Research on the trend of stroke burden in China from 1990 to 2021 and its age-period-cohort model_Chinese Journal of Evidence-Based Medicine

Authors：

GAO lingxiao , CAO Yuanyuan , TIAN Ruotong , DONG Xiaoyu , ZHANG Jiaqi , LYU Wenpei , CHENG Huaizhi ,  GUO Bin

DaQing Campus of Harbin Medical University, Daqing 163319, P. R. China;

Corresponding author：

GUO Bin, Email: guobinlover@163.com

Keywords：

Stroke; Disease burden; Age-period-cohort model; Trend analysis; Risk factors

DOI：

10.7507/1672-2531.202411020

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To understand the burden of stroke disease and age-period-cohort effects in China from 1990 to 2021, and to provide scientific basis for formulating relevant prevention and treatment strategies. Methods Based on GBD2021 data, the Joinpoint regression model was used to analyze the trend of incidence rate, mortality and DALYs rate of stroke, and the APC model was used to analyze the impact of age, period and birth cohort on the incidence and mortality of stroke. Results From 1990 to 2021, the standardized incidence rate, standardized mortality rate and standardized DALYs rate of stroke in China showed an overall downward trend, with AAPC of −0.37% (95%CI −0.45% to −0.29%), −1.79% (95%CI −1.99% to −1.59%), and −1.93% (95%CI −2.07% to −1.80%), respectively. The results of the age-period-cohort model showed that the incidence and mortality risks of stroke increased with age; The risk of female onset remained stable in the early stage but increased rapidly in the later stage, while the risk of male mortality showed a slight upward trend; The risk of onset and death generally decreased with the passage of the birth cohort. Hypertension had always been the primary risk factor for stroke, and metabolic factors such as high blood sugar had become the main factors affecting disease burden. Conclusion The burden of stroke disease in China is still relatively heavy, and differentiated intervention measures should be developed for different age and gender groups based on controllable risk factors, especially focusing on the elderly and male population.

1.	《中国脑卒中防治报告2021》编写组. 《中国脑卒中防治报告2021》概要. 中国脑血管病杂志, 2023, 20(11): 783-793.
2.	GBD 2021 Causes of Death Collaborators. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990―2021: a systematic analysis for the global burden of disease study 2021. Lancet, 2024, 403(10440): 2100-2132.
3.	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.
4.	Liu L, Liu J, Wang Y, et al. Substantial improvement of stroke care in China. Stroke, 2018, 49(12): 3085-3091.
5.	Tu WJ, Wang LD,. China stroke surveillance report 2021. Mil Med Res, 2023, 10(1): 33.
6.	《中国卒中中心报告2022》概要. 中国脑血管病杂志, 2024, 21(8): 565-576.
7.	GBD 2016 Stroke Collaborators. Global, regional, and national burden of stroke, 1990―2016: a systematic analysis for the global burden of disease study 2016. Lancet Neurol, 2019, 18(5): 439-458.
8.	GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990―2021: a systematic analysis for the global burden of disease study 2021. Lancet, 2024, 403(10440): 2133-2161.
9.	GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990―2019: a systematic analysis for the global burden of disease study 2019. Lancet, 2020, 396(10258): 1223-1249.
10.	Kim HJ, Fay MP, Feuer EJ, et al. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med, 2000, 19(3): 335-351.
11.	Luo L, Jiang J, Yu C, et al. Stroke mortality attributable to low fruit intake in China: a joinpoint and age-period-cohort analysis. Front Neurosci, 2020, 14: 552113.
12.	王越, 刘鲁蓉. 1990—2019年中国老年人跌倒发生与死亡趋势及其年龄-时期-队列模型分析. 中国循证医学杂志, 2024, 24(7): 783-791.
13.	World Health Organization. World health statistics 2016: monitoring health for the SDGs, sustainable development goals. 2022.
14.	乔玥, 李传辉, 赵文博. 急性缺血性脑卒中的再灌注治疗的现状与未来. 首都医科大学学报, 2025, 46(1): 68-70.
15.	Chen D, Zhao Z, Zhang S, et al. Evolving Therapeutic landscape of intracerebral hemorrhage: emerging cutting-edge advancements in surgical robots, regenerative medicine, and neurorehabilitation techniques. Transl Stroke Res, 2024.
16.	闫润楠. 脑卒中早期康复住院费用影响因素及病例组合研究. 北京: 北京协和医学院, 2023.
17.	谢春艳, 王海银, 王美凤, 等. 基于价值的战略购买: 健康中国背景下医保治理的现代化转向. 中国卫生事业管理, 2022, 39(5): 348-352.
18.	何峰, 何蓓蓓, 王仲朋, 等. 脑-机交互运动训练的神经反馈方法及康复应用. 中国生物医学工程学报, 2021, 40(6): 719-730.
19.	Murphy CC, Yang YC. Use of age-period-cohort analysis in cancer epidemiology research. Curr Epidemiol Rep, 2018, 5(4): 418-431.
20.	汤少梁, 赵兴华, 董慧秋, 等. 中国、美国和全球居民2010―2019年脑卒中疾病, 负担趋势年龄–时期–队列分析. 中国公共卫生, 2024, 40(6): 649-658.
21.	侯吉玉, 商黔惠, 刘风玲. 高血压患者早期血管衰老防治的研究新进展. 中国老年学杂志, 2024, 44(18): 4591-4595.
22.	张雪莉, 吕恒梁, 胡梦梦, 等. 1990~2021年中国55岁及以上人群缺血性脑卒中疾病负担及不良饮食危险因素变化趋势. 中国老年学杂志, 2024, 44(21): 5340-5343.
23.	秦莉花, 黄娟, 李晟, 等. 脑卒中流行病学及与性激素的相关性. 中国老年学杂志, 2018, 38(20): 5099-5103.
24.	Roy-O'Reilly M, McCullough LD. Age and sex are critical factors in ischemic stroke pathology. Endocrinology, 2018, 159(8): 3120-3131.
25.	魏欣悦, 祖力亚尔·塔力甫, 钟盼亮, 等. 1990―2019年中国60岁及以上老年人疾病负担趋势分析. 中华疾病控制杂志, 2024, 28(11): 1321-1329,1343.
26.	Tharmaratnam D, Karayiannis CC, Collyer TA, et al. Is blood pressure lowering in the very elderly with previous stroke associated with a higher risk of adverse events. J Am Heart Assoc, 2021, 10(24): e022240.
27.	秦静, 周亚霖, 朱书平, 等. 城市社区老年人脑卒中患病状况及健康管理. 中国老年学杂志, 2021, 41(8): 1730-1732.
28.	陈晓荣, 颜流霞, 厚磊, 等. 2015~2019年中国居民脑卒中发病与死亡特征分析. 中国循环杂志, 2024, 39(5): 470-476.
29.	Denny MC, Rosendale N, Gonzales NR, et al. Addressing disparities in acute stroke management and prognosis. J Am Heart Assoc. 2024, 13(7): e031313.
30.	Zeng C, Chen Z, Yang H, et al. Advanced high resolution three-dimensional imaging to visualize the cerebral neurovascular network in stroke. Int J Biol Sci, 2022, 18(2): 552-571.
31.	张玉, 李咏梅, 陆慧萍, 等. 2002—2023年上海市松江区脑卒中疾病负担变化分析. 中国慢性病预防与控制, 2024, 32(9): 717-720.
32.	GBD 2017 Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990―2017: a systematic analysis for the global burden of disease study 2017. Lancet, 2018, 392(10159): 1923-1994.
33.	Bell S, Sahm JL, Moriarty F, et al. Medication adherence for people with acquired communication disorders: a systematic review. Br J Clin Pharmacol, 2024, 90(11): 2742-2753.
34.	夏达建, 谢云芳, 张冬梅, 等. 1982—2021年中国缺血性脑卒中死亡趋势及年龄-时期-队列效应分析. 现代预防医学, 2025, 52(4): 590-596,607.
35.	曾媛媛, 朱其凤, 张永全. 缺血性脑卒中与相关信号通路的关系及中医药调控的研究进展. 中国实验方剂学杂志, 2024, 30(20): 252-263.
36.	鲁君, 张归玲, 朱文珍. 人工智能在缺血性脑卒中影像中的应用进展. 中国医学影像学杂志, 2022, 30(4): 396-400.
37.	李超, 杨辉. 脑卒中病人出院准备度循证干预方案临床应用效果评价. 护理研究, 2022, 36(12): 2101-2106.
38.	吴琼, 王晨冉, 赵燕, 等. 1990―2019年中国卒中危险因素的归因负担及变化趋势. 中华疾病控制杂志, 2022, 26(1): 28-33,79.
39.	Ormazabal V, Nair S, Elfeky O, et al. Association between insulin resistance and the development of cardiovascular disease. Cardiovasc Diabetol, 2018, 17(1): 122-135.
40.	Koliaki C, Liatis S, Kokkinos A. Obesity and cardiovascular disease: revisiting an old relationship. Metabolism, 2019, 92: 98-107.
41.	王维国, 付嘉为, 范丹. 清洁能源发展的健康效应—以西气东输工程为例. 数量经济技术经济研究, 2024, 41(10): 150-170.
42.	曹清明, 王蔚婕, 张琳, 等. 中国居民平衡膳食模式的践行—《中国居民膳食指南(2022)》解读. 食品与机械, 2022, 38(6): 22-29.
43.	聂祖娇, 郑聪毅, 王馨, 等. 健康社会决定因素水平与脑卒中发病风险的关系—一项基于全国前瞻性队列的研究. 中国循环杂志, 2024, 39(6): 599-605.

1. 《中国脑卒中防治报告2021》编写组. 《中国脑卒中防治报告2021》概要. 中国脑血管病杂志, 2023, 20(11): 783-793.
2. GBD 2021 Causes of Death Collaborators. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990―2021: a systematic analysis for the global burden of disease study 2021. Lancet, 2024, 403(10440): 2100-2132.
3. 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.
4. Liu L, Liu J, Wang Y, et al. Substantial improvement of stroke care in China. Stroke, 2018, 49(12): 3085-3091.
5. Tu WJ, Wang LD,. China stroke surveillance report 2021. Mil Med Res, 2023, 10(1): 33.
6. 《中国卒中中心报告2022》概要. 中国脑血管病杂志, 2024, 21(8): 565-576.
7. GBD 2016 Stroke Collaborators. Global, regional, and national burden of stroke, 1990―2016: a systematic analysis for the global burden of disease study 2016. Lancet Neurol, 2019, 18(5): 439-458.
8. GBD 2021 Diseases and Injuries Collaborators. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990―2021: a systematic analysis for the global burden of disease study 2021. Lancet, 2024, 403(10440): 2133-2161.
9. GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990―2019: a systematic analysis for the global burden of disease study 2019. Lancet, 2020, 396(10258): 1223-1249.
10. Kim HJ, Fay MP, Feuer EJ, et al. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med, 2000, 19(3): 335-351.
11. Luo L, Jiang J, Yu C, et al. Stroke mortality attributable to low fruit intake in China: a joinpoint and age-period-cohort analysis. Front Neurosci, 2020, 14: 552113.
12. 王越, 刘鲁蓉. 1990—2019年中国老年人跌倒发生与死亡趋势及其年龄-时期-队列模型分析. 中国循证医学杂志, 2024, 24(7): 783-791.
13. World Health Organization. World health statistics 2016: monitoring health for the SDGs, sustainable development goals. 2022.
14. 乔玥, 李传辉, 赵文博. 急性缺血性脑卒中的再灌注治疗的现状与未来. 首都医科大学学报, 2025, 46(1): 68-70.
15. Chen D, Zhao Z, Zhang S, et al. Evolving Therapeutic landscape of intracerebral hemorrhage: emerging cutting-edge advancements in surgical robots, regenerative medicine, and neurorehabilitation techniques. Transl Stroke Res, 2024.
16. 闫润楠. 脑卒中早期康复住院费用影响因素及病例组合研究. 北京: 北京协和医学院, 2023.
17. 谢春艳, 王海银, 王美凤, 等. 基于价值的战略购买: 健康中国背景下医保治理的现代化转向. 中国卫生事业管理, 2022, 39(5): 348-352.
18. 何峰, 何蓓蓓, 王仲朋, 等. 脑-机交互运动训练的神经反馈方法及康复应用. 中国生物医学工程学报, 2021, 40(6): 719-730.
19. Murphy CC, Yang YC. Use of age-period-cohort analysis in cancer epidemiology research. Curr Epidemiol Rep, 2018, 5(4): 418-431.
20. 汤少梁, 赵兴华, 董慧秋, 等. 中国、美国和全球居民2010―2019年脑卒中疾病, 负担趋势年龄–时期–队列分析. 中国公共卫生, 2024, 40(6): 649-658.
21. 侯吉玉, 商黔惠, 刘风玲. 高血压患者早期血管衰老防治的研究新进展. 中国老年学杂志, 2024, 44(18): 4591-4595.
22. 张雪莉, 吕恒梁, 胡梦梦, 等. 1990~2021年中国55岁及以上人群缺血性脑卒中疾病负担及不良饮食危险因素变化趋势. 中国老年学杂志, 2024, 44(21): 5340-5343.
23. 秦莉花, 黄娟, 李晟, 等. 脑卒中流行病学及与性激素的相关性. 中国老年学杂志, 2018, 38(20): 5099-5103.
24. Roy-O'Reilly M, McCullough LD. Age and sex are critical factors in ischemic stroke pathology. Endocrinology, 2018, 159(8): 3120-3131.
25. 魏欣悦, 祖力亚尔·塔力甫, 钟盼亮, 等. 1990―2019年中国60岁及以上老年人疾病负担趋势分析. 中华疾病控制杂志, 2024, 28(11): 1321-1329,1343.
26. Tharmaratnam D, Karayiannis CC, Collyer TA, et al. Is blood pressure lowering in the very elderly with previous stroke associated with a higher risk of adverse events. J Am Heart Assoc, 2021, 10(24): e022240.
27. 秦静, 周亚霖, 朱书平, 等. 城市社区老年人脑卒中患病状况及健康管理. 中国老年学杂志, 2021, 41(8): 1730-1732.
28. 陈晓荣, 颜流霞, 厚磊, 等. 2015~2019年中国居民脑卒中发病与死亡特征分析. 中国循环杂志, 2024, 39(5): 470-476.
29. Denny MC, Rosendale N, Gonzales NR, et al. Addressing disparities in acute stroke management and prognosis. J Am Heart Assoc. 2024, 13(7): e031313.
30. Zeng C, Chen Z, Yang H, et al. Advanced high resolution three-dimensional imaging to visualize the cerebral neurovascular network in stroke. Int J Biol Sci, 2022, 18(2): 552-571.
31. 张玉, 李咏梅, 陆慧萍, 等. 2002—2023年上海市松江区脑卒中疾病负担变化分析. 中国慢性病预防与控制, 2024, 32(9): 717-720.
32. GBD 2017 Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990―2017: a systematic analysis for the global burden of disease study 2017. Lancet, 2018, 392(10159): 1923-1994.
33. Bell S, Sahm JL, Moriarty F, et al. Medication adherence for people with acquired communication disorders: a systematic review. Br J Clin Pharmacol, 2024, 90(11): 2742-2753.
34. 夏达建, 谢云芳, 张冬梅, 等. 1982—2021年中国缺血性脑卒中死亡趋势及年龄-时期-队列效应分析. 现代预防医学, 2025, 52(4): 590-596,607.
35. 曾媛媛, 朱其凤, 张永全. 缺血性脑卒中与相关信号通路的关系及中医药调控的研究进展. 中国实验方剂学杂志, 2024, 30(20): 252-263.
36. 鲁君, 张归玲, 朱文珍. 人工智能在缺血性脑卒中影像中的应用进展. 中国医学影像学杂志, 2022, 30(4): 396-400.
37. 李超, 杨辉. 脑卒中病人出院准备度循证干预方案临床应用效果评价. 护理研究, 2022, 36(12): 2101-2106.
38. 吴琼, 王晨冉, 赵燕, 等. 1990―2019年中国卒中危险因素的归因负担及变化趋势. 中华疾病控制杂志, 2022, 26(1): 28-33,79.
39. Ormazabal V, Nair S, Elfeky O, et al. Association between insulin resistance and the development of cardiovascular disease. Cardiovasc Diabetol, 2018, 17(1): 122-135.
40. Koliaki C, Liatis S, Kokkinos A. Obesity and cardiovascular disease: revisiting an old relationship. Metabolism, 2019, 92: 98-107.
41. 王维国, 付嘉为, 范丹. 清洁能源发展的健康效应—以西气东输工程为例. 数量经济技术经济研究, 2024, 41(10): 150-170.
42. 曹清明, 王蔚婕, 张琳, 等. 中国居民平衡膳食模式的践行—《中国居民膳食指南(2022)》解读. 食品与机械, 2022, 38(6): 22-29.
43. 聂祖娇, 郑聪毅, 王馨, 等. 健康社会决定因素水平与脑卒中发病风险的关系—一项基于全国前瞻性队列的研究. 中国循环杂志, 2024, 39(6): 599-605.

Chinese Journal of Evidence-Based Medicine

Latest ArticlesResearch on the trend of stroke burden in China from 1990 to 2021 and its age-period-cohort model

Abstract Full text Figures/Tables Video References Cited by

Format

Content