Comparative Risk of Stroke Associated with Active Smoking in Chinese and Asian Populations

Stroke is the third leading cause of death worldwide, with the highest incidence in Asia, particularly in China, where smoking remains a major risk factor. The smoking prevalence in China is similar to that in Asia. Whether the risk estimates for smoking-related stroke in China and all Asian countries are still unknown which is worth evaluating. Thus, this study aims to compare the Relative Risk ( RR) of smoking-attributed stroke among the Chinese and Asian populations.

A literature search was conducted from the inception to September 10, 2022. Studies meeting the criteria were included. The articles were screened, and related information was extracted. Pooled RRs stratified by smoking status and sex were analyzed, including subgroup analyses for China, other Asian countries, and Asia overall. Finally, publication bias and sensitivity analyses were conducted.

Thirty-seven articles on the Chinese population and 15 on other Asian populations were included, with a mean Newcastle-Ottawa scale (NOS) score of 7.25. About ever smokers, there had no statistical difference existed in both sexes and females between China and other Asian countries, while the RRof males in other Asian countries [2.31 (1.38, 3.86)] was higher than that in China [1.21 (1.15, 1.26)]; further subgroup analysis indicated that other Asian countries had higher RR [3.76 (3.02, 4.67)] in the morbidity subgroup. The RRs of both sexes, males and females, between China and the whole of Asia were not statistically different. As for current and former smokers, no meaningful statistical difference was observed in the pooled RRs of both sexes, males and females, in China, other Asian countries, and all of Asia.

The RR of males ever smokers in China was smaller than that in other Asian countries due to the few articles of morbidity subgroup, but had no statistical difference with the whole of Asia; other groups of ever smokers, current smokers, and former smokers were not statistically significant with other Asian countries or the whole of Asia.