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Proportion of different subtypes of stroke in China
Lin-Feng Zhang1, Jun Yang, Zhen Hong
1Department of Epidemiology, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bei Li Shi Rd 167, Beijing, 100037, People's Republic of China.
Insights
In China, ischemic stroke is more common than hemorrhagic stroke. Stroke subtype proportions vary significantly among Chinese populations, sometimes more than between Chinese and Western populations.
Area of Science:
- Neurology
- Epidemiology
- Public Health
Background:
- Stroke is the leading cause of death in China.
- Understanding stroke subtype distribution is crucial for public health strategies.
Purpose of the Study:
- To determine the proportion of different stroke subtypes in China.
- To analyze variations in stroke subtype prevalence across Chinese populations.
Main Methods:
- Utilized data from 16,031 first-ever strokes (age >= 25) from 1991-2000.
- Employed World Health Organization criteria for stroke subtype classification.
- Focused on 8,268 strokes from 10 populations with >75% CT scan rates (1996-2000).
Main Results:
- Cerebral infarction accounted for 62.4%, intracerebral hemorrhage for 27.5%, subarachnoid hemorrhage for 1.8%, and undetermined stroke for 8.3%.
- Significant population-based variations observed: intracerebral hemorrhage (17.1%-39.4%), cerebral infarction (45.5%-75.9%).
- Ischemic to hemorrhagic stroke ratio averaged 2.0; 28-day fatality rates varied by subtype.
Conclusions:
- Ischemic stroke is more prevalent than hemorrhagic stroke in China.
- Chinese populations exhibit considerable variation in stroke subtype proportions, potentially exceeding inter-population differences.
- Hemorrhagic stroke is more common in Chinese than Western populations, but subtype variation within China is notable.
Background And Purpose:
The goal of this article is to clarify the proportion of stroke subtypes in China, where stoke is the most common cause of death.
Methods:
A total of 16,031 first-ever strokes in subjects >or=25 years of age were identified in 1991 to 2000 from 17 Chinese populations through a community-based cardiovascular disease surveillance program in the China Multicenter Collaborative Study of Cardiovascular Epidemiology. World Health Organization diagnosis criteria were used for classification of stroke subtypes.
Results:
CT scan rate of stroke cases reached a satisfactorily high level only after 1996 in the study populations. In 8268 first-ever stroke events from 10 populations with CT scan rate >75% in 1996 to 2000, 1.8% were subarachnoid hemorrhage, 27.5% were intracerebral hemorrhage, 62.4% were cerebral infarction, and 8.3% were undetermined stroke. The proportion of intracerebral hemorrhage varied from 17.1% to 39.4% and that for cerebral infarction varied from 45.5% to 75.9% from population to population. The ratio of ischemic to hemorrhagic stroke ranged from 1.1 to 3.9 and averaged 2.0). The 28-day fatality rate was 33.3% for subarachnoid hemorrhage, 49.4% for intracerebral hemorrhage, 16.9% for cerebral infarction, and 64.6% for undetermined stroke.
Conclusions:
In our study, ischemic stroke was more frequent and its proportion was higher than hemorrhagic stroke in Chinese populations. Although hemorrhagic stroke was more frequent in Chinese than in Western populations, the variation in the proportion of stroke subtypes among Chinese populations could be as large as or larger than that between Chinese and Western populations.