China Stroke Statistics 2019: A Report From the National Center for Healthcare Quality Management in Neurological Diseases, China National Clinical Research Center for Neurological Diseases, the Chinese Stroke Association, National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention and Institute for Global Neuroscience and Stroke Collaborations

Abstract

China faces the greatest challenge from stroke in the world. The death rate for cerebrovascular diseases in China was 149.49 per 100 000, accounting for 1.57 million deaths in 2018. It ranked third among the leading causes of death behind malignant tumours and heart disease. The age-standardised prevalence and incidence of stroke in 2013 were 1114.8 per 100 000 population and 246.8 per 100 000 person-years, respectively. According to the Global Burden of Disease Study 2017, the years of life lost (YLLs) per 100 000 population for stroke increased by 14.6%; YLLs due to stroke rose from third highest among all causes in 1990 to the highest in 2017. The absolute numbers and rates per 100 000 population for all-age disability-adjusted life years (DALYs) for stroke increased substantially between 1990 and 2017, and stroke was the leading cause of all-age DALYs in 2017. The main contributors to cerebrovascular diseases include behavioural risk factors (smoking and alcohol use) and pre-existing conditions (hypertension, diabetes mellitus, dyslipidaemia and atrial fibrillation (AF)). The most prevalent risk factors among stroke survivors were hypertension (63.0%-84.2%) and smoking (31.7%-47.6%). The least prevalent was AF (2.7%-7.4%). The prevalences for major risk factors for stroke are high and most have increased over time. Based on the latest national epidemiological data, 26.6% of adults aged ≥15 years (307.6 million adults) smoked tobacco products. For those aged ≥18 years, age-adjusted prevalence of hypertension was 25.2%; adjusted prevalence of hypercholesterolaemia was 5.8%; and the standardised prevalence of diabetes was 10.9%. For those aged ≥40 years, the standardised prevalence of AF was 2.31%. Data from the Hospital Quality Monitoring System showed that 3 010 204 inpatients with stroke were admitted to 1853 tertiary care hospitals during 2018. Of those, 2 466 785 (81.9%) were ischaemic strokes (ISs); 447 609 (14.9%) were intracerebral haemorrhages (ICHs); and 95 810 (3.2%) were subarachnoid haemorrhages (SAHs). The average age of patients admitted was 66 years old, and nearly 60% were male. A total of 1555 (0.1%), 2774 (0.6%) and 1347 (1.4%) paediatric strokes (age <18 years) were identified among IS, ICH and SAH, respectively. Over one-third (1 063 892 (35.3%)) of the patients were covered by urban resident basic medical insurance, followed by urban employee basic medical insurance (699 513 (23.2%)) and new rural cooperative medical schema (489 361 (16.3%)). The leading risk factor was hypertension (67.4% for IS, 77.2% for ICH and 49.1% for SAH), and the leading comorbidity was pneumonia or pulmonary infection (10.1% for IS, 31.4% for ICH and 25.2% for SAH). In-hospital death/discharge against medical advice rate was 8.3% for stroke inpatients, ranging from 5.8% for IS to 19.5% for ICH. The median and IQR of length of stay was 10.0 (7.0-14.0) days, ranging from 10.0 (7.0-13.0) in IS to 14.0 (8.0-22.0) in SAH. Data from the Chinese Stroke Center Alliance demonstrated that the composite scores of guideline-recommended key performance indicators for patients with IS, ICH and SAH were 0.77±0.21, 0.72±0.28 and 0.59±0.32, respectively.

Keywords: statistics; stroke.

Conflict of interest statement

Competing interests: All authors declared that they have no financial and personal relationships with other people or organizations that can inappropriately influence their works.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1

Crude mortality rate of cerebrovascular disease in Chinese residents by sex and region, National Mortality Surveillance System 2018.

Figure 2

Crude mortality rate of cerebrovascular disease in Chinese urban residents by age and sex, National Mortality Surveillance System 2018.

Figure 3

Crude mortality rate of cerebrovascular disease in Chinese rural residents by age and sex, National Mortality Surveillance System 2018.

Figure 4

Crude mortality rate of cerebrovascular disease in Chinese residents, National Mortality Surveillance System 2005–2018.

Figure 5

Age-specific prevalence of stroke per 100 000 of Chinese adults by sex, National Epidemiological Survey of Stroke in China 2013.

Figure 6

Incidence rates of stroke per 100 000 person-years of Chinese adults (≥20 years) by sex, National Epidemiological Survey of Stroke in China 2013.

Figure 7

Current tobacco smoking rate for adults aged 15 years and older by age and sex, China Global Adult Tobacco Survey 2018.

Figure 8

Comparison of Chinese adults’ food consumption, Chinese Nutrition and Health Surveillance 2002 and 2010–2012.

Figure 9

Proportion of fat-based energy for Chinese adults by region, Chinese Nutrition and Health Surveillance 1992, 2002 and 2010–2012.

Figure 10

Salt intake for Chinese adults by region, Chinese Nutrition and Health Surveillance 1992, 2002 and 2010–2012.

Figure 11

Prevalence of overweight among Chinese adults by regions and age groups, Chinese Nutrition and Health Surveillance 2002 and 2010–2012 (Chinese standard for body mass index).

Figure 12

Prevalence of obesity among Chinese adults by regions and age groups, Chinese Nutrition and Health Surveillance 2002 and 2010–2012 (Chinese standard for body mass index).

Figure 13

Prevalence of hypertension aged 35–75 years, China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE) Million Persons Project 2014–2017.

Figure 14

Hypertension awareness rate of Chinese adults aged 18 years and above by region and sex, Chinese Nutrition and Health Surveillance 2002 and 2010–2012.

Figure 15

Hypertension treatment rate of Chinese adults aged 18 years and above by region and sex, Chinese Nutrition and Health Surveillance 2002 and 2010–2012.

Figure 16

Hypertension control rates for Chinese adults aged 18 years and above by region and sex, Chinese Nutrition and Health Surveillance 2002 and 2010–2012.

Figure 17

Hypertension treatment and control rates for Chinese adults aged 18 years and above by region and sex, Chinese Nutrition and Health Surveillance 2002 and 2010–2012.

Figure 18

Prevalence of dyslipidaemia in Chinese adults aged 18 years and above, Chinese Nutrition and Health Surveillance 2002, 2010–2012 and 2015.

Figure 19

Percentage of adults who reported having had a cholesterol check by regions and sex, Chinese Nutrition and Health Surveillance 2002 and 2010–2012.

Figure 20

Dyslipidaemia awareness rate of Chinese adults aged 18 years and above by region and sex, Chinese Nutrition and Health Surveillance 2002 and 2010–2012.

Figure 21

Dyslipidaemia treatment rate of Chinese adults aged 18 years and above by region and sex, Chinese Nutrition and Health Surveillance 2002 and 2010–2012.

Figure 22

Prevalence of atrial fibrillation among adults aged ≥40 years by region and sex, China National Stroke Screening and Prevention Project 2014–2015.

Figure 23

Distribution of hospitals and participants from the Hospital Quality Monitoring System in 2018.

Figure 24

Proportion of stroke type for in-hospital patients with stroke from the Hospital Quality Monitoring System in 2018 stratified by province.

Figure 25

Risk factors or comorbidities for patients with ischaemic stroke from the Hospital Quality Monitoring System in 2018.

Figure 26

Risk factors or comorbidities for patients with intracerebral haemorrhage from the Hospital Quality Monitoring System in 2018.

Figure 27

Risk factors or comorbidities for patients with subarachnoid haemorrhage from the Hospital Quality Monitoring System in 2018.

Figure 28

Distribution of hospitals and participants from Chinese Stroke Center Alliance in 2018.

Figure 29

Procedures for patients with ischaemic stroke from the Hospital Quality Monitoring System in 2018.

Figure 30

Procedures for patients with intracerebral haemorrhage from the Hospital Quality Monitoring System in 2018.

Figure 31

Intervention for patients with subarachnoid haemorrhage from the Hospital Quality Monitoring System in 2018.

Figure 32

Proceduresfor patients with subarachnoid haemorrhage from the Hospital Quality Monitoring System in 2018.

Figure 33

In-hospital outcomes of patients with ischaemic stroke from the Hospital Quality Monitoring System in 2018 by province, autonomous region, or municipality. DAMA, discharge against medical advice.

Figure 34

In-hospital outcomes of patients with intracerebral haemorrhage from the Hospital Quality Monitoring System in 2018 by province, autonomous region, or municipality. DAMA, discharge against medical advice.

Figure 35

In-hospital outcomes of patients with subarachnoid haemorrhage from the Hospital Quality Monitoring System in 2018 by province, autonomous region, or municipality. DAMA, discharge without medical advice.