China stroke surveillance report 2021

Wen-Jun Tu; Long-De Wang; on behalf of the Special Writing Group of China Stroke Surveillance Report

doi:10.1186/s40779-023-00463-x

Your Location：

Home >

Browse articles >

China stroke surveillance report 2021

REVIEW | Updated：2025-12-13

- China stroke surveillance report 2021
- China stroke surveillance report 2021
- MMR 2024年11卷第3期页码：374-399
- Affiliations：
  
  1.Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
  2.School of Public Health, Peking University, Beijing 100191, China
- Author bio：
  
  *wangld@nhfpc.gov.cn
- Funds：
  
  the National Major Public Health Service Projects(Z135080000022)
- DOI：10.1186/s40779-023-00463-x
  中图分类号：
- 纸质出版：2024-06
- Accepted：
Scan QR Code
China stroke surveillance report 2021[J]. MMR, 2024,11(3):374-399.

Cite this article as: Tu WJ, Wang LD on behalf of the Special Writing Group of China Stroke Surveillance Report. China stroke surveillance report 2021. Mil Med Res. 2023;10(1):33.
China stroke surveillance report 2021[J]. MMR, 2024,11(3):374-399. DOI： 10.1186/s40779-023-00463-x.

Cite this article as: Tu WJ, Wang LD on behalf of the Special Writing Group of China Stroke Surveillance Report. China stroke surveillance report 2021. Mil Med Res. 2023;10(1):33. DOI： 10.1186/s40779-023-00463-x.

摘要

Abstract

Since 2015

stroke has become the leading cause of death and disability in China

posing a significant threat to the health of its citizens as a major chronic non-communicable disease. According to the China Stroke High-risk Population Screening and Intervention Program

an estimated 17.8 million [95% confidence interval (CI) 17.6–18.0 million] adults in China had experienced a stroke in 2020

with 3.4 million (95%CI 3.3–3.5 million) experiencing their first-ever stroke and another 2.3 million (95%CI 2.2–2.4 million) dying as a result. Additionally

approximately 12.5% (95%CI 12.4%–12.5%) of stroke survivors were left disabled

as defined by a modified Rankin Scale score greater than 1

equating to 2.2 million (95%CI 2.1–2.2 million) stroke-related disabilities in 2020. As the population ages and the prevalence of risk factors like diabetes

hypertension

and hyperlipidemia continues to rise and remains poorly controlled

the burden of stroke in China is also increasing. A large national epidemiological survey initiated by the China Hypertension League in 2017 showed that the prevalence of hypertension was 24.7%; the awareness

treatment

and control rates in hypertensive patients were: 60.1%

42.5%

and 25.4%

respectively. A nationally representative sample of the Chinese mainland population showed that the weighted prevalence of total diabetes diagnosed by the American Diabetes Association criteria was 12.8%

suggesting there are 120 million adults with diabetes in China

and the awareness

treatment

and control rates in diabetic patients were: 43.3%

49.0%

and 49.4%

respectively. The "Sixth National Health Service Statistical Survey Report in 2018" showed that the proportion of the obese population in China was 37.4%

an increase of 7.2 points from 2013. Data from 1599 hospitals in the Hospital Quality Monitoring System and Bigdata Observatory Platform for Stroke of China (BOSC) showed that a total of 3

418

432 stroke cases [mean age±standard error (SE) was (65.700±0.006) years

and 59.1% were male] were admitted during 2020. Of those

over 80.0% (81.9%) were ischemic stroke (IS)

14.9% were intracerebral hemorrhage (ICH) strokes

and 3.1% were subarachnoid hemorrhage (SAH) strokes. The mean±SE of hospitalization expenditures was Chinese Yuan (CNY) (16

975.6±16.3)

ranging from (13

310.1±12.8) in IS to (81

369.8±260.7) in SAH

and out-of-pocket expenses were (5788.9±8.6)

ranging from (4449.0±6.6) in IS to (30

778.2±156.8) in SAH. It was estimated that the medical cost of hospitalization for stroke in 2020 was CNY 58.0 billion

of which the patient pays approximately CNY 19.8 billion. In-hospital death/discharge against medical advice rate was 9.2% (95%CI 9.2%–9.2%)

ranging from 6.4% (95%CI 6.4%–6.5%) for IS to 21.8% (95%CI 21.8%–21.9%) for ICH. From 2019 to 2020

the information about 188

648 patients with acute IS receiving intravenous thrombolytic therapy (IVT)

845 patients receiving mechanical thrombectomy (MT)

and 14

087 patients receiving bridging (IVT+MT) were collected through BOSC. The incidence of intracranial hemorrhage during treatment was 3.2% (95%CI 3.2%–3.3%)

7.7% (95%CI 7.5%–8.0%)

and 12.9% (95%CI 12.3%–13.4%)

respectively. And in-hospital death/discharge against medical advice rate was 8.9% (95%CI 8.8%–9.0%)

16.5% (95%CI 16.2%–16.9%)

and 16.8% (95%CI 16.2%–17.4%)

respectively. A prospective nationwide hospital-based study was conducted at 231 stroke base hospitals (Level III) from 31 provinces in China through BOSC from January 2019 to December 2020 and 136

282 stroke patients were included and finished 12-month follow-up. Of those

over 86.9% were IS

10.8% were ICH strokes

and 2.3% were SAH strokes. The disability rate [%(95%CI)] in survivors of stroke at 3-month and 12-month was 14.8% (95%CI 14.6%–15.0%) and 14.0% (95%CI 13.8%–14.2%)

respectively. The mortality rate [%(95%CI)] of stroke at 3-month and 12-month was 4.2% (95%CI 4.1%–4.3%) and 8.5% (95%CI 8.4%–8.6%)

respectively. The recurrence rate [%(95%CI)] of stroke at 3-month and 12-month was 3.6% (95%CI 3.5%–3.7%) and 5.6% (95%CI 5.4%–5.7%)

respectively. The Healthy China 2030 Stroke Action Plan was launched as part of this review

and the above data provide valuable guidelines for future stroke prevention and treatment efforts in China.

关键词

Keywords

references

Wang Y , Li Z , Zhao X , Wang D , Li H , Xian Y , et al . Stroke care quality in China: substantial improvement, and a huge challenge and opportunity . Int J Stroke . 2017 ; 12 ( 3 ): 229 – 35 .

Chao BH , Yan F , Hua Y , Liu JM , Yang Y , Ji XM , et al . Stroke prevention and control system in China: CSPPC-stroke program . Int J Stroke . 2021 ; 16 ( 3 ): 265 – 72 .

Tu WJ , Hua Y , Yan F , Bian H , Yang Y , Lou M , et al . Prevalence of stroke in China, 2013–2019: a population-based study . Lancet Reg Health West Pac . 2022 ; 28 : 100550 .

GBD 2019 Stroke Collaborators . Global regional, and national burden of stroke and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019 . Lancet Neurol . 2021 ; 20 ( 10 ): 795 – 820 .

Ma Q , Li R , Wang L , Yin P , Wang Y , Yan C , et al . Temporal trend and attributable risk factors of stroke burden in China, 1990–2019: an analysis for the Global Burden of Disease Study 2019 . Lancet Public Health . 2021 ; 6 ( 12 ): e897 – 906 .

Wang YJ , Li ZX , Gu HQ , Zhai Y , Jiang Y , Zhao XQ , et al . 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 . Stroke Vasc Neurol . 2020 ; 5 ( 3 ): 211 – 39 .

Wu S , Wu B , Liu M , Chen Z , Wang W , Anderson CS , et al . Stroke in China: advances and challenges in epidemiology, prevention, and management . Lancet Neurol . 2019 ; 18 ( 4 ): 394 – 405 .

Wang LD , Wang JH , Peng B , Xu YM . Brief report on stroke prevention and treatment in China, 2019 . Chin J Cerebrovasc Dis . 2020 ; 17 ( 5 ): 272 – 81 .

Network GBoDC . Global Burden of Disease Study 2019 (GBD 2019) Results . 2020 . http://ghdx.healthdata.org/gbd-results-tool http://ghdx.healthdata.org/gbd-results-tool .

Tu W , Zhao Z , Yin P , Cao L , Zeng J , Chen H , et al . Estimated burden of stroke in China in 2020 . JAMA Netw Open . 2023 ; 6 ( 3 ): e231455 .

Chen Y , Wright N , Guo Y , Turnbull I , Kartsonaki C , Yang L , et al . Mortality and recurrent vascular events after first incident stroke: a 9-year community-based study of 0.5 million Chinese adults . Lancet Global Health . 2020 ; 8 ( 4 ): e580 – 90 .

Tu WJ , Chao BH , Ma L , Yan F , Cao L , Qiu H , et al . Case-fatality, disability and recurrence rates after first-ever stroke: a study from bigdata observatory platform for stroke of China . Brain Res Bull . 2021 ; 175 : 130 - 5 .

National Health Commission . China Health Statistical Yearbook 2020 . Beijing : China Union Medical College Press ; 2020 .

Network GBoDC . Global Burden of Disease Study 2017 (GBD 2017) Results 2018 . http://ghdx.healthdata.org/gbd-results-tool http://ghdx.healthdata.org/gbd-results-tool .

Xia F , Yu X , Li Y , Chen Y , Zhang W , You C , et al . Geographic variations of stroke incidence in Chinese communities: an 18-year prospective cohort study from 1997 to 2015 . J Stroke . 2020 ; 22 ( 3 ): 345 – 56 .

Wang W , Jiang B , Sun H , Ru X , Sun D , Wang L , et al . Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480,687 adults . Circulation . 2017 ; 135 ( 8 ): 759 – 71 .

Statistical Information Center of National Health and Family Planning Commission . 2013 Fifth National Health Service Survey and Analysis Report . Beijing : China Union Medical College Press ; 2015 .

Xing L , Jing L , Tian Y , Liu S , Lin M , Du Z , et al . High prevalence of stroke and uncontrolled associated risk factors are major public health challenges in rural northeast China: a population-based study . Int J Stroke . 2020 ; 15 ( 4 ): 399 – 411 .

China Stroke Prevention and Control Report writing group . Summary of China Stroke Prevention and Control Report 2020 . Chin J Cerebrovasc Dis . 2022 ; 19 ( 2 ): 136 – 44 .

Yan S , Gan Y , Li L , Jiang H , Song F , Yin X , et al . Sex differences in risk factors for stroke: a nationwide survey of 700,000 Chinese Adults . Eur J Prev Cardiol . 2020 ; 27 ( 3 ): 323 – 7 .

Qi W , Ma J , Guan T , Zhao D , Abu-Hanna A , Schut M , et al . Risk factors for incident stroke and its subtypes in China: a prospective study . J Am Heart Assoc . 2020 ; 9 ( 21 ): e016352 .

O'Donnell MJ , Chin SL , Rangarajan S , Xavier D , Liu L , Zhang H , et al . Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study . Lancet . 2016 ; 388 ( 10046 ): 761 – 75 .

Owolabi MO , Sarfo F , Akinyemi R , Gebregziabher M , Akpa O , Akpalu A , et al . Dominant modifiable risk factors for stroke in Ghana and Nigeria (SIREN): a case-control study . Lancet Global Health . 2018 ; 6 ( 4 ): e436 – 46 .

Xia X , Yue W , Chao B , Li M , Cao L , Wang L , et al . Prevalence and risk factors of stroke in the elderly in Northern China: data from the National Stroke Screening Survey . J Neurol . 2019 ; 266 ( 6 ): 1449 – 58 .

Wang Z , Chen Z , Zhang L , Wang X , Hao G , Zhang Z , et al . Status of hypertension in China: results from the China Hypertension Survey, 2012–2015 . Circulation . 2018 ; 137 ( 22 ): 2344 – 56 .

Li Y , Yang L , Wang L , Zhang M , Huang Z , Deng Q , et al . Burden of hypertension in China: a nationally representative survey of 174,621 adults . Int J Cardiol . 2017 ; 227 : 516 - 23 .

Wu S , Song Y , Chen S , Zheng M , Ma Y , Cui L , et al . Blood pressure classification of 2017 associated with cardiovascular disease and mortality in young Chinese adults . Hypertension . 2020 ; 76 ( 1 ): 251 – 8 .

Xie X , Gu HQ , Wang X , Chen P , Liu L , Li Z , et al . Assessing the applicability of 2017 ACC/AHA hypertension guidelines for secondary stroke prevention in the BOSS study . J Clin Hypertens . 2019 ; 21 ( 10 ): 1534 – 41 .

Dai L , Cheng A , Hao X , Xu J , Zuo Y , Wang A , et al . Different contribution of SBP and DBP variability to vascular events in patients with stroke . Stroke Vasc Neurol . 2020 ; 5 ( 2 ): 110 – 5 .

Li Y , Teng DI , Shi X , Qin G , Qin Y , Quan H , et al . Prevalence of diabetes recorded in mainland China using 2018 diagnostic criteria from the American Diabetes Association: national cross-sectional study . BMJ . 2020 ; 369 : m997 .

Wang L , Gao P , Zhang M , Huang Z , Zhang D , Deng Q , et al . Prevalence and ethnic pattern of diabetes and prediabetes in China in 2013 . JAMA . 2017 ; 317 ( 24 ): 2515 – 23 .

Statistical Information Center of the National Health and Health Commission . The 6th National Health Service Statistical Survey Report in 2018 . Beijing : People's Health Publishing House ; 2021 .

Bragg F , Holmes MV , Iona A , Guo Y , Du H , Chen Y , et al . Association between diabetes and cause-specific mortality in rural and urban areas of China . JAMA . 2017 ; 317 ( 3 ): 280 – 9 .

Wang A , Li H , Yuan J , Zuo Y , Zhang Y , Chen S , et al . Visit-to-visit variability of lipids measurements and the risk of stroke and stroke types: a prospective cohort study . J Stroke . 2020 ; 22 ( 1 ): 119 – 29 .

Pan L , Yang Z , Wu Y , Yin RX , Liao Y , Wang J , et al . The prevalence, awareness, treatment and control of dyslipidemia among adults in China . Atherosclerosis . 2016 ; 248 : 2 - 9 .

Zhang M , Deng Q , Wang L , Huang Z , Zhou M , Li Y , et al . Prevalence of dyslipidemia and achievement of low-density lipoprotein cholesterol targets in Chinese adults: a nationally representative survey of 163,641 adults . Int J Cardiol . 2018 ; 260 : 196 - 203 .

Gu X , Li Y , Chen S , Yang X , Liu F , Li Y , et al . Association of lipids with ischemic and hemorrhagic stroke: a prospective cohort study among 267,500 Chinese . Stroke . 2019 ; 50 ( 12 ): 3376 – 84 .

Hu G , Liu D , Tong H , Huang W , Hu Y , Huang Y . Lipoprotein-associated phospholipase A2 activity and mass as independent risk factor of stroke: a meta-analysis . Biomed Res Int . 2019 ; 2019 : 8642784 .

Wang Y , Hu S , Ren L , Lei Z , Lan T , Cai J , et al . Lp-PLA as a risk factor of early neurological deterioration in acute ischemic stroke with TOAST type of large arterial atherosclerosis . Neurol Res . 2019 ; 41 ( 1 ): 1 – 8 .

Wolf PA , Abbott RD , Kannel WB . Atrial fibrillation as an independent risk factor for stroke: the Framingham study . Stroke . 1991 ; 22 ( 8 ): 983 – 8 .

Wang X , Fu Q , Song F , Li W , Yin X , Yue W , et al . Prevalence of atrial fibrillation in different socioeconomic regions of China and its association with stroke: results from a national stroke screening survey . Int J Cardiol . 2018 ; 271 : 92 - 7 .

Sun Y , Zhu J , Ma C , Liu S , Yang Y , Hu D . Stroke risk status, anticoagulation treatment, and quality-of-life in Chinese patients with atrial fibrillation: China Registry of Atrial Fibrillation (CRAF) . Cardiovasc Ther . 2019 ; 2019 : 7372129 .

Du X , Guo L , Xia S , Du J , Anderson C , Arima H , et al . Atrial fibrillation prevalence, awareness and management in a nationwide survey of adults in China . Heart . 2021 ; 107 ( 7 ): 535 – 41 .

Peters SA , Huxley RR , Woodward M . Smoking as a risk factor for stroke in women compared with men: a systematic review and meta-analysis of 81 cohorts, including 3,980,359 individuals and 42,401 strokes . Stroke . 2013 ; 44 ( 10 ): 2821 – 8 .

Ovbiagele B , Weir CJ , Saver JL , Muir KW , Lees KR . Effect of smoking status on outcome after acute ischemic stroke . Cerebrovasc Dis . 2006 ; 21 ( 4 ): 260 – 5 .

Wen H , Xie C , Wang F , Wu Y , Yu C . Trends in disease burden attributable to tobacco in China, 1990–2017: findings from the Global Burden of Disease Study 2017 . Front Public Health . 2020 ; 8 : 237 .

http://www.gov.cn/xinwen/2021-05/30/content_ 5613994.htm http://www.gov.cn/xinwen/2021-05/30/content_ 5613994.htm .

Ding N , Sang Y , Chen J , Ballew SH , Kalbaugh CA , Salameh MJ , et al . Cigarette smoking, smoking cessation, and long-term risk of 3 major atherosclerotic diseases . J Am Coll Cardiol . 2019 ; 74 ( 4 ): 498 – 507 .

Chen Z , Peto R , Zhou M , Iona A , Smith M , Yang L , et al . Contrasting male and female trends in tobacco-attributed mortality in China: evidence from successive nationwide prospective cohort studies . Lancet . 2015 ; 386 ( 10002 ): 1447 – 56 .

Epstein KA , Viscoli CM , Spence JD , Young LH , Inzucchi SE , Gorman M , et al . Smoking cessation and outcome after ischemic stroke or TIA . Neurology . 2017 ; 89 ( 16 ): 1723 – 9 .

Fan M , Lv J , Yu C , Guo Y , Bian Z , Yang S , et al . Family history, tobacco smoking, and risk of ischemic stroke . J Stroke . 2019 ; 21 ( 2 ): 175 – 83 .

Wang Q , Li Y , Fan ZQ , Su J , Han RQ , Yu H , et al . Study on the relationship between passive smoking and disease burden of stroke in people aged 60 years and over in Jiangsu province, 2013 . Zhonghua Liu Xing Bing Xue Za Zhi . 2019 ; 40 ( 9 ): 1089 – 94 .

Zhang C , Qin YY , Chen Q , Jiang H , Chen XZ , Xu CL , et al . Alcohol intake and risk of stroke: a dose–response meta-analysis of prospective studies . Int J Cardiol . 2014 ; 174 ( 3 ): 669 – 77 .

Millwood IY , Li L , Smith M , Guo Y , Yang L , Bian Z , et al . Alcohol consumption in 0.5 million people from 10 diverse regions of China: prevalence, patterns and socio-demographic and health-related correlates . Int J Epidemiol . 2013 ; 42 ( 3 ): 816 – 27 .

Gao J , Zheng Q , Lai FY , Gartner C , Du P , Ren Y , et al . Using wastewater-based epidemiology to estimate consumption of alcohol and nicotine in major cities of China in 2014 and 2016 . Environ Int . 2020 ; 136 : 105492 .

O'Donnell MJ , Xavier D , Liu L , Zhang H , Chin SL , Rao-Melacini P , et al . Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study . Lancet . 2010 ; 376 ( 9735 ): 112 – 23 .

Yu Z , Liu S , Guo R , Wang Y , Dai Y , Sun Z , et al . Putting the glass down may keep the stroke away: results from a prospective cohort study in rural China . Nutr Metab Cardiovasc Dis . 2021 ; 31 ( 4 ): 1113 – 20 .

Duan Y , Wang A , Wang Y , Wang X , Chen S , Zhao Q , et al . Cumulative alcohol consumption and stroke risk in men . J Neurol . 2019 ; 266 ( 9 ): 2112 – 9 .

Yang L , Zhou M , Sherliker P , Cai Y , Peto R , Wang L , et al . Alcohol drinking and overall and cause-specific mortality in China: nationally representative prospective study of 220,000 men with 15 years of follow-up . Int J Epidemiol . 2012 ; 41 ( 4 ): 1101 – 13 .

Sherzai A , Heim LT , Boothby C , Sherzai AD . Stroke, food groups, and dietary patterns: a systematic review . Nutr Rev . 2012 ; 70 ( 8 ): 423 – 35 .

Yang H , Yu SW , Chen F , Li N , Yang ZS . Nutrition and food safety in China: problems, countermeasures and prospects . Zhonghua Yu Fang Yi Xue Za Zhi . 2019 ; 53 ( 3 ): 233 – 40 .

Li Y , He Y , Lai J , Wang D , Zhang J , Fu P , et al . Dietary patterns are associated with stroke in Chinese adults . J Nutr . 2011 ; 141 ( 10 ): 1834 – 9 .

Li Y , Huang Z , Jin C , Xing A , Liu Y , Huangfu C , et al . Longitudinal change of perceived salt intake and stroke risk in a Chinese population . Stroke . 2018 ; 49 ( 6 ): 1332 – 9 .

Neal B , Wu Y , Feng X , Zhang R , Zhang Y , Shi J , et al . Effect of salt substitution on cardiovascular events and death . N Engl J Med . 2021 ; 385 ( 12 ): 1067 – 77 .

Li KC , Huang L , Tian M , Di Tanna GL , Yu J , Zhang X , et al . Cost-effectiveness of a household salt substitution intervention: findings from 20,995 participants of the salt substitute and stroke study . Circulation . 2022 ; 145 ( 20 ): 1534 – 41 .

Marklund M , Singh G , Greer R , Cudhea F , Matsushita K , Micha R , et al . Estimated population wide benefits and risks in China of lowering sodium through potassium enriched salt substitution: modelling study . BMJ . 2020 ; 369 : m824 .

Van Gaal LF , Mertens IL , De Block CE . Mechanisms linking obesity with cardiovascular disease . Nature . 2006 ; 444 ( 7121 ): 875 – 80 .

Lu Y , Hajifathalian K , Ezzati M , Woodward M , Rimm EB , Danaei G . Metabolic mediators of the effects of body-mass index, overweight, and obesity on coronary heart disease and stroke: a pooled analysis of 97 prospective cohorts with 1.8 million participants . Lancet . 2014 ; 383 ( 9921 ): 970 – 83 .

Marini S , Merino J , Montgomery BE , Malik R , Sudlow CL , Dichgans M , et al . International Stroke Genetics Consortium . Mendelian randomization study of obesity and cerebrovascular disease. Ann Neurol . 2020 ; 87 ( 4 ): 516 – 24 .

Horn JW , Feng T , Mørkedal B , Strand LB , Horn J , Mukamal K , et al . Obesity and risk for first ischemic stroke depends on metabolic syndrome: the HUNT study . Stroke . 2021 ; 52 ( 11 ): 3555 – 61 .

NCD Risk Factor Collaboration (NCD-RisC) . Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19.2 million participants . Lancet . 2016 ; 387 ( 10026 ): 1377 – 96 .

Liu X , Zhang D , Liu Y , Sun X , Hou Y , Wang B , et al . A J-shaped relation of BMI and stroke: systematic review and dose-response metaanalysis of 4.43 million participants . Nutr Metab Cardiovasc Dis . 2018 ; 28 ( 11 ): 1092 – 9 .

Liu S , Gao Z , Dai Y , Guo R , Wang Y , Sun Z , et al . Association of general and abdominal obesity and their changes with stroke in Chinese adults: results from an 11.8-year follow-up study . Nutr Metab Cardiovasc Dis . 2020 ; 30 ( 11 ): 2001 – 7 .

Zhou Y , Zhang X , Zhang L , Li Z , Wu Q , Jin Z , et al . Increased stroke risk in metabolically abnormal normal weight: a 10-year follow-up of 102,037 participants in China . Transl Stroke Res . 2021 ; 12 : 725 - 34 .

Wang J , Wen X , Li W , Li X , Wang Y , Lu W . Risk factors for stroke in the Chinese population: a systematic review and meta-analysis . J Stroke Cerebrovasc Dis . 2017 ; 26 ( 3 ): 509 – 17 .

Willey JZ , Moon YP , Sacco RL , Greenlee H , Diaz KM , Wright CB , et al . Physical inactivity is a strong risk factor for stroke in the oldest old: findings from a multi-ethnic population (the Northern Manhattan Study) . Int J Stroke . 2017 ; 12 ( 2 ): 197 – 200 .

Yi X , Luo H , Zhou J , Yu M , Chen X , Tan L , et al . Prevalence of stroke and stroke related risk factors: a population based cross sectional survey in southwestern China . BMC Neurol . 2020 ; 20 ( 1 ): 5 .

Arnett DK , Blumenthal RS , Albert MA , Buroker AB , Goldberger ZD , Hahn EJ , et al . 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American college of cardiology/American Heart Association Task Force on clinical practice guidelines . Circulation . 2019 ; 140 ( 11 ): e596 – 646 .

Luo L , Meng H , Wang Z , Zhu S , Yuan S , Wang Y , et al . Effect of highintensity exercise on cardiorespiratory fitness in stroke survivors: a systematic review and meta-analysis . Ann Phys Rehabil Med . 2020 ; 63 ( 1 ): 59 – 68 .

Luan X , Tian X , Zhang H , Huang R , Li N , Chen P , et al . Exercise as a prescription for patients with various diseases . J Sport Health Sci . 2019 ; 8 ( 5 ): 422 – 41 .

Everson SA , Roberts RE , Goldberg DE , Kaplan GA . Depressive symptoms and increased risk of stroke mortality over a 29-year period . Arch Intern Med . 1998 ; 158 ( 10 ): 1133 – 8 .

Booth J , Connelly L , Lawrence M , Chalmers C , Joice S , Becker C , et al . Evidence of perceived psychosocial stress as a risk factor for stroke in adults: a meta-analysis . BMC Neurol . 2015 ; 15 : 233 .

Sun J , Ma H , Yu C , Lv J , Guo Y , Bian Z , et al . Association of major depressive episodes with stroke risk in a prospective study of 0.5 million Chinese adults . Stroke . 2016 ; 47 ( 9 ): 2203 – 8 .

Cai H , Cai B , Zhang H , Sun W , Wang Y , Zhou S , et al . Major depression and small vessel stroke: a Mendelian randomization analysis . J Neurol . 2019 ; 266 ( 11 ): 2859 – 66 .

Jackson CA , Sudlow CL , Mishra GD . Psychological distress and risk of myocardial infarction and stroke in the 45 and up study: a prospective cohort study . Circ Cardiovasc Qual Outcomes . 2018 ; 11 ( 9 ): e004500 .

Wang X , Wang Y , Zhang L , Zhang D , Bai L , Kong W , et al . L-cystathionine protects against homocysteine-induced mitochondria-dependent apoptosis of vascular endothelial cells . Oxid Med Cell Longev . 2019 ; 2019 : 1253289 .

Al MF . Hyperhomocysteinemia: clinical insights . J Cent Nerv Syst Dis . 2020 ; 12 : 1179573520962230 .

Yang B , Fan S , Zhi X , Wang Y , Wang Y , Zheng Q , et al . Prevalence of hyperhomocysteinemia in China: a systematic review and meta-analysis . Nutrients . 2014 ; 7 ( 1 ): 74 – 90 .

Tu W , Yan F , Chao B , Ji X , Wang L . Status of hyperhomocysteinemia in China: results from the China Stroke High-risk Population Screening Program, 2018 . Front Med . 2021 ; 15 ( 6 ): 903 – 12 .

Poddar R . Hyperhomocysteinemia is an emerging comorbidity in ischemic stroke . Exp Neurol . 2021 ; 336 : 113541 .

Kumral E , Saruhan G , Aktert D , Orman M . Association of hyperhomocysteinemia with stroke recurrence after initial stroke . J Stroke Cerebrovasc Dis . 2016 ; 25 ( 8 ): 2047 – 54 .

Wu X , Zhou Q , Chen Q , Li Q , Guo C , Tian G , et al . Association of homocysteine level with risk of stroke: a dose-response meta-analysis of prospective cohort studies . Nutr Metab Cardiovasc Dis . 2020 ; 30 ( 11 ): 1861 – 9 .

Chen L , Li Q , Fang X , Wang X , Min J , Wang F . Dietary intake of homocysteine metabolism-related B-vitamins and the risk of stroke: a dose-response meta-analysis of prospective studies . Adv Nutr . 2020 ; 11 ( 6 ): 1510 – 28 .

Huo Y , Li J , Qin X , Huang Y , Wang X , Gottesman RF , et al . Efficacy of folic acid therapy in primary prevention of stroke among adults with hypertension in China: the CSPPT randomized clinical trial . JAMA . 2015 ; 313 ( 13 ): 1325 – 35 .

Wellenius GA , Burger MR , Coull BA , Schwartz J , Suh HH , Koutrakis P , et al . Ambient air pollution and the risk of acute ischemic stroke . Arch Intern Med . 2012 ; 172 ( 3 ): 229 – 34 .

Amini H , Dehlendorff C , Lim YH , Mehta A , Jørgensen JT , Mortensen LH , et al . Long-term exposure to air pollution and stroke incidence: a Danish Nurse cohort study . Environ Int . 2020 ; 142 : 105891 .

Niu Z , Liu F , Yu H , Wu S , Xiang H . Association between exposure to ambient air pollution and hospital admission, incidence, and mortality of stroke: an updated systematic review and meta-analysis of more than 23 million participants . Environ Health Prev Med . 2021 ; 26 ( 1 ): 15 .

Morakinyo OM , Adebowale AS , Mokgobu MI , Mukhola MS . Health risk of inhalation exposure to sub-10 μm particulate matter and gaseous pollutants in an urban-industrial area in South Africa: an ecological study . BMJ Open . 2017 ; 7 ( 3 ): e013941 .

Miller L , Xu X . Ambient PM2.5 human health effects—findings in China and research directions . Atmosphere . 2018 ; 9 ( 11 ): 424 .

Bu X , Xie Z , Liu J , Wei L , Wang X , Chen M , et al . Global PM2.5-attributable health burden from 1990 to 2017: estimates from the Global Burden of disease study 2017 . Environ Res . 2021 ; 197 : 111123 .

Brauer M , Freedman G , Frostad J , van Donkelaar A , Martin RV , Dentener F , et al . Ambient air pollution exposure estimation for the Global Burden of Disease 2013 . Environ Sci Technol . 2016 ; 50 ( 1 ): 79 – 88 .

Chen L , Zhang Y , Zhang W , Chen G , Lu P , Guo Y , et al . Short-term effect of PM1 on hospital admission for ischemic stroke: a multi-city casecrossover study in China . Environ Pollut . 2020 ; 260 : 113776 .

Huang K , Liang F , Yang X , Liu F , Li J , Xiao Q , et al . Long-term exposure to ambient fine particulate matter and incidence of stroke: prospective cohort study from the China-PAR project . BMJ . 2019 ; 367 : l6720 .

Qian Y , Yu H , Cai B , Fang B , Wang C . Association between incidence of fatal intracerebral hemorrhagic stroke and fine particulate air pollution . Environ Health Prev Med . 2019 ; 24 ( 1 ): 38 .

Xue T , Guan T , Liu Y , Zheng Y , Guo J , Fan S , et al . A national case-crossover study on ambient ozone pollution and first-ever stroke among Chinese adults: interpreting a weak association via differential susceptibility . Sci Total Environ . 2019 ; 654 : 135 - 43 .

Shen Y , Chao BH , Cao L , Tu WJ , Wang LD . Stroke center care and outcome: results from the CSPPC stroke program . Transl Stroke Res . 2020 ; 11 : 377 - 86 .

Tu WJ , Chao BH , Yan F , Cao L , Wang LD . Stroke unit care for ischemic stroke in China: results of a nation-based study . Intensive Care Med . 2020 ; 46 : 1489 - 91 .

Tu WJ , Yan F , Chao BH , Ji XM , Wang L . Stroke-unit care for stroke patients in China: the results from bigdata observatory platform for stroke of China . J Neurol . 2021 ; 268 : 4213 - 20 .

Tu WJ , Yan F , Chao BH , Cao L , Wang L . Treatment and 1-year prognosis of ischemic stroke in China in 2018: a hospital-based study from bigdata observatory platform for stroke of China . Stroke . 2022 ; 53 ( 9 ): e415 – 7 .

Ye Q , Zhai F , Chao B , Cao L , Xu Y , Zhang P , et al . Rates of intravenous thrombolysis and endovascular therapy for acute ischaemic stroke in China between 2019 and 2020 . Lancet Reg Health West Pac . 2022 ; 21 : 100406 .

Wang YJ , Li ZX , Gu HQ , Zhai Y , Zhou Q , Jiang Y , et al . China stroke statistics: an update on the 2019 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 . Stroke Vasc Neurol . 2022 ; 7 ( 5 ): e001374 .

Böhmer M , Niederstadt T , Heindel W , Wildgruber M , Sträter R , Hanning U , et al . Impact of childhood arterial ischemic stroke standardized classification and diagnostic evaluation classification on further course of arteriopathy and recurrence of childhood stroke . Stroke . 2018 ; STROKEAHA118023060 .

Tu WJ , Zeng X , Liu Q . Aging tsunami coming: the main finding from China's seventh national population census . Aging Clin Exp Res . 2022 ; 34 ( 5 ): 1159 – 63 .

Tu WJ , Chao B , Wang L . Prevalence of stroke in China: over-estimated? . Lancet Public Health . 2022 ; 7 ( 5 ): e4

浏览量

Downloads

CSCD

文章被引用时，请邮件提醒。

Submit

工具集

关联资源

The national and provincial prevalence and non-fatal burdens of diabetes in China from 2005 to 2023 with projections of prevalence to 2050

Exosome autoantibody biomarkers for detection of lung cancer

National age-specific mortality trends for cervical and breast cancers in urban-rural areas of China from 2009 to 2021: a population-based analysis

The emerging role of ferroptosis in the pathological development and progression of sepsis

Identification of the lymph node metastasis atlas and optimal lymph node dissection strategy in patients with resectable lung invasive mucinous adenocarcinoma: a real-world multicenter study