., D.S., Z.C.); Beijing Tiantan Hospital, Capital Medical University, Beijing Institute for Brain Disorders, China (Y.J., Yilong Wang, Yongjun Wang); National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing (Y.L., Linhong Wang, Limin Wang); Department of Neurology, OSF/INI Comprehensive Stroke Center at SFMC, University of Illinois College of Medicine at Peoria (D.W.); and National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, New Zealand (V.L.F.).
authors.forename: Yazhuo
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: From Department of Neuroepidemiology, Beijing Neurosurgical Institute; Capital Medical University, China (W.W., B.J., H.S., X.R., D.S., Z.C., S.W., Y.Z.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (W.W., B.J., H.S., X.R., D.S., Z.C.); Beijing Tiantan Hospital, Capital Medical University, Beijing Institute for Brain Disorders, China (Y.J., Yilong Wang, Yongjun Wang); National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing (Y.L., Linhong Wang, Limin Wang); Department of Neurology, OSF/INI Comprehensive Stroke Center at SFMC, University of Illinois College of Medicine at Peoria (D.W.); and National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, New Zealand (V.L.F.).
authors.forename: David
authors.initials: D
authors.lastname: Wang
authors.affiliation: From Department of Neuroepidemiology, Beijing Neurosurgical Institute; Capital Medical University, China (W.W., B.J., H.S., X.R., D.S., Z.C., S.W., Y.Z.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (W.W., B.J., H.S., X.R., D.S., Z.C.); Beijing Tiantan Hospital, Capital Medical University, Beijing Institute for Brain Disorders, China (Y.J., Yilong Wang, Yongjun Wang); National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing (Y.L., Linhong Wang, Limin Wang); Department of Neurology, OSF/INI Comprehensive Stroke Center at SFMC, University of Illinois College of Medicine at Peoria (D.W.); and National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, New Zealand (V.L.F.). qgnfbwwz@163.com Yongjunwang1962@gmail.com valery.feigin@aut.ac.nz.
authors.forename: Yongjun
authors.initials: Y
authors.lastname: Wang
authors.affiliation: From Department of Neuroepidemiology, Beijing Neurosurgical Institute; Capital Medical University, China (W.W., B.J., H.S., X.R., D.S., Z.C., S.W., Y.Z.); Beijing Municipal Key Laboratory of Clinical Epidemiology, China (W.W., B.J., H.S., X.R., D.S., Z.C.); Beijing Tiantan Hospital, Capital Medical University, Beijing Institute for Brain Disorders, China (Y.J., Yilong Wang, Yongjun Wang); National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing (Y.L., Linhong Wang, Limin Wang); Department of Neurology, OSF/INI Comprehensive Stroke Center at SFMC, University of Illinois College of Medicine at Peoria (D.W.); and National Institute for Stroke and Applied Neurosciences, School of Public Health and Psychosocial Studies, Faculty of Health and Environmental Sciences, Auckland University of Technology, New Zealand (V.L.F.). qgnfbwwz@163.com Yongjunwang1962@gmail.com valery.feigin@aut.ac.nz.
authors.forename: Valery L
authors.initials: VL
authors.lastname: Feigin
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012424:Rural Population; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D011795:Surveys and Questionnaires; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D014505:Urban Population; D055815:Young Adult
keywords: demographics; incidence; mortality; prevalence; stroke; surveys and questionnaires