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Changing patterns of stroke and subtypes attributable to smoking from 1990 to 2021 in China and projections to 2050
Bo Hei1, Jiayu Liu2, Jixia Fang1
1Department of Neurosurgery, Peking University People's Hospital, No.11 Xizhimen South Street, Beijing, 100044, China.
Background:
It is uncertain whether smoking exerts similar effects on the stroke and subtypes. The aim of this study was to assess the long-term trends of stroke and subtypes attributable to smoking in China from 1990 to 2021 and to predict changes to 2050.
Methods:
Data on stroke and its subtypes mortality attributable to smoking in China were extracted from the Global Burden of Disease (GBD) 2021. Linear regression and age-period-cohort models were used to calculate age-standardised mortality rate (ASMR) trends, and the BAPC (Bayesian age-period-cohort) model was used to predict trends from 2022 to 2050.
Results:
The changing trend of ASMR on stroke attributable to smoking in China differed among subtypes, with an estimated annual percentage change (EAPC) of -2.40 for intracerebral hemorrhage (ICH); -0.67 for ischemic stroke (IS); -0.65 for subarachnoid hemorrhage (SAH). The local drift curves reflect the average annual percentage change in stroke mortality attributable to smoking in all age groups, with a decreasing trend in stroke and subtypes. The decline in SAH mortality was much greater than for IS and ICH across all age groups. The period rate ratio (PRR) and cohort rate ratio (CRR) varied by subtype, showing the decline for all subtypes. Mortality rates for IS and ICH increase significantly with age; the mortality rate for SAH increases followed by a decrease, peaking in the 65-70 year age group. Finally, the ASMR and ASDR for stroke and subtypes attributable to smoking in China will continue to decline from 2022 to 2050.
Conclusions:
Our study shows that stroke burden attributable to smoking in China declined from 1990 to 2021 but remained higher than global levels, with continue to decline from 2022 to 2050. IS showed the least reduction, especially among older men. Projections suggest continued improvement, though rising adolescent smoking-particularly among women-poses a threat. Strengthened tobacco control, smoking cessation, and targeted IS prevention, especially in older males, are crucial.
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