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Real-world analysis and future trends of stroke-related mortality and burden in Pudong: a comprehensive study from
Zheng Luo1, Chunyan Kuang2, Yan Zhang1
1Department of Neurology, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China.
Objectives:
Stroke is a major global health issue with rising incidence in China. Current estimates often focus on specific deaths, underestimating their impact. This study aimed to quantify and predict the all-cause and cause-specific burden of stroke using real-world data.
Design:
Population-based study.
Participants And Setting:
Residents in Shanghai Pudong, which covers an area of 1210.41 km² (467.34 mi²) and has a population of 3.17 million, spanning from 2005 to 2021.
Outcomes:
Stroke-related deaths in Pudong (2005-2021) were analysed by gender, age and subtype. Metrics included crude mortality rates (CMR), age-standardised mortality rates (ASMRW) and years of life lost (YLL). The Joinpoint Regression Programme determined average annual per cent change (AAPC), while the decomposition method assessed ageing's impact. The AutoRegressive Integrated Moving-Average (ARIMA) model projected trends from 2022 to 2035.
Results:
Among the 92 779 stroke-related deaths, the top three causes were stroke, heart disease and diabetes mellitus. From 2005 to 2021, the CMR for stroke-related deaths (AAPC=1.65%), stroke-specific deaths (AAPC=0.60%) and YLL rates (AAPC=0.36%) increased significantly (all p<0.05), and the ASMRW of both stroke-related and stroke-specific deaths showed significant decreases among males, females and the total population (all p<0.05). The proportion of stroke-related or specific deaths in individuals aged 60-69 and ≥80 years also increased significantly (all p<0.001). Ageing contributed to a 36.95% and 35.54% increase in CMR for stroke-related and stroke-specific deaths, respectively (all p<0.001). Projections indicate that from 2022 to 2035, the CMR for stroke-specific deaths will rise at an AAPC of 0.24%, reaching 141.96 per 100 000 by 2035 (p=0.008), while the CMR for stroke-related deaths will increase at an AAPC of 0.69%, reaching 235.44 per 100 000 by 2035 (p<0.001).
Conclusion:
Stroke's real-world burden is substantial, with ageing exacerbating mortality. Urgent action is needed to manage risk factors and prevent stroke.
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