Trend analysis of stroke subtypes mortality attributable to high body-mass index in China from 1990 to 2019
Ying Gao1, Kangding Liu1, Shaokuan Fang2
1Neuroscience Center, Department of Neurology, First Hospital of Jilin University, No. 71 Xinmin Street, Chaoyang, Changchun, Jilin, 130021, China.
Insights
High body-mass index (BMI) is linked to rising stroke mortality in China. Trends vary by stroke subtype, age, and gender, necessitating targeted public health strategies.
Area of Science:
- Public Health
- Epidemiology
- Cardiovascular Disease
Background:
- High body-mass index (BMI) prevalence has increased significantly over three decades, correlating with rising stroke disability.
- The specific impact of high BMI on the disease burden of various stroke subtypes remains unclear.
- Understanding these trends is crucial for public health interventions in China.
Purpose of the Study:
- To assess long-term trends in stroke and stroke subtype mortality attributable to high BMI in China from 1990 to 2019.
- To analyze how these trends differ across stroke subtypes, age groups, and genders.
Main Methods:
- Utilized data from the Global Burden of Disease (GBD) 2019 study for China.
- Calculated age-standardized mortality rates (ASMR) using linear regression and an age-period-cohort framework.
- Analyzed trends using estimated annual percentage change (EAPC) and drift analyses.
Main Results:
- Stroke mortality attributable to high BMI showed varying trends across subtypes: ischemic stroke (IS) increased (2.04% annually), intracerebral hemorrhage (ICH) showed a slight increase (0.36%), and subarachnoid hemorrhage (SAH) decreased (-4.62%).
- Age-specific analyses revealed increasing mortality with age for IS and ICH, while SAH peaked between 50-70 years.
- Males exhibited higher ASMR for stroke compared to females, with different age distribution patterns observed between genders.
Conclusions:
- Stroke mortality trends attributable to high BMI in China vary significantly by subtype, age, and gender.
- Public health authorities must develop targeted guidelines for specific stroke subtypes, genders, and age groups to mitigate the burden of high BMI-related stroke.
- These findings underscore the need for personalized prevention and management strategies for high BMI-related cardiovascular diseases.
Background:
The prevalence of stroke disability associated with high BMI has significantly increased over the past three decades. However, it remains uncertain whether high body-mass index (BMI) exerts a similar impact on the disease burden of different stroke subtypes. The aim of this study is to assess the long-term trends of stroke and subtypes mortality attributable to high BMI in China between 1990 and 2019.
Methods:
Data on stroke and subtypes mortality attributable to high BMI in China was extracted in the Global Burden of Disease (GBD) 2019. The trends of age-standardized mortality rate (ASMR) were calculated using the linear regression and age-period-cohort framework.
Results:
The changing trend of ASMR on stroke attributable to high BMI in China differed among subtypes, with an estimated annual percentage change (EAPC) and 95%CI of 2.04 (1.86 to 2.21) for ischemic stroke (IS), 0.36 (-0.03 to 0.75) for intracerebral hemorrhage (ICH), and - 4.62 (-5.44 to -3.78) for subarachnoid hemorrhage (SAH). Net and local drift analyses revealed a gradual increase in the proportion of older people with IS and a gradual increase in the proportion of younger people with hemorrhagic strokes. The cohort and period rate ratios varied by subtype, showing an increasing trend for IS and ICH but a decreasing trend for SAH. The stroke mortality attributable to high BMI increased significantly with age for IS and ICH, peaking between ages 50-70 for SAH. Notably, males had higher ASMR related to stroke but exhibited slighter declines or higher growth compared to females in China. Moreover, the population affected by fatal strokes tended to be older among females but more evenly distributed across a wider age range encompassing both younger and older individuals.
Conclusion:
The research findings indicate a rising trend in the ASMR of stroke and subtypes attributable to high BMI in China from 1990 to 2019, with different patterns of change for different subtypes, genders and ages. Consequently, it is imperative for public health authorities in China to formulate guidelines for specific stroke subtypes, genders and ages to prevent the burden of stroke attributable to high BMI.
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