Trends in the incidence of recurrent stroke at 5 years after the first-ever stroke in rural China: a population-based stroke surveillance from 1992 to 2017

Wenjuan Zhao, Jialing Wu, Jie Liu, Yanan Wu, Jingxian Ni, Hongfei Gu, Jun Tu, Jinghua Wang, Zhongping An, Xianjia Ning, Wenjuan Zhao, Jialing Wu, Jie Liu, Yanan Wu, Jingxian Ni, Hongfei Gu, Jun Tu, Jinghua Wang, Zhongping An, Xianjia Ning

Abstract

Recent data on the incidence and trends for recurrent strokes in China are scarce. We assessed the temporal trends in recurrent stroke incidence using in rural China. The age-standardized incidences of recurrent stroke, within 5 years of the incident stroke event, were estimated for 3 time periods: 1992-1998, 1999-2005, and 2006-2012. Among the 768 documented incident stroke cases, 26.3% of the patients experienced recurrent stroke within 5 years. The overall age-adjusted recurrent stroke incidence was 43.93 per 100,000 person-years (1992-2012). During the 2006-2012 period, the recurrent stroke incidence per 100,000 person-years was 107.79 in men, and 557.76 in individuals ≥65 years old. There were significant upward tendencies observed in this population across sex, age, or type of stroke (except for among individuals ≥65 years old with incident intracerebral hemorrhages). Compared with the recurrent stroke incidence observed in the 1992-1998 period, that observed during the 2006-2012 period was more than 3-fold higher; the greatest increase (6.8-fold) was observed in women. These findings suggest an urgent need to improve risk factor management and implement appropriate medical resources to contain this upward trend in recurrent stroke incidence and reduce the overall stroke burden in China.

Keywords: epidemiology; recurrence; stroke; trend.

Conflict of interest statement

CONFLICTS OF INTEREST: The authors declare no competing financial interests.

References

    1. Coull AJ, Rothwell PM. Underestimation of the early risk of recurrent stroke: evidence of the need for a standard definition. Stroke. 2004; 35:1925–29. 10.1161/01.STR.0000133129.58126.67
    1. Wang Z, Li J, Wang C, Yao X, Zhao X, Wang Y, Li H, Liu G, Wang A, Wang Y. Gender differences in 1-year clinical characteristics and outcomes after stroke: results from the China National Stroke Registry. PLoS One. 2013; 8:e56459. 10.1371/journal.pone.0056459
    1. Kissela BM, Khoury JC, Alwell K, Moomaw CJ, Woo D, Adeoye O, Flaherty ML, Khatri P, Ferioli S, De Los Rios La Rosa F, Broderick JP, Kleindorfer DO. Age at stroke: temporal trends in stroke incidence in a large, biracial population. Neurology. 2012; 79:1781–87. 10.1212/WNL.0b013e318270401d
    1. Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, Moran AE, Sacco RL, Anderson L, Truelsen T, O’Donnell M, Venketasubramanian N, Barker-Collo S, et al., and Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) and the GBD Stroke Experts Group. Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet. 2014; 383:245–54. 10.1016/S0140-6736(13)61953-4
    1. Lee S, Shafe AC, Cowie MR. UK stroke incidence, mortality and cardiovascular risk management 1999-2008: time-trend analysis from the General Practice Research Database. BMJ Open. 2011; 1:e000269. 10.1136/bmjopen-2011-000269
    1. Redon J, Olsen MH, Cooper RS, Zurriaga O, Martinez-Beneito MA, Laurent S, Cifkova R, Coca A, Mancia G. Stroke mortality and trends from 1990 to 2006 in 39 countries from Europe and Central Asia: implications for control of high blood pressure. Eur Heart J. 2011; 32:1424–31. 10.1093/eurheartj/ehr045
    1. Vaartjes I, O’Flaherty M, Capewell S, Kappelle J, Bots M. Remarkable decline in ischemic stroke mortality is not matched by changes in incidence. Stroke. 2013; 44:591–97. 10.1161/STROKEAHA.112.677724
    1. Touzé E, Varenne O, Chatellier G, Peyrard S, Rothwell PM, Mas JL. Risk of myocardial infarction and vascular death after transient ischemic attack and ischemic stroke: a systematic review and meta-analysis. Stroke. 2005; 36:2748–55. 10.1161/01.STR.0000190118.02275.33
    1. Putaala J, Haapaniemi E, Metso AJ, Metso TM, Artto V, Kaste M, Tatlisumak T. Recurrent ischemic events in young adults after first-ever ischemic stroke. Ann Neurol. 2010; 68:661–71. 10.1002/ana.22091
    1. Giang KW, Björck L, Ståhl CH, Nielsen S, Sandström TZ, Jern C, Torén K, Rosengren A. Trends in risk of recurrence after the first ischemic stroke in adults younger than 55 years of age in Sweden. Int J Stroke. 2016; 11:52–61. 10.1177/1747493015607519
    1. Liu L, Wang D, Wong KS, Wang Y. Stroke and stroke care in China: huge burden, significant workload, and a national priority. Stroke. 2011; 42:3651–54. 10.1161/STROKEAHA.111.635755
    1. Zhao D, Liu J, Wang W, Zeng Z, Cheng J, Liu J, Sun J, Wu Z. Epidemiological transition of stroke in China: twenty-one-year observational study from the Sino-MONICA-Beijing Project. Stroke. 2008; 39:1668–74. 10.1161/STROKEAHA.107.502807
    1. Jiang B, Wang WZ, Chen H, Hong Z, Yang QD, Wu SP, Du XL, Bao QJ. Incidence and trends of stroke and its subtypes in China: results from three large cities. Stroke. 2006; 37:63–68. 10.1161/01.STR.0000194955.34820.78
    1. Wang J, Bai L, Shi M, Yang L, An Z, Li B, Zhao W, Gu H, Zhan C, Tu J, Ning X. Trends in age of first-ever stroke following increased incidence and life expectancy in a low-income Chinese population. Stroke. 2016; 47:929–35. 10.1161/STROKEAHA.115.012466
    1. Wang J, An Z, Li B, Yang L, Tu J, Gu H, Zhan C, Liu B, Su TC, Ning X. Increasing stroke incidence and prevalence of risk factors in a low-income Chinese population. Neurology. 2015; 84:374–81. 10.1212/WNL.0000000000001175
    1. Aarnio K, Haapaniemi E, Melkas S, Kaste M, Tatlisumak T, Putaala J. Long-term mortality after first-ever and recurrent stroke in young adults. Stroke. 2014; 45:2670–76. 10.1161/STROKEAHA.114.005648
    1. Pezzini A, Grassi M, Lodigiani C, Patella R, Gandolfo C, Zini A, Delodovici ML, Paciaroni M, Del Sette M, Toriello A, Musolino R, Calabrò RS, Bovi P, et al., and Italian Project on Stroke in Young Adults (IPSYS) Investigators. Predictors of long-term recurrent vascular events after ischemic stroke at young age: the Italian Project on Stroke in Young Adults. Circulation. 2014; 129:1668–76. 10.1161/CIRCULATIONAHA.113.005663
    1. Rutten-Jacobs LC, Maaijwee NA, Arntz RM, Schoonderwaldt HC, Dorresteijn LD, van der Vlugt MJ, van Dijk EJ, de Leeuw FE. Long-term risk of recurrent vascular events after young stroke: the FUTURE study. Ann Neurol. 2013; 74:592–601. 10.1002/ana.23953
    1. Boysen G, Truelsen T. Prevention of recurrent stroke. Neurol Sci. 2000; 21:67–72. 10.1007/s100720070098
    1. Anderson CS, Carter KN, Brownlee WJ, Hackett ML, Broad JB, Bonita R. Very long-term outcome after stroke in Auckland, New Zealand. Stroke. 2004; 35:1920–24. 10.1161/01.STR.0000133130.20322.9f
    1. Dhamoon MS, Sciacca RR, Rundek T, Sacco RL, Elkind MS. Recurrent stroke and cardiac risks after first ischemic stroke: the Northern Manhattan Study. Neurology. 2006; 66:641–46. 10.1212/01.wnl.0000201253.93811.f6
    1. Hardie K, Jamrozik K, Hankey GJ, Broadhurst RJ, Anderson C. Trends in five-year survival and risk of recurrent stroke after first-ever stroke in the Perth Community Stroke Study. Cerebrovasc Dis. 2005; 19:179–85. 10.1159/000083253
    1. Petty GW, Brown RD Jr, Whisnant JP, Sicks JD, O’Fallon WM, Wiebers DO. Survival and recurrence after first cerebral infarction: a population-based study in Rochester, Minnesota, 1975 through 1989. Neurology. 1998; 50:208–16. 10.1212/WNL.50.1.208
    1. Burn J, Dennis M, Bamford J, Sandercock P, Wade D, Warlow C. Long-term risk of recurrent stroke after a first-ever stroke. The Oxfordshire Community Stroke Project. Stroke. 1994; 25:333–37. 10.1161/01.STR.25.2.333
    1. Ning X, Sun J, Jiang R, Lu H, Bai L, Shi M, Tu J, Wu Y, Wang J, Zhang J. Increased stroke burdens among the low-income young and middle aged in rural China. Stroke. 2017; 48:77–83. 10.1161/STROKEAHA.116.014897
    1. National Bureau of Statistics of China. In China Statistical Yearbook—2016 (2016). Beijing: China Statistics Press; 2016.
    1. Tuttolomondo A, Pecoraro R, Simonetta I, Miceli S, Arnao V, Licata G, Pinto A. Neurological complications of Anderson-Fabry disease. Curr Pharm Des. 2013; 19:6014–30. 10.2174/13816128113199990387
    1. Tuttolomondo A, Pecoraro R, Simonetta I, Miceli S, Pinto A, Licata G. Anderson-Fabry disease: a multiorgan disease. Curr Pharm Des. 2013; 19:5974–96. 10.2174/13816128113199990352
    1. Wang J, Ning X, Yang L, Lu H, Tu J, Jin W, Zhang W, Su TC. Trends of hypertension prevalence, awareness, treatment and control in rural areas of northern China during 1991-2011. J Hum Hypertens. 2014; 28:25–31. 10.1038/jhh.2013.44
    1. Tuttolomondo A, Di Sciacca R, Di Raimondo D, Pedone C, La Placa S, Pinto A, Licata G. Effects of clinical and laboratory variables and of pretreatment with cardiovascular drugs in acute ischaemic stroke: a retrospective chart review from the GIFA study. Int J Cardiol. 2011; 151:318–22. 10.1016/j.ijcard.2010.06.005
    1. Di Raimondo D, Tuttolomondo A, Buttà C, Miceli S, Licata G, Pinto A. Effects of ACE-inhibitors and angiotensin receptor blockers on inflammation. Curr Pharm Des. 2012; 18:4385–413. 10.2174/138161212802481282
    1. Bergström L, Irewall AL, Söderström L, Ögren J, Laurell K, Mooe T. One-year incidence, time trends, and predictors of recurrent ischemic stroke in Sweden from 1998 to 2010: an observational study. Stroke. 2017; 48:2046–51. 10.1161/STROKEAHA.117.016815
    1. Lee M, Wu YL, Ovbiagele B. Trends in incident and recurrent rates of first-ever ischemic stroke in Taiwan between 2000 and 2011. J Stroke. 2016; 18:60–65. 10.5853/jos.2015.01326
    1. Santalucia P, Baviera M, Cortesi L, Tettamanti M, Marzona I, Nobili A, Riva E, Fortino I, Bortolotti A, Merlino L, Roncaglioni MC. Epidemiologic trends in hospitalized ischemic stroke from2002 to 2010: results from a large Italian population-based study. J Stroke Cerebrovasc Dis. 2015; 24:1917–23. 10.1016/j.jstrokecerebrovasdis.2015.05.008
    1. Pennlert J, Eriksson M, Carlberg B, Wiklund PG. Long-term risk and predictors of recurrent stroke beyond the acute phase. Stroke. 2014; 45:1839–41. 10.1161/STROKEAHA.114.005060
    1. Lewsey J, Jhund PS, Gillies M, Chalmers JW, Redpath A, Briggs A, Walters M, Langhorne P, Capewell S, McMurray JJ, MacIntyre K. Temporal trends in hospitalisation for stroke recurrence following incident hospitalisation for stroke in Scotland. BMC Med. 2010; 8:23. 10.1186/1741-7015-8-23
    1. Sjölander M, Eriksson M, Glader EL. Social stratification in the dissemination of statins after stroke in Sweden. Eur J Clin Pharmacol. 2013; 69:1173–80. 10.1007/s00228-012-1454-8
    1. Aho K, Harmsen P, Hatano S, Marquardsen J, Smirnov VE, Strasser T. Cerebrovascular disease in the community: results of a WHO collaborative study. Bull World Health Organ. 1980; 58:113–30.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera