Article(id=1321169942163075279, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1321169924697993338, articleNumber=null, orderNo=null, doi=10.11847/zgggws1145478, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1721232000000, receivedDateStr=2024-07-18, revisedDate=1732204800000, revisedDateStr=2024-11-22, acceptedDate=1743436800000, acceptedDateStr=2025-04-01, onlineDate=1792921060362, onlineDateStr=2026-10-25, pubDate=1746806400000, pubDateStr=2025-05-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1792921060362, onlineIssueDateStr=2026-10-25, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1792921060362, creator=13701087609, updateTime=1792921060362, updator=13701087609, issue=Issue{id=1321169924697993338, tenantId=1146029695717560320, journalId=1319373219989389464, year='2025', volume='41', issue='5', pageStart='513', pageEnd='640', issueExtLink='null', onlineDate='null', pubDate='1746806400000', pubDateStr='2025-05-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1792921056198, creator='13701087609', updateTime=1792921056198, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=599, endPage=605, ext={EN=ArticleExt(id=1321169942389567696, articleId=1321169942163075279, tenantId=1146029695717560320, journalId=1319373219989389464, language=EN, title=Incidence and mortality trends of stroke and its subtypes among residents in China from 1990 to 2021: an analysis of GBD 2021 data, columnId=1320427686514770171, journalTitle=Chinese Journal of Public Health, columnName=Survey and Report, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the trends in incidence and mortality of stroke, including ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH), among Chinese residents from 1990 to 2021, and to provide a reference for stroke prevention and control strategies in China.

Methods

Data on the incidence and mortality of stroke, IS, ICH, and SAH among Chinese residents in 1990 and 2021 were obtained from the Global Burden of Disease (GBD) 2021 study. Descriptive analyses were performed using the number of incident cases, incidence rate, number of deaths, and mortality rate. Statistical analyses were conducted using R 4.1.0 software. Trends in the incidence and mortality of stroke and its three subtypes from 1990 to 2021 were analyzed using the overall percentage change and estimated annual percentage change (EAPC).

Results

The number of incident stroke cases, incidence rate (per 100 000), number of deaths, and mortality rate (per 100 000) among Chinese residents increased from 1 685 762, 143.29, 1 530 590, and 130.10 in 1990 to 4 090 480, 287.51, 2 591 647, and 182.16 in 2021, with overall relative percentage changes of 142.65%, 100.64%, 69.32%, and 40.01%, respectively. Both the incidence and mortality rates of stroke showed a significant increasing trend from 1990 to 2021 (EAPC = 2.02% and 1.01%, both P < 0.001). For IS, the number of incident cases, incidence rate, number of deaths, and mortality rate increased from 761 191, 64.70, 427 970, and 36.38 in 1990 to 2 772 053, 194.84, 1 176 952, and 82.72 in 2021, with overall relative percentage changes of 264.17%, 201.13%, 175.01%, and 127.40%, respectively. Both the incidence and mortality rates of IS showed a significant increasing trend (EAPC = 3.56% and 2.74%, both P < 0.001). For ICH, the corresponding figures increased from 774 012, 65.79, 913 023, and 77.61 in 1990 to 1 173 288, 82.47, 1 322 893, and 92.98 in 2021, with overall relative percentage changes of 51.59%, 25.34%, 44.89%, and 19.81%, respectively. Both the incidence and mortality rates of ICH showed a significant increasing trend (EAPC = 0.40% and 0.50%, both P < 0.01). In contrast, for SAH, the figures decreased from 150 559, 12.80, 189 598, and 16.12 in 1990 to 145 138, 10.20, 91 802, and 6.45 in 2021, with overall relative percentage changes of –3.60%, –20.29%, –51.58%, and –59.96%, respectively. Both the incidence and mortality rates of SAH showed a significant decreasing trend (EAPC = –1.69% and –4.02%, both P < 0.001). In both 1990 and 2021, male residents had higher incidence and mortality rates of stroke, IS, and ICH, as well as a higher incidence rate of SAH compared to females, except for the SAH mortality rate. From 1990 to 2021, the incidence and mortality rates of stroke, IS, and ICH increased in males (EAPC = 2.33% and 1.51%, 3.98% and 3.25%, 0.70% and 1.01%, respectively; all P < 0.05), while the incidence and mortality rates of SAH decreased (EAPC = –1.59% and –3.44%, respectively; both P < 0.05). In females, the incidence and mortality rates of stroke and IS increased (EAPC = 1.61% and 0.40%, 3.15% and 2.12%, respectively; all P<0.05), while the incidence and mortality rates of SAH decreased (EAPC = –1.69% and –4.69%, respectively; both P < 0.05). In both 1990 and 2021, the incidence and mortality rates of stroke and its three subtypes increased with age. The incidence rate of stroke decreased in all age groups from 1990 to 2021 (all P < 0.05), except for the 75 - 79 age group, where the difference was not statistically significant. The incidence rate of IS increased in all age groups (all P < 0.05), except for the age group under 20, which showed a decreasing trend, and the 20 - 24 age group, where the difference was not statistically significant. The mortality rate of IS decreased in all age groups (all P < 0.05), except for the 80 - 84 and ≥ 85 age groups, where the differences were not statistically significant. The incidence and mortality rates of ICH and SAH decreased in all age groups (all P < 0.05).

Conclusions

From 1990 to 2021, the incidence and mortality rates of stroke, IS, and ICH increased among Chinese residents, while the incidence and mortality rates of SAH decreased. Males and the elderly are high-risk groups for stroke incidence and mortality.

, authors=Wenjiao DONG, Fengxia LAI, Yao LING, Zhimei JIN, Hao CHEN, Danli KONG, Yuanlin DING, authorsList=Wenjiao DONG, Fengxia LAI, Yao LING, Zhimei JIN, Hao CHEN, Danli KONG, Yuanlin DING, authorCompany=null, correspAuthors=Yuanlin DING, authorNote=null, correspAuthorsNote=
DING Yuanlin, E-mail:
, copyrightStatement=Copyright © 2025 Chinese Journal of Public Health. All rights reserved., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1321169945459798237, articleId=1321169942163075279, tenantId=1146029695717560320, journalId=1319373219989389464, language=CN, title=1990—2021年中国居民脑卒中及其亚型发病和死亡趋势分析, columnId=1320427686770622717, journalTitle=中国公共卫生, columnName=调查报告与分析, runingTitle=null, highlight=null, articleAbstract=
目的

分析中国居民1990—2021年脑卒中及缺血性脑卒中(IS)、脑出血(ICH)和蛛网膜下腔出血(SAH)3种亚型的发病和死亡趋势,为我国居民脑卒中的预防控制提供参考依据。

方法

收集2021年全球疾病负担(GBD 2021)研究中1990—2021年中国居民脑卒中及IS、ICH和SAH 3种亚型发病和死亡的相关数据,采用发病数、发病率、死亡数和死亡率等指标进行描述性分析,采用总变化率和年估计变化百分比(EAPC)分析我国居民1990—2021年脑卒中及其3种亚型发病和死亡的变化趋势。

结果

中国居民脑卒中发病数、发病率、死亡数和死亡率分别从1990年的1 685 762例、143.29/10万、1 530 590例和130.10/10万上升至2021年的4 090 480例、287.51/10万、2 591 647例和182.16/10万,总变化率分别为142.65%、100.64%、69.32%和40.01%,中国居民1990—2021年脑卒中发病率和死亡率均呈上升趋势(EAPC=2.02%和1.01%,均P<0.001)。IS发病数、发病率、死亡数和死亡率分别从1990年的761 191例、64.70/10万、427 970例和36.38/10万上升至2021年的2 772 053例、194.84/10万、1 176 952例和82.72/10万,总变化率分别为264.17%、201.13%、175.01%和127.40%,中国居民1990—2021年IS发病率和死亡率均呈上升趋势(EAPC=3.56%和2.74%,均P<0.001);ICH发病数、发病率、死亡数和死亡率分别从1990年的774 012例、65.79/10万、913 023例和77.61/10万上升至2021年的1 173 288例、82.47/10万、1 322 893例和92.98/10万,总变化率分别为51.59%、25.34%、44.89%和19.81%,中国居民1990—2021年ICH发病率和死亡率均呈上升趋势(EAPC=0.40%和0.50%,均P<0.01);SAH发病数、发病率、死亡数和死亡率分别从1990年的150 559例、12.80/10万、189 598例和16.12/10万下降至2021年的145 138例、10.20/10万、91 802例和6.45/10万,总变化率分别为−3.60%、−20.29%、−51.58%和−59.96%,中国居民1990—2021年SAH发病率和死亡率均呈下降趋势(EAPC= –1.69%和−4.02%,均P<0.001)。不同性别居民中,1990年和2021年除SAH死亡率外,男性居民脑卒中、IS、ICH发病率和死亡率及SAH发病率均高于女性居民;男性居民1990—2021年脑卒中、IS、ICH的发病率和死亡率均呈上升趋势(EAPC=2.33%和1.51%、3.98%和3.25%、0.70%和1.01%,均P<0.05),SAH的发病率和死亡率均呈下降趋势(EAPC= –1.59%和−3.44%,均P<0.05);女性居民1990—2021年脑卒中、IS的发病率和死亡率均呈上升趋势(EAPC=1.61%和0.40%、3.15%和2.12%,均P<0.05),SAH的发病率和死亡率均呈下降趋势(EAPC= –1.69%和−4.69%,均P<0.05)。不同年龄居民中,1990年和2021年脑卒中及3种亚型的发病率和死亡率均随年龄增长而升高;脑卒中发病率除75~79岁居民差异无统计学意义外,其他各年龄组居民1990—2021年脑卒中发病率和死亡率均呈下降趋势(均P<0.05);IS发病率除<20岁居民呈下降趋势和20~24岁居民差异均无统计学意义外,其他各年龄组居民1990—2021年IS发病率均呈上升趋势(均P<0.05);IS死亡率除80~84岁和≥85岁居民差异均无统计学意义外,其他各年龄组居民1990—2021年IS死亡率均呈下降趋势(均P<0.05);各年龄组居民1990—2021年ICH、SAH发病率和死亡率均呈下降趋势(均P<0.05)。

结论

中国居民1990—2021年脑卒中、IS和ICH的发病率和死亡率均呈上升趋势,SAH的发病率和死亡率均呈下降趋势,男性和老年人为脑卒中发病和死亡的高危人群。

, authors=董文娇, 赖凤霞, 令垚, 金智美, 陈浩, 孔丹莉, 丁元林*, *, authorsList=董文娇, 赖凤霞, 令垚, 金智美, 陈浩, 孔丹莉, 丁元林, authorCompany=null, correspAuthors=丁元林, authorNote=

董文娇(1998—),硕士在读,研究方向:慢性非传染性疾病流行病学

, correspAuthorsNote=
丁元林,E-mail:
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董文娇(1998—),硕士在读,研究方向:慢性非传染性疾病流行病学

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董文娇(1998—),硕士在读,研究方向:慢性非传染性疾病流行病学

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Stroke, 2024, 55(6): 1543-1553., articleTitle=null, refAbstract=null), Reference(id=1321169951965163821, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169942163075279, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=26, rfOrder=25, authorNames=null, journalName=null, refType=null, unstructuredReference=黎健. 血管衰老干预的新策略[J]. 中国心血管杂志, 2021, 26(5): 425-427., articleTitle=null, refAbstract=null), Reference(id=1321169952032272686, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169942163075279, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=27, rfOrder=26, authorNames=null, journalName=null, refType=null, unstructuredReference=汤少梁, 赵兴华, 董慧秋, 等. 中国、美国和全球居民2010—2019年脑卒中疾病负担趋势年龄–时期–队列分析[J]. 中国公共卫生, 2024, 40(6): 649-658., articleTitle=null, refAbstract=null), Reference(id=1321169952090992943, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169942163075279, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=28, rfOrder=27, authorNames=null, journalName=null, refType=null, unstructuredReference=李娜, 王浩, 阮钰涵, 等. 1990—2019年浙江省脑卒中疾病负担和危险因素变化趋势研究[J]. 疾病监测, 2022, 37(7): 901-906., articleTitle=null, refAbstract=null), Reference(id=1321169952174879024, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169942163075279, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=29, rfOrder=28, authorNames=null, journalName=null, refType=null, unstructuredReference=Roy-O’Reilly M, McCullough L D. Age and sex are critical factors in ischemic stroke pathology[J]. Endocrinology, 2018, 159(8): 3120-3131., articleTitle=null, refAbstract=null), Reference(id=1321169952250376497, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169942163075279, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=30, rfOrder=29, authorNames=null, journalName=null, refType=null, unstructuredReference=甘勇, 杨婷婷, 刘建新, 等. 国内外脑卒中流行趋势及影响因素研究进展[J]. 中国预防医学杂志, 2019, 20(2): 139-144., articleTitle=null, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1321169945707262174, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169942163075279, xref=null, ext=[AuthorCompanyExt(id=1321169945728233695, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169942163075279, companyId=1321169945707262174, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Public Health, Guangdong Medical University, Dongguan 523000, China), AuthorCompanyExt(id=1321169945740816608, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169942163075279, companyId=1321169945707262174, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=广东医科大学公共卫生学院,东莞 523000)])], figs=[ArticleFig(id=1321169949859623184, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169942163075279, language=EN, label=Tab.1, caption=

Incidence and mortality numbers and rates of stroke, ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage among male and female Chinese residents in 1990 and 2021, with total percentage change and estimated annual percentage change during the period

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疾病分类男性女性
发病数/例发病率/(1/10万)死亡数/例死亡率/(1/10万)发病数/例发病率/(1/10万)死亡数/例死亡率/(1/10万)
脑卒中1990年900 161148.34796 977131.33785 601137.92733 613128.79
2021年2 305 942316.711 506 012206.841 784 539256.901 085 635156.29
总变化率/%156.17113.5188.9757.49127.1686.2747.9821.35
EAPC/%2.33 a1.51 a1.61 a0.40 a
IS1990年398 89365.73221 18036.45362 29963.60206 79036.30
2021年1 547 096212.48674 86592.691 224 957176.34502 08772.28
总变化率/%287.85223.25205.12154.30238.11177.25142.8099.10
EAPC/%3.98 a3.25 a3.15 a2.12 a
ICH1990年423 00769.71484 16679.78351 00561.62428 85775.29
2021年679 85593.37782 062107.41493 43371.03540 83077.86
总变化率/%60.7233.9561.5334.6340.5815.2826.113.41
EAPC/%0.70 a1.01 a0.00−0.10
SAH1990年78 26112.9091 63215.1072 29712.6997 96617.20
2021年78 99010.8549 0856.7466 1489.5242 7176.15
总变化率/%0.93−15.88−46.43−55.35−8.51−24.97−56.40−64.24
EAPC/%−1.59 a−3.44 a−1.69 a−4.69 a
), ArticleFig(id=1321169949951897873, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169942163075279, language=CN, label=表1, caption=

中国不同性别居民1990—2021年脑卒中及3种亚型发病和死亡趋势

, figureFileSmall=null, figureFileBig=null, tableContent=
疾病分类男性女性
发病数/例发病率/(1/10万)死亡数/例死亡率/(1/10万)发病数/例发病率/(1/10万)死亡数/例死亡率/(1/10万)
脑卒中1990年900 161148.34796 977131.33785 601137.92733 613128.79
2021年2 305 942316.711 506 012206.841 784 539256.901 085 635156.29
总变化率/%156.17113.5188.9757.49127.1686.2747.9821.35
EAPC/%2.33 a1.51 a1.61 a0.40 a
IS1990年398 89365.73221 18036.45362 29963.60206 79036.30
2021年1 547 096212.48674 86592.691 224 957176.34502 08772.28
总变化率/%287.85223.25205.12154.30238.11177.25142.8099.10
EAPC/%3.98 a3.25 a3.15 a2.12 a
ICH1990年423 00769.71484 16679.78351 00561.62428 85775.29
2021年679 85593.37782 062107.41493 43371.03540 83077.86
总变化率/%60.7233.9561.5334.6340.5815.2826.113.41
EAPC/%0.70 a1.01 a0.00−0.10
SAH1990年78 26112.9091 63215.1072 29712.6997 96617.20
2021年78 99010.8549 0856.7466 1489.5242 7176.15
总变化率/%0.93−15.88−46.43−55.35−8.51−24.97−56.40−64.24
EAPC/%−1.59 a−3.44 a−1.69 a−4.69 a
), ArticleFig(id=1321169950027395346, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169942163075279, language=EN, label=Tab.2, caption=

Age-specific incidence and mortality rates of stroke, ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage among the Chinese population in 1990 and 2021, with total and estimated annual percentage changes during 1990 - 2021

, figureFileSmall=null, figureFileBig=null, tableContent=
疾病年龄/岁发病率/(1/10万)死亡率/(1/10万)
1990年2021年变化率/%EAPC/%1990年2021年变化率/%EAPC/%
脑卒中<2016.9011.60−31.33−1.49 a2.850.44−84.65−5.92 a
20~2418.8615.99−15.22−0.80 a3.492.07−40.65−1.88 a
25~2924.1619.78−18.11−1.00 a4.752.92−38.54−1.49 a
30~3436.6530.04−1.80−1.00 a9.105.62−3.82−1.59 a
35~3956.0746.05−17.86−1.00 a19.3210.80−44.08−2.08 a
40~4497.3478.88−18.97−1.00 a43.8122.11−49.54−2.37 a
45~49161.25129.03−19.98−1.09 a75.6634.19−54.82−2.47 a
50~54237.78198.56−16.49−0.90 a163.2665.84−59.67−3.15 a
55~59324.85287.67−1.14−0.70 a278.77110.08−60.51−3.15 a
60~64510.76470.14−7.95−0.60 a443.79201.31−54.64−2.57 a
65~69792.84740.23−6.63−0.50 a765.66364.35−52.41−2.57 a
70~741 258.951 258.61−0.03−0.20 a1 402.83730.82−47.90−2.27 a
75~791 894.182 005.455.87−0.102 281.501 290.57−43.43−1.88 a
80~842 698.332 550.54−0.55−0.40 a3 678.752 341.30−36.36−1.49 a
≥853 957.433 177.13−19.72−0.10 a6 436.944 600.99−28.52−1.19 a
IS<207.606.59−13.30−0.70 a0.190.05−74.03−4.11 a
20~247.928.446.510.000.260.24−7.52−0.40 a
25~299.099.908.960.10 a0.400.34−13.93−0.30 a
30~3411.4614.022.240.40 a0.860.74−1.30−0.40 a
35~3914.8620.3937.250.80 a1.891.51−20.46−1.00 a
40~4427.3339.8645.851.01 a4.803.54−26.29−1.19 a
45~4948.8572.4548.301.11 a9.926.48−34.65−1.19 a
50~5492.33125.3335.740.90 a25.8614.97−42.09−1.88 a
55~59156.69198.7926.870.70 a51.1129.64−42.01−1.69 a
60~64273.43345.7526.450.60 a104.2170.08−32.75−1.19 a
65~69441.28557.6426.370.60 a205.26142.17−30.74−1.19 a
70~74646.21924.3143.031.11 a444.88332.57−25.25−1.00 a
75~79884.021 427.5061.481.71 a762.20620.11−18.64−0.60 a
80~841 117.411 668.5349.321.41 a1 310.241 220.53−6.85−0.10
≥851 439.391 790.3824.380.60 a2 375.392 507.015.54−0.20
ICH<206.553.29−49.81−2.47 a1.640.29−82.08−5.26 a
20~247.665.36−30.04−1.39 a2.121.52−28.41−1.09 a
25~2910.687.08−33.67−1.59 a3.012.19−27.36−0.80 a
30~3418.6212.16−3.47−1.69 a6.034.28−2.91−1.00 a
35~3931.3520.32−35.20−1.69 a13.148.27−37.06−1.59 a
40~4455.4631.89−42.50−2.08 a30.5316.76−45.11−1.98 a
45~4991.5847.23−48.43−2.47 a53.4125.27−52.69−2.18 a
50~54120.0262.25−48.13−2.47 a112.3746.68−58.45−3.05 a
55~59139.7776.95−44.95−2.27 a187.2074.14−60.40−3.15 a
60~64201.38110.13−45.31−2.37 a281.06121.86−56.64−2.66 a
65~69303.43164.38−45.83−2.37 a467.64206.97−55.74−2.66 a
70~74532.33303.82−42.93−2.18 a797.66372.32−53.32−2.57 a
75~79878.93527.49−39.99−1.98 a1 279.35630.50−50.72−2.37 a
80~841 408.90815.00−42.15−2.18 a2006.121 058.02−47.26−2.18 a
≥852 301.741 301.49−43.46−2.27 a3 469.001 980.87−42.90−1.98 a
SAH<202.751.73−37.13−1.98 a1.020.09−90.74−7.87 a
20~243.282.19−33.12−2.08 a1.110.31−71.93−4.78 a
25~294.392.80−36.31−2.37 a1.330.39−71.12−4.50 a
30~346.573.86−4.13−2.66 a2.210.60−7.31−4.88 a
35~399.855.34−45.80−2.96 a4.281.03−76.06−5.26 a
40~4414.567.14−50.96−3.25 a8.481.81−78.66−5.64 a
45~4920.829.36−55.03−3.44 a12.332.44−80.25−5.73 a
50~5425.4310.98−56.83−3.44 a25.044.18−83.29−6.67 a
55~5928.3911.92−58.00−3.44 a40.456.31−84.41−6.95 a
60~6435.9514.25−60.35−3.63 a58.529.36−84.01−6.76 a
65~6948.1218.22−62.15−3.92 a92.7615.21−83.61−6.76 a
70~7480.4130.48−62.10−4.21 a160.2925.93−83.82−6.85 a
75~79131.2350.46−61.55−4.40 a239.9639.96−83.35−6.76 a
80~84172.0367.01−61.05−4.40 a362.3862.75−82.68−6.85 a
≥85216.3085.26−60.58−4.30 a592.55113.11−80.91−6.48 a
), ArticleFig(id=1321169950132252947, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321169942163075279, language=CN, label=表2, caption=

中国不同年龄居民1990—2021年脑卒中及3种亚型发病和死亡趋势

, figureFileSmall=null, figureFileBig=null, tableContent=
疾病年龄/岁发病率/(1/10万)死亡率/(1/10万)
1990年2021年变化率/%EAPC/%1990年2021年变化率/%EAPC/%
脑卒中<2016.9011.60−31.33−1.49 a2.850.44−84.65−5.92 a
20~2418.8615.99−15.22−0.80 a3.492.07−40.65−1.88 a
25~2924.1619.78−18.11−1.00 a4.752.92−38.54−1.49 a
30~3436.6530.04−1.80−1.00 a9.105.62−3.82−1.59 a
35~3956.0746.05−17.86−1.00 a19.3210.80−44.08−2.08 a
40~4497.3478.88−18.97−1.00 a43.8122.11−49.54−2.37 a
45~49161.25129.03−19.98−1.09 a75.6634.19−54.82−2.47 a
50~54237.78198.56−16.49−0.90 a163.2665.84−59.67−3.15 a
55~59324.85287.67−1.14−0.70 a278.77110.08−60.51−3.15 a
60~64510.76470.14−7.95−0.60 a443.79201.31−54.64−2.57 a
65~69792.84740.23−6.63−0.50 a765.66364.35−52.41−2.57 a
70~741 258.951 258.61−0.03−0.20 a1 402.83730.82−47.90−2.27 a
75~791 894.182 005.455.87−0.102 281.501 290.57−43.43−1.88 a
80~842 698.332 550.54−0.55−0.40 a3 678.752 341.30−36.36−1.49 a
≥853 957.433 177.13−19.72−0.10 a6 436.944 600.99−28.52−1.19 a
IS<207.606.59−13.30−0.70 a0.190.05−74.03−4.11 a
20~247.928.446.510.000.260.24−7.52−0.40 a
25~299.099.908.960.10 a0.400.34−13.93−0.30 a
30~3411.4614.022.240.40 a0.860.74−1.30−0.40 a
35~3914.8620.3937.250.80 a1.891.51−20.46−1.00 a
40~4427.3339.8645.851.01 a4.803.54−26.29−1.19 a
45~4948.8572.4548.301.11 a9.926.48−34.65−1.19 a
50~5492.33125.3335.740.90 a25.8614.97−42.09−1.88 a
55~59156.69198.7926.870.70 a51.1129.64−42.01−1.69 a
60~64273.43345.7526.450.60 a104.2170.08−32.75−1.19 a
65~69441.28557.6426.370.60 a205.26142.17−30.74−1.19 a
70~74646.21924.3143.031.11 a444.88332.57−25.25−1.00 a
75~79884.021 427.5061.481.71 a762.20620.11−18.64−0.60 a
80~841 117.411 668.5349.321.41 a1 310.241 220.53−6.85−0.10
≥851 439.391 790.3824.380.60 a2 375.392 507.015.54−0.20
ICH<206.553.29−49.81−2.47 a1.640.29−82.08−5.26 a
20~247.665.36−30.04−1.39 a2.121.52−28.41−1.09 a
25~2910.687.08−33.67−1.59 a3.012.19−27.36−0.80 a
30~3418.6212.16−3.47−1.69 a6.034.28−2.91−1.00 a
35~3931.3520.32−35.20−1.69 a13.148.27−37.06−1.59 a
40~4455.4631.89−42.50−2.08 a30.5316.76−45.11−1.98 a
45~4991.5847.23−48.43−2.47 a53.4125.27−52.69−2.18 a
50~54120.0262.25−48.13−2.47 a112.3746.68−58.45−3.05 a
55~59139.7776.95−44.95−2.27 a187.2074.14−60.40−3.15 a
60~64201.38110.13−45.31−2.37 a281.06121.86−56.64−2.66 a
65~69303.43164.38−45.83−2.37 a467.64206.97−55.74−2.66 a
70~74532.33303.82−42.93−2.18 a797.66372.32−53.32−2.57 a
75~79878.93527.49−39.99−1.98 a1 279.35630.50−50.72−2.37 a
80~841 408.90815.00−42.15−2.18 a2006.121 058.02−47.26−2.18 a
≥852 301.741 301.49−43.46−2.27 a3 469.001 980.87−42.90−1.98 a
SAH<202.751.73−37.13−1.98 a1.020.09−90.74−7.87 a
20~243.282.19−33.12−2.08 a1.110.31−71.93−4.78 a
25~294.392.80−36.31−2.37 a1.330.39−71.12−4.50 a
30~346.573.86−4.13−2.66 a2.210.60−7.31−4.88 a
35~399.855.34−45.80−2.96 a4.281.03−76.06−5.26 a
40~4414.567.14−50.96−3.25 a8.481.81−78.66−5.64 a
45~4920.829.36−55.03−3.44 a12.332.44−80.25−5.73 a
50~5425.4310.98−56.83−3.44 a25.044.18−83.29−6.67 a
55~5928.3911.92−58.00−3.44 a40.456.31−84.41−6.95 a
60~6435.9514.25−60.35−3.63 a58.529.36−84.01−6.76 a
65~6948.1218.22−62.15−3.92 a92.7615.21−83.61−6.76 a
70~7480.4130.48−62.10−4.21 a160.2925.93−83.82−6.85 a
75~79131.2350.46−61.55−4.40 a239.9639.96−83.35−6.76 a
80~84172.0367.01−61.05−4.40 a362.3862.75−82.68−6.85 a
≥85216.3085.26−60.58−4.30 a592.55113.11−80.91−6.48 a
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1990—2021年中国居民脑卒中及其亚型发病和死亡趋势分析
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董文娇 , 赖凤霞 , 令垚 , 金智美 , 陈浩 , 孔丹莉 , 丁元林 *, *
中国公共卫生 | 调查报告与分析 2025,41(5): 599-605
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中国公共卫生 |调查报告与分析 2025 , 41 (5) : 599 -605
1990—2021年中国居民脑卒中及其亚型发病和死亡趋势分析
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董文娇, 赖凤霞, 令垚, 金智美, 陈浩, 孔丹莉, 丁元林*, *
作者信息
  • 广东医科大学公共卫生学院,东莞 523000
通讯作者:
丁元林,E-mail:
作者简介:

董文娇(1998—),硕士在读,研究方向:慢性非传染性疾病流行病学

Incidence and mortality trends of stroke and its subtypes among residents in China from 1990 to 2021: an analysis of GBD 2021 data
Wenjiao DONG, Fengxia LAI, Yao LING, Zhimei JIN, Hao CHEN, Danli KONG, Yuanlin DING
Affiliations
  • School of Public Health, Guangdong Medical University, Dongguan 523000, China
  • Corresponding Author:
    DING Yuanlin, E-mail:
出版时间: 2025-05-10 doi: 10.11847/zgggws1145478
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目的

分析中国居民1990—2021年脑卒中及缺血性脑卒中(IS)、脑出血(ICH)和蛛网膜下腔出血(SAH)3种亚型的发病和死亡趋势,为我国居民脑卒中的预防控制提供参考依据。

方法

收集2021年全球疾病负担(GBD 2021)研究中1990—2021年中国居民脑卒中及IS、ICH和SAH 3种亚型发病和死亡的相关数据,采用发病数、发病率、死亡数和死亡率等指标进行描述性分析,采用总变化率和年估计变化百分比(EAPC)分析我国居民1990—2021年脑卒中及其3种亚型发病和死亡的变化趋势。

结果

中国居民脑卒中发病数、发病率、死亡数和死亡率分别从1990年的1 685 762例、143.29/10万、1 530 590例和130.10/10万上升至2021年的4 090 480例、287.51/10万、2 591 647例和182.16/10万,总变化率分别为142.65%、100.64%、69.32%和40.01%,中国居民1990—2021年脑卒中发病率和死亡率均呈上升趋势(EAPC=2.02%和1.01%,均P<0.001)。IS发病数、发病率、死亡数和死亡率分别从1990年的761 191例、64.70/10万、427 970例和36.38/10万上升至2021年的2 772 053例、194.84/10万、1 176 952例和82.72/10万,总变化率分别为264.17%、201.13%、175.01%和127.40%,中国居民1990—2021年IS发病率和死亡率均呈上升趋势(EAPC=3.56%和2.74%,均P<0.001);ICH发病数、发病率、死亡数和死亡率分别从1990年的774 012例、65.79/10万、913 023例和77.61/10万上升至2021年的1 173 288例、82.47/10万、1 322 893例和92.98/10万,总变化率分别为51.59%、25.34%、44.89%和19.81%,中国居民1990—2021年ICH发病率和死亡率均呈上升趋势(EAPC=0.40%和0.50%,均P<0.01);SAH发病数、发病率、死亡数和死亡率分别从1990年的150 559例、12.80/10万、189 598例和16.12/10万下降至2021年的145 138例、10.20/10万、91 802例和6.45/10万,总变化率分别为−3.60%、−20.29%、−51.58%和−59.96%,中国居民1990—2021年SAH发病率和死亡率均呈下降趋势(EAPC= –1.69%和−4.02%,均P<0.001)。不同性别居民中,1990年和2021年除SAH死亡率外,男性居民脑卒中、IS、ICH发病率和死亡率及SAH发病率均高于女性居民;男性居民1990—2021年脑卒中、IS、ICH的发病率和死亡率均呈上升趋势(EAPC=2.33%和1.51%、3.98%和3.25%、0.70%和1.01%,均P<0.05),SAH的发病率和死亡率均呈下降趋势(EAPC= –1.59%和−3.44%,均P<0.05);女性居民1990—2021年脑卒中、IS的发病率和死亡率均呈上升趋势(EAPC=1.61%和0.40%、3.15%和2.12%,均P<0.05),SAH的发病率和死亡率均呈下降趋势(EAPC= –1.69%和−4.69%,均P<0.05)。不同年龄居民中,1990年和2021年脑卒中及3种亚型的发病率和死亡率均随年龄增长而升高;脑卒中发病率除75~79岁居民差异无统计学意义外,其他各年龄组居民1990—2021年脑卒中发病率和死亡率均呈下降趋势(均P<0.05);IS发病率除<20岁居民呈下降趋势和20~24岁居民差异均无统计学意义外,其他各年龄组居民1990—2021年IS发病率均呈上升趋势(均P<0.05);IS死亡率除80~84岁和≥85岁居民差异均无统计学意义外,其他各年龄组居民1990—2021年IS死亡率均呈下降趋势(均P<0.05);各年龄组居民1990—2021年ICH、SAH发病率和死亡率均呈下降趋势(均P<0.05)。

结论

中国居民1990—2021年脑卒中、IS和ICH的发病率和死亡率均呈上升趋势,SAH的发病率和死亡率均呈下降趋势,男性和老年人为脑卒中发病和死亡的高危人群。

脑卒中  /  亚型  /  发病  /  死亡  /  趋势  /  中国居民
Objective

To analyze the trends in incidence and mortality of stroke, including ischemic stroke (IS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH), among Chinese residents from 1990 to 2021, and to provide a reference for stroke prevention and control strategies in China.

Methods

Data on the incidence and mortality of stroke, IS, ICH, and SAH among Chinese residents in 1990 and 2021 were obtained from the Global Burden of Disease (GBD) 2021 study. Descriptive analyses were performed using the number of incident cases, incidence rate, number of deaths, and mortality rate. Statistical analyses were conducted using R 4.1.0 software. Trends in the incidence and mortality of stroke and its three subtypes from 1990 to 2021 were analyzed using the overall percentage change and estimated annual percentage change (EAPC).

Results

The number of incident stroke cases, incidence rate (per 100 000), number of deaths, and mortality rate (per 100 000) among Chinese residents increased from 1 685 762, 143.29, 1 530 590, and 130.10 in 1990 to 4 090 480, 287.51, 2 591 647, and 182.16 in 2021, with overall relative percentage changes of 142.65%, 100.64%, 69.32%, and 40.01%, respectively. Both the incidence and mortality rates of stroke showed a significant increasing trend from 1990 to 2021 (EAPC = 2.02% and 1.01%, both P < 0.001). For IS, the number of incident cases, incidence rate, number of deaths, and mortality rate increased from 761 191, 64.70, 427 970, and 36.38 in 1990 to 2 772 053, 194.84, 1 176 952, and 82.72 in 2021, with overall relative percentage changes of 264.17%, 201.13%, 175.01%, and 127.40%, respectively. Both the incidence and mortality rates of IS showed a significant increasing trend (EAPC = 3.56% and 2.74%, both P < 0.001). For ICH, the corresponding figures increased from 774 012, 65.79, 913 023, and 77.61 in 1990 to 1 173 288, 82.47, 1 322 893, and 92.98 in 2021, with overall relative percentage changes of 51.59%, 25.34%, 44.89%, and 19.81%, respectively. Both the incidence and mortality rates of ICH showed a significant increasing trend (EAPC = 0.40% and 0.50%, both P < 0.01). In contrast, for SAH, the figures decreased from 150 559, 12.80, 189 598, and 16.12 in 1990 to 145 138, 10.20, 91 802, and 6.45 in 2021, with overall relative percentage changes of –3.60%, –20.29%, –51.58%, and –59.96%, respectively. Both the incidence and mortality rates of SAH showed a significant decreasing trend (EAPC = –1.69% and –4.02%, both P < 0.001). In both 1990 and 2021, male residents had higher incidence and mortality rates of stroke, IS, and ICH, as well as a higher incidence rate of SAH compared to females, except for the SAH mortality rate. From 1990 to 2021, the incidence and mortality rates of stroke, IS, and ICH increased in males (EAPC = 2.33% and 1.51%, 3.98% and 3.25%, 0.70% and 1.01%, respectively; all P < 0.05), while the incidence and mortality rates of SAH decreased (EAPC = –1.59% and –3.44%, respectively; both P < 0.05). In females, the incidence and mortality rates of stroke and IS increased (EAPC = 1.61% and 0.40%, 3.15% and 2.12%, respectively; all P<0.05), while the incidence and mortality rates of SAH decreased (EAPC = –1.69% and –4.69%, respectively; both P < 0.05). In both 1990 and 2021, the incidence and mortality rates of stroke and its three subtypes increased with age. The incidence rate of stroke decreased in all age groups from 1990 to 2021 (all P < 0.05), except for the 75 - 79 age group, where the difference was not statistically significant. The incidence rate of IS increased in all age groups (all P < 0.05), except for the age group under 20, which showed a decreasing trend, and the 20 - 24 age group, where the difference was not statistically significant. The mortality rate of IS decreased in all age groups (all P < 0.05), except for the 80 - 84 and ≥ 85 age groups, where the differences were not statistically significant. The incidence and mortality rates of ICH and SAH decreased in all age groups (all P < 0.05).

Conclusions

From 1990 to 2021, the incidence and mortality rates of stroke, IS, and ICH increased among Chinese residents, while the incidence and mortality rates of SAH decreased. Males and the elderly are high-risk groups for stroke incidence and mortality.

stroke  /  subtype  /  incidence  /  mortality  /  trend  /  Chinese residents
董文娇, 赖凤霞, 令垚, 金智美, 陈浩, 孔丹莉, 丁元林. 1990—2021年中国居民脑卒中及其亚型发病和死亡趋势分析. 中国公共卫生, 2025 , 41 (5) : 599 -605 . DOI: 10.11847/zgggws1145478
Wenjiao DONG, Fengxia LAI, Yao LING, Zhimei JIN, Hao CHEN, Danli KONG, Yuanlin DING. Incidence and mortality trends of stroke and its subtypes among residents in China from 1990 to 2021: an analysis of GBD 2021 data[J]. Chinese Journal of Public Health, 2025 , 41 (5) : 599 -605 . DOI: 10.11847/zgggws1145478
脑卒中,又称中风和脑血管意外,指因血管突然破裂或因脑部血管堵塞导致血液不能进入大脑而引起脑组织损伤或者功能障碍的一种急性脑血管疾病[1]。根据世界中风组织统计,脑卒中是全球居民第二大死因[2],也是中国居民死亡的首位病因[3],因此研究我国居民脑卒中发病和死亡变化趋势对于脑卒中的防控具有重要意义[4]。为分析中国居民1990—2021年脑卒中及缺血性脑卒中(ischemic stroke,IS)、脑出血(intracerebral hemorrhage,ICH)和蛛网膜下腔出血(subarachnoid hemorrhage,SAH)3种亚型的发病和死亡趋势,为我国居民脑卒中的预防控制提供参考依据,本研究收集2021年全球疾病负担(Global Burden of Disease Study 2021,GBD 2021)研究中1990—2021年中国居民脑卒中及IS、ICH和SAH 3种亚型发病和死亡的相关数据,采用发病数、发病率、死亡数和死亡率等指标进行描述性分析,采用总变化率和年估计变化百分比(estimated annual percentage change, EAPC)分析我国居民1990—2021年脑卒中及其3种亚型发病和死亡的变化趋势。结果报告如下。
资料来源于GBD 2021研究,所有数据均可在全球健康数据交换(Global Health Data Exchange,GHDx)网站(http://ghdx.healthdata.org/gbd-results-tool)查询下载。GBD 2021数据库采用统一、可比的方法对全球204个国家和地区的371种疾病类型以及88种危险因素进行整合并免费开放[5],该数据库收录的中国居民发病率和患病率数据主要来自国家卫生服务调查、疾病监测和已发表的文献研究等,死亡数据主要来自中国疾病预防控制中心死因报告数据、人口普查数据和中国死因监测系统等[6],可以极大程度地保证数据的可靠性和代表性。本研究收集其中1990—2021年中国居民脑卒中发病及死亡情况,采用发病数、发病率、死亡数和死亡率等数据进行分析。根据《国际疾病分类第10版(International Classification of Diseases Version 10,ICD-10)》编码原则[7],脑卒中分为IS和出血性脑卒中(hemorrhage stroke,HS),其中HS又分为ICH和SAH,脑卒中、IS、ICH和SAH编码分别为I64、I63.9、I61和I60。本研究从GBD 2021数据库中提取1990—2021年中国脑卒中及IS、ICH和SAH 3种亚型发病和死亡相关数据进行分析。
采用Excel 2016建立数据库进行一般描述性分析,分析指标包括发病数、发病率、死亡数和死亡率;应用R 4.1.0软件进行统计分析,通过计算总变化率和EAPC分析脑卒中及IS、ICH和SAH 3种亚型发病率和死亡率的变化趋势[8–9]。总变化率=(2021年指标数值–1990年指标数值)/1990年指标数值×100%;$ \mathrm{E}\mathrm{A}\mathrm{P}\mathrm{C}({\%})= 100\times(e^{\alpha}-1) $。其中$ , $e为自然常数;$ \alpha $为一元线性回归方程$ y=\alpha x+\varepsilon $的回归系数,y表示脑卒中及其亚型发病率/死亡率的自然对数,$ x $表示年份,$ \varepsilon $为一元线性回归方程的截距的近似值。检验水准为双侧检验α=0.05。
中国居民脑卒中发病数和发病率分别从1990年的1 685 762例和143.29/10万上升至2021年的4 090 480例和287.51/10万,总变化率分别为142.65%和100.64%,中国居民1990—2021年脑卒中发病率呈上升趋势(EAPC=2.02%,P<0.001);IS发病数和发病率分别从1990年的761 191例和64.70/10万上升至2021年的2 772 053例和194.84/10万,总变化率分别为264.17%和201.13%,中国居民1990—2021年IS发病率呈上升趋势(EAPC=3.56%,P<0.001);ICH发病数和发病率分别从1990年的774 012例和65.79/10万上升至2021年的1 173 288例和82.47/10万,总变化率分别为51.59%和25.34%,中国居民1990—2021年ICH发病率呈上升趋势(EAPC=0.40%,P=0.002);SAH发病数和发病率分别从1990年的150 559例和12.80/10万下降至2021年的145 138例和10.20/10万,总变化率分别为−3.60%和−20.29%,中国居民1990—2021年SAH发病率呈下降趋势(EAPC= –1.69%,P<0.001)。
中国居民脑卒中死亡数和死亡率分别从1990年的1 530 590例和130.10/10万上升至2021年的2 591 647例和182.16/10万,总变化率分别为69.32%和40.01%,中国居民1990—2021年脑卒中死亡率呈上升趋势(EAPC=1.01%,P<0.001);IS死亡数和死亡率分别从1990年的427 970例和36.38/10万上升至2021年的1 176 952例和82.72/10万,总变化率分别为175.01%和127.40%,中国居民1990—2021年IS死亡率呈上升趋势(EAPC=2.74%,P<0.001);ICH死亡数和死亡率分别从1990年的913 023例和77.61/10万上升至2021年的1 322 893例和92.98/10万,总变化率分别为44.89%和19.81%,中国居民1990—2021年ICH死亡率呈上升趋势(EAPC=0.50%,P=0.001);SAH死亡数和死亡率分别从1990年的189 598例和16.12/10万下降至2021年的91 802例和6.45/10万,总变化率分别为−51.58%和−59.96%,中国居民1990—2021年SAH死亡率呈下降趋势(EAPC= –4.02%,P<0.001)。
不同性别居民中,1990年和2021年除SAH死亡率外,男性居民脑卒中、IS、ICH发病率和死亡率及SAH发病率均高于女性居民;男性居民1990—2021年脑卒中、IS、ICH的发病率和死亡率均呈上升趋势,SAH的发病率和死亡率均呈下降趋势(均P<0.05);女性居民1990—2021年脑卒中、IS的发病率和死亡率均呈上升趋势,SAH的发病率和死亡率均呈下降趋势(均P<0.05)。
不同年龄居民中,1990年和2021年脑卒中及3种亚型的发病率和死亡率均随年龄增长而升高;除75~79岁居民脑卒中发病率下降趋势差异无统计学意义外,其他各年龄组居民1990—2021年脑卒中发病率和死亡率均呈下降趋势(均P<0.05);IS发病率除<20岁居民呈下降趋势和20~24岁居民差异无统计学意义外,其他各年龄组居民1990—2021年IS发病率均呈上升趋势(均P<0.05);IS死亡率除80~84岁和≥85岁居民差异均无统计学意义外,其他各年龄组居民1990—2021年IS死亡率均呈下降趋势(均P<0.05);各年龄组居民1990—2021年ICH、SAH发病率和死亡率均呈下降趋势(均P<0.05)。
脑卒中作为一种严重的脑血管疾病,具有高发病率、高死亡率和高复发率等特点[10–11],是中国最严重的公共卫生问题之一[12]。本研究通过GBD 2021数据库对中国居民1990—2021年脑卒中及IS、ICH、SAH 3种亚型发病率和死亡率数据进行分析发现,中国居民1990—2021年脑卒中的发病率和死亡率均呈上升趋势,3种亚型中IS和ICH的发病率和死亡率均呈上升趋势,而SAH的发病率和死亡率均呈下降趋势,与Sun T等[13]研究结果一致,提示我国脑卒中防控形势依然严峻。这可能是因为随着经济的快速发展,居民生活方式和饮食习惯发生了改变,如缺少运动、吸烟饮酒以及高糖高盐高脂饮食等,这些均为脑卒中发病率和死亡率上升的重要原因[14–15];与此同时,中国作为世界上人口老龄化速度最快的国家之一,中老年人口数的持续增加会加重脑卒中的疾病负担[16];此外,诊断技术水平的提高亦为脑卒中发病率的上升提供了数据支持,而医疗资源的不平衡分配也会使偏远和欠发达地区的脑卒中患者无法得到及时有效的诊治而导致死亡率的上升[17]。
与国内外相关研究[18–19]一致,1990—2021年我国男性和女性居民脑卒中的发病率和死亡率均呈上升趋势,且男性居民的发病率和死亡率均高于女性居民;1990—2021年我国男性和女性居民IS的发病率和死亡率亦均呈上升趋势,男性居民发病率和死亡率均高于女性居民且增长速度高于女性居民,与全球变化趋势相似[20]。1990—2021年ICH仅男性居民的发病率和死亡率呈上升趋势,且男性居民发病率和死亡率均高于女性居民,与Xu L B等[21]研究结果一致;1990—2021年我国男性和女性居民SAH的发病率和死亡率均呈下降趋势,男性居民发病率和死亡率均高于女性居民但男性居民的下降速度低于女性居民。提示男性居民脑卒中疾病负担更为沉重,可能与女性教育不平等状态改善、雌激素的保护作用、脑卒中的防范意识更强以及男性具有吸烟、饮酒和高盐饮食的习惯有关[22],提示在制定脑卒中防控策略时应考虑性别因素的影响,针对不同性别制定个性化的干预措施。
本研究结果显示,中国居民1990—2021年脑卒中及IS、ICH、SAH 3种亚型的发病率和死亡率均随年龄的增长而升高,与国内外研究[23–24]结果一致。其中,脑卒中发病率和死亡率在<20岁年龄组居民中变化最大(EAPC= –1.49%和−5.92%),表明该年龄组居民脑卒中疾病负担较轻且呈下降趋势,但该年龄组居民脑卒中产生的长期经济负担可能高于成年人[25],仍需采取具有针对性的预防措施;在30~34岁年龄组居民中,脑卒中的发病率和死亡率降低较小,总变化率分别为−1.80%和−3.82%,提示对于中青年人群脑卒中的防控工作仍需重视;在75~79岁年龄组居民中,脑卒中发病率的变化差异无统计学意义,但在该年龄组居民中脑卒中亚型IS的发病率变化最大(EAPC=1.71%),研究表明IS发病率的升高可能与老年人血管出现退行性改变有关[26];在≥85岁年龄组居民中,脑卒中及3种亚型的发病率和死亡率均最高,与汤少梁等[27]研究结果一致,这可能与高龄者免疫力较差、基础疾病患病风险较高和自我管理能力较弱有关[28]。有研究表明,年龄为脑卒中发病的独立危险因素[29],年龄每增加1岁,脑卒中的发病风险约增加10%[30]。因此,加强对中老年群体脑卒中的监测并开展健康教育,提高其对脑卒中的预防意识,对脑卒中的防治具有重要意义。
综上所述,中国居民1990—2021年脑卒中、IS和ICH的发病率和死亡率均呈上升趋势,SAH的发病率和死亡率均呈下降趋势,男性和老年人为脑卒中发病和死亡的高危人群。因此应将男性、老年人和IS亚型患者作为脑卒中的重点关注对象,适当予以卫生资源分配的倾斜,并根据不同性别、年龄和脑卒中亚型制定具有针对性的防治措施以减轻脑卒中的疾病负担。由于本研究数据来源于GBD 2021,无法对中国各地区居民脑卒中发病率和死亡率的变化趋势分析,因此不能准确反映内部差异性。今后可借助国家及地方健康统计系统获取分地区的脑卒中发病率和死亡率数据,并联合多中心研究以及区域性流行病学调查补充全球疾病负担数据库中未涵盖的区域性数据,为制定分层化和针对性的防控措施提供科学依据。

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doi: 10.11847/zgggws1145478
  • 接收时间:2024-07-18
  • 首发时间:2026-10-25
  • 出版时间:2025-05-10
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  • 收稿日期:2024-07-18
  • 修回日期:2024-11-22
  • 录用日期:2025-04-01
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