Article(id=1321170564102861032, tenantId=1146029695717560320, journalId=1319373219989389464, issueId=1321170520196895605, articleNumber=null, orderNo=null, doi=10.11847/zgggws1144703, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1713024000000, receivedDateStr=2024-04-14, revisedDate=1725465600000, revisedDateStr=2024-09-05, acceptedDate=1731945600000, acceptedDateStr=2024-11-19, onlineDate=1792921208644, onlineDateStr=2026-10-25, pubDate=1741536000000, pubDateStr=2025-03-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1792921208644, onlineIssueDateStr=2026-10-25, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1792921208644, creator=13701087609, updateTime=1792921208644, updator=13701087609, issue=Issue{id=1321170520196895605, tenantId=1146029695717560320, journalId=1319373219989389464, year='2025', volume='41', issue='3', pageStart='257', pageEnd='384', issueExtLink='null', onlineDate='null', pubDate='1741536000000', pubDateStr='2025-03-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1792921198175, creator='13701087609', updateTime=1792921198175, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=257, endPage=262, ext={EN=ArticleExt(id=1321170564513902826, articleId=1321170564102861032, tenantId=1146029695717560320, journalId=1319373219989389464, language=EN, title=The trends in stroke burden and its associated risk factors among Chinese residents from 1990 to 2019, columnId=1321170564291604713, journalTitle=Chinese Journal of Public Health, columnName=Special Report–Research on Disease Burden, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the trends in the burden of stroke and its risk factors among Chinese residents from 1990 to 2019, and to provide a scientific basis for formulating targeted stroke prevention and control strategies.

Methods

Data on the burden of stroke among Chinese residents in 1990, 2000, 2010, and 2019 were collected from the 2019 Global Burden of Disease Study (GBD 2019). Indicators such as disability-adjusted life years (DALYs), DALY rates, and population attributable fractions (PAFs) were used to analyze the trends in the burden of stroke and its risk factors among Chinese residents from 1990 to 2019.

Results

In 2019, the DALY rates of stroke, ischemic stroke, and hemorrhagic stroke among Chinese residents increased with age, with the highest rates observed in the ≥70 age group (21 061.26/100 000, 11 858.11/100 000, and 8 505.17/100 000, respectively). The DALY rates of stroke, ischemic stroke, and hemorrhagic stroke were higher in men (3 739.30/100 000, 1 627.23/100 000, and 1 924.07/100 000, respectively) than in women (2 701.81/100 000, 1 376.19/100 000, and 1 184.82/100 000, respectively). From 1990 to 2019, the DALY rates of stroke and ischemic stroke increased (with average annual growth rates of 0.44% and 2.39%, respectively), while the DALY rate of hemorrhagic stroke decreased (with an average annual growth rate of –0.08%). In 2019, the top three risk factors for stroke in terms of DALYs, PAFs, and DALY rates were high systolic blood pressure (251763 million person-years, 54.80%, and 1 770.05/100 000, respectively), ambient air pollution (128473 million person-years, 27.95%, and 903.24/100 000, respectively), and smoking (10.099 3 million person-years, 21.96%, and 710.04/100 000, respectively). The top three risk factors for ischemic stroke were high systolic blood pressure (10.896 8 million person-years, 50.94%, and 766.11/100 000, respectively), ambient air pollution (5.737 8 million person-years, 26.81%, and 403.40/100 000, respectively), and high LDL cholesterol (4.427 7 million person-years, 20.69%, and 311.29/100 000, respectively). The top three risk factors for hemorrhagic stroke were high systolic blood pressure (12.919 0 million person-years, 58.18%, and 908.28/100 000, respectively), ambient air pollution (6.403 9 million person-years, 28.82%, and 450.23/100 000, respectively), and high-sodium diet (5.421 3 million person-years, 24.40%, and 381.15/100 000, respectively). From 1990 to 2019, the PAFs of eight risk factors for stroke increased and two decreased, six risk factors for ischemic stroke increased and four decreased, and eight risk factors for hemorrhagic stroke increased and two decreased. Among these, the PAF of ambient air pollution showed the largest increase (with average annual growth rates of 2.83%, 2.65%, and 2.90%, respectively), while the PAF of high-sodium diet showed the largest decrease (with average annual growth rates of –0.36%, –0.43%, and –0.16%, respectively).

Conclusions

The burden of stroke among Chinese residents remained high from 1990 to 2019, with an increasing trend in DALY rates. High systolic blood pressure remained the leading risk factor for stroke and its subtypes.

, authors=Xiangrui FU1, Guanghan ZHU1, Wenxin TIAN1, Wen LI1, Wenbo XIAO1, Wenli LU1, 2, Yuan WANG1, 2, authorsList=Xiangrui FU, Guanghan ZHU, Wenxin TIAN, Wen LI, Wenbo XIAO, Wenli LU, Yuan WANG, authorCompany=null, correspAuthors=Yuan WANG, authorNote=null, correspAuthorsNote=
WANG Yuan, 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=1321170565096911084, articleId=1321170564102861032, tenantId=1146029695717560320, journalId=1319373219989389464, language=CN, title=1990—2019年中国居民脑卒中及其危险因素疾病负担变化趋势分析, columnId=1321170564589400299, journalTitle=中国公共卫生, columnName=专题报道——疾病负担研究, runingTitle=null, highlight=null, articleAbstract=
目的

分析1990—2019年中国居民脑卒中及其危险因素疾病负担变化趋势,为制定有针对性的脑卒中防治策略提供科学依据。

方法

收集2019年全球疾病负担研究(GBD 2019)中1990、2000、2010和2019年中国居民脑卒中的疾病负担相关数据,采用伤残调整寿命年(DALYs)、DALYs率和人群归因分值(PAF)等指标对1990—2019年中国居民脑卒中及其危险因素疾病负担的变化趋势进行分析。

结果

2019年中国居民脑卒中、缺血性脑卒中和出血性脑卒中的DALYs率均随年龄增长而升高,其中以≥70岁年龄组最高,分别为21 061.26/10万、11 858.11/10万和8 505.17/10万;男性居民脑卒中、缺血性脑卒中和出血性脑卒中的DALYs率分别为3 739.30/10万、1 627.23/10万和1924.07/10万,均高于女性居民的2 701.81/10万、1 376.19/10万和1 184.82/10万;1990—2019年中国居民脑卒中和缺血性脑卒中的DALYs率均有所上升(年均增长率分别为0.44%和2.39%),出血性脑卒中的DALYs率有所下降(年均增长率为–0.08%);2019年DALYs、PAF和DALYs率居于脑卒中前3位的危险因素依次为高收缩压(2 517.63万人年、54.80%和1 770.05/10万)、室外空气污染(1 284.73万人年、27.95%和903.24/10万)、吸烟(1 009.93万人年、21.96%和710.04/10万),居于缺血性脑卒中前3位的危险因素依次为高收缩压(1 089.68万人年、50.94%和766.11/10万)、室外空气污染(573.78万人年、26.81%和403.40/10万)、高低密度脂蛋白胆固醇(442.77万人年、20.69%和311.29/10万),居于出血性脑卒中前3位的危险因素依次为高收缩压(1 291.90万人年、58.18%和908.28/10万)、室外空气污染(640.39万人年、28.82%和450.23/10万)、高钠饮食(542.13万人年、24.40%和381.15/10万);1990—2019年中国居民脑卒中、缺血性脑卒中、出血性脑卒中危险因素PAF上升的和下降的分别为8种和2种、6种和4种、8种和2种,其中室外空气污染的PAF上升幅度均最大(年均增长率分别为2.83%、2.65%、2.90%),高钠饮食的PAF下降幅度均最大(年均增长率分别为–0.36%、–0.43%、–0.16%)。

结论

1990—2019年中国居民脑卒中的疾病负担仍然较高,DALYs率呈上升趋势,高收缩压始终是造成脑卒中及其亚型疾病负担的首位危险因素。

, authors=付祥锐1, 朱广涵1, 田文心1, 李文1, 肖文博1, 芦文丽1, 2, 王媛1, 2, *, *, authorsList=付祥锐, 朱广涵, 田文心, 李文, 肖文博, 芦文丽, 王媛, authorCompany=null, correspAuthors=王媛, authorNote=

付祥锐(1998—),硕士在读,研究方向:流行病与卫生统计学

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王媛,E-mail:
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Burden and trend of stroke, ischemic stroke, and hemorrhagic stroke in Chinese residents from 1990 to 2019

, figureFileSmall=null, figureFileBig=null, tableContent=
年龄及年均增长率年份脑卒中DALYs率/(1/10万)缺血性脑卒中DALYs率/(1/10万)出血性脑卒中DALYs率/(1/10万)
男性女性合计男性女性合计男性女性合计
15~49岁1990952.91718.87839.81138.50146.16142.20613.71407.79514.20
20001 032.96824.31931.48164.35172.71168.42715.71507.06614.23
20101 025.14526.13780.32174.77135.50155.51763.33331.27551.36
2019908.03423.07671.78183.55138.97161.83636.23231.64439.13
年均增长率/%1990—20000.811.381.041.731.681.711.552.201.79
2000—2010–0.08–4.39–1.760.62–2.40–0.790.65–4.17–1.07
2010—2019–1.34–2.39–1.650.550.280.44–2.00–3.90–2.50
1990—2019–0.17–1.81–0.770.98–0.170.450.12–1.93–0.54
50~69岁199010 933.958 951.279 978.182 670.062 175.522 431.666 576.495 142.165 885.06
20009 768.446 604.408 239.592 576.371 908.612 253.716 067.353 863.645 002.53
20107 552.404 681.396 141.472 372.591 645.932 002.904 814.472 762.343 805.97
20196 174.603 732.944 954.132 394.171 611.412 015.483 446.581 882.592 664.82
年均增长率/%1990—2000–1.12–2.99–1.90–0.36–1.30–0.76–0.80–2.82–1.61
2000—2010–2.54–3.38–2.90–0.82–1.47–1.17–2.29–3.30–2.70
2010—2019–2.21–2.48–2.360.10–0.240.07–3.65–4.17–3.88
1990—2019–1.95–2.97–2.39–0.38–1.03–0.65–2.20–3.41–2.70
≥70岁199033 603.6927 990.0230 412.2411 859.4710 139.2010 881.4717 462.2213 777.6915 367.51
200033 650.4926 304.6229 604.4212 812.0610 890.3111 753.5717 949.5813 031.1515 240.54
201029 743.2822 104.3125 628.3913 746.1411 085.8412 313.1215 098.3010 358.1612 544.93
201924 990.9317 766.3021 061.2613 575.2310 418.3311 858.1110 593.076 754.508 505.17
年均增长率/%1990—20000.01–0.62–0.270.780.720.770.28–0.56–0.08
2000—2010–1.23–1.72–1.430.710.180.47–1.71–2.27–1.93
2010—2019–1.92–2.40–2.16–0.14–0.69–0.42–3.86–4.64–4.23
1990—2019–1.02–1.56–1.260.470.090.30–1.71–2.43–2.02
合计19902 967.312 705.372 840.40756.30758.48757.361 731.901 458.301 599.34
20003 312.492 744.853 037.45950.27909.20930.371 990.291 504.361 754.84
20103 599.662 625.383 123.991 267.981 100.901 186.412 160.381 392.171 785.32
20193 739.302 701.813 230.511 627.231 376.191 504.121924.071 184.821 561.54
年均增长率/%1990—20001.110.140.672.311.832.081.400.310.93
2000—20100.83–0.440.282.931.932.460.82–0.770.17
2010—20190.420.320.372.812.512.67–1.28–1.78–1.48
1990—20190.800.000.442.682.082.390.36–0.71–0.08
), ArticleFig(id=1321170876981166500, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170564102861032, language=CN, label=表1, caption=

1990—2019年中国居民脑卒中、缺血性脑卒中和出血性脑卒中疾病负担及其变化趋势

, figureFileSmall=null, figureFileBig=null, tableContent=
年龄及年均增长率年份脑卒中DALYs率/(1/10万)缺血性脑卒中DALYs率/(1/10万)出血性脑卒中DALYs率/(1/10万)
男性女性合计男性女性合计男性女性合计
15~49岁1990952.91718.87839.81138.50146.16142.20613.71407.79514.20
20001 032.96824.31931.48164.35172.71168.42715.71507.06614.23
20101 025.14526.13780.32174.77135.50155.51763.33331.27551.36
2019908.03423.07671.78183.55138.97161.83636.23231.64439.13
年均增长率/%1990—20000.811.381.041.731.681.711.552.201.79
2000—2010–0.08–4.39–1.760.62–2.40–0.790.65–4.17–1.07
2010—2019–1.34–2.39–1.650.550.280.44–2.00–3.90–2.50
1990—2019–0.17–1.81–0.770.98–0.170.450.12–1.93–0.54
50~69岁199010 933.958 951.279 978.182 670.062 175.522 431.666 576.495 142.165 885.06
20009 768.446 604.408 239.592 576.371 908.612 253.716 067.353 863.645 002.53
20107 552.404 681.396 141.472 372.591 645.932 002.904 814.472 762.343 805.97
20196 174.603 732.944 954.132 394.171 611.412 015.483 446.581 882.592 664.82
年均增长率/%1990—2000–1.12–2.99–1.90–0.36–1.30–0.76–0.80–2.82–1.61
2000—2010–2.54–3.38–2.90–0.82–1.47–1.17–2.29–3.30–2.70
2010—2019–2.21–2.48–2.360.10–0.240.07–3.65–4.17–3.88
1990—2019–1.95–2.97–2.39–0.38–1.03–0.65–2.20–3.41–2.70
≥70岁199033 603.6927 990.0230 412.2411 859.4710 139.2010 881.4717 462.2213 777.6915 367.51
200033 650.4926 304.6229 604.4212 812.0610 890.3111 753.5717 949.5813 031.1515 240.54
201029 743.2822 104.3125 628.3913 746.1411 085.8412 313.1215 098.3010 358.1612 544.93
201924 990.9317 766.3021 061.2613 575.2310 418.3311 858.1110 593.076 754.508 505.17
年均增长率/%1990—20000.01–0.62–0.270.780.720.770.28–0.56–0.08
2000—2010–1.23–1.72–1.430.710.180.47–1.71–2.27–1.93
2010—2019–1.92–2.40–2.16–0.14–0.69–0.42–3.86–4.64–4.23
1990—2019–1.02–1.56–1.260.470.090.30–1.71–2.43–2.02
合计19902 967.312 705.372 840.40756.30758.48757.361 731.901 458.301 599.34
20003 312.492 744.853 037.45950.27909.20930.371 990.291 504.361 754.84
20103 599.662 625.383 123.991 267.981 100.901 186.412 160.381 392.171 785.32
20193 739.302 701.813 230.511 627.231 376.191 504.121924.071 184.821 561.54
年均增长率/%1990—20001.110.140.672.311.832.081.400.310.93
2000—20100.83–0.440.282.931.932.460.82–0.770.17
2010—20190.420.320.372.812.512.67–1.28–1.78–1.48
1990—20190.800.000.442.682.082.390.36–0.71–0.08
), ArticleFig(id=1321170877081829797, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170564102861032, language=EN, label=Tab.2, caption=

Trends in attributable DALYs and PAFs of risk factors for stroke, ischemic stroke, and hemorrhagic stroke among Chinese residents from 1990 to 2019

, figureFileSmall=null, figureFileBig=null, tableContent=
项目危险因素DALYs/万人年年均增长率/%PAF/%年均增长率/%
1990年2000年2010年2019年1990年2000年2010年2019年
脑卒中高收缩压1 518.981 948.592 312.622 517.631.7645.1549.3354.2554.800.67
室外空气污染418.07752.061 093.771 284.733.9512.4319.0525.6627.952.83
吸烟704.40955.54979.071 009.931.2520.9424.1922.9621.960.16
高钠饮食811.54907.02950.57999.020.7224.1222.9622.3021.74–0.36
高体质量指数337.64497.63661.91818.833.1010.0412.6015.5217.822.00
高血糖457.06625.16744.07753.321.7413.5915.8217.4616.380.65
红肉摄入过多244.16325.14424.11494.142.467.268.239.9510.751.36
高低密度脂蛋白胆固醇194.75260.34343.91442.772.875.796.598.079.641.77
低温315.81364.36393.07398.570.819.399.229.228.67–0.27
饮酒208.90261.64338.98374.942.046.216.627.958.150.94
缺血性脑卒中高收缩压381.60551.04810.331 089.683.6842.5545.5450.0650.940.62
室外空气污染112.40224.71400.04573.785.7812.5418.5824.7126.812.65
高低密度脂蛋白胆固醇194.75260.34343.91442.772.8721.7321.5221.2420.69–0.17
吸烟176.08266.53325.83417.253.0219.6322.0320.1319.49–0.02
高钠饮食189.25235.39302.61397.932.6021.1019.4618.7018.61–0.43
高血糖135.26213.27308.27366.733.5015.0617.6119.0517.130.45
高体质量指数64.75106.86173.70272.265.087.228.8310.7312.731.97
红肉摄入过多57.2185.21136.06197.614.376.387.048.419.231.28
肾脏功能受损76.7797.55141.41184.603.078.568.068.738.620.02
低温74.8099.50132.51163.782.748.348.238.197.66–0.29
出血性脑卒中高收缩压882.711 170.321 385.881 291.901.3246.5851.2856.8958.180.77
室外空气污染238.12443.15638.04640.393.4712.5819.4326.1928.822.90
高钠饮食483.77562.46596.38542.130.3925.5324.6424.4724.40–0.16
吸烟415.76580.40604.04538.400.9021.9425.4224.7924.210.34
高体质量指数210.21325.16444.71487.832.9511.1014.2518.2521.962.38
高血糖250.48346.90404.51350.661.1713.2415.2016.6015.790.61
饮酒190.24236.68295.12304.401.6310.0410.3712.1113.691.08
红肉摄入过多144.27199.57263.67266.292.147.638.7510.8211.991.57
低温185.17221.22241.64213.920.509.789.699.929.63–0.05
肾脏功能受损148.58171.39201.13182.670.717.857.518.268.220.16
), ArticleFig(id=1321170877341876647, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170564102861032, language=CN, label=表2, caption=

1990—2019年中国居民脑卒中、缺血性脑卒中和出血性脑卒中危险因素的归因DALYs和PAF变化趋势

, figureFileSmall=null, figureFileBig=null, tableContent=
项目危险因素DALYs/万人年年均增长率/%PAF/%年均增长率/%
1990年2000年2010年2019年1990年2000年2010年2019年
脑卒中高收缩压1 518.981 948.592 312.622 517.631.7645.1549.3354.2554.800.67
室外空气污染418.07752.061 093.771 284.733.9512.4319.0525.6627.952.83
吸烟704.40955.54979.071 009.931.2520.9424.1922.9621.960.16
高钠饮食811.54907.02950.57999.020.7224.1222.9622.3021.74–0.36
高体质量指数337.64497.63661.91818.833.1010.0412.6015.5217.822.00
高血糖457.06625.16744.07753.321.7413.5915.8217.4616.380.65
红肉摄入过多244.16325.14424.11494.142.467.268.239.9510.751.36
高低密度脂蛋白胆固醇194.75260.34343.91442.772.875.796.598.079.641.77
低温315.81364.36393.07398.570.819.399.229.228.67–0.27
饮酒208.90261.64338.98374.942.046.216.627.958.150.94
缺血性脑卒中高收缩压381.60551.04810.331 089.683.6842.5545.5450.0650.940.62
室外空气污染112.40224.71400.04573.785.7812.5418.5824.7126.812.65
高低密度脂蛋白胆固醇194.75260.34343.91442.772.8721.7321.5221.2420.69–0.17
吸烟176.08266.53325.83417.253.0219.6322.0320.1319.49–0.02
高钠饮食189.25235.39302.61397.932.6021.1019.4618.7018.61–0.43
高血糖135.26213.27308.27366.733.5015.0617.6119.0517.130.45
高体质量指数64.75106.86173.70272.265.087.228.8310.7312.731.97
红肉摄入过多57.2185.21136.06197.614.376.387.048.419.231.28
肾脏功能受损76.7797.55141.41184.603.078.568.068.738.620.02
低温74.8099.50132.51163.782.748.348.238.197.66–0.29
出血性脑卒中高收缩压882.711 170.321 385.881 291.901.3246.5851.2856.8958.180.77
室外空气污染238.12443.15638.04640.393.4712.5819.4326.1928.822.90
高钠饮食483.77562.46596.38542.130.3925.5324.6424.4724.40–0.16
吸烟415.76580.40604.04538.400.9021.9425.4224.7924.210.34
高体质量指数210.21325.16444.71487.832.9511.1014.2518.2521.962.38
高血糖250.48346.90404.51350.661.1713.2415.2016.6015.790.61
饮酒190.24236.68295.12304.401.6310.0410.3712.1113.691.08
红肉摄入过多144.27199.57263.67266.292.147.638.7510.8211.991.57
低温185.17221.22241.64213.920.509.789.699.929.63–0.05
肾脏功能受损148.58171.39201.13182.670.717.857.518.268.220.16
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Rank of DALYs rate for 10 risk factors of stroke, ischemic stroke, and hemorrhagic stroke among Chinese residents from 1990 to 2019

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项目顺位1990年2000年2010年2019年
危险因素DALYs率/
(1/10万)
危险因素DALYs率/
(1/10万)
危险因素DALYs率/
(1/10万)
危险因素DALYs率/
(1/10万)
脑卒中1高收缩压1 283.27高收缩压1 498.39高收缩压1 694.81高收缩压1 770.05
2室内空气污染837.85吸烟734.77室外空气污染801.57室外空气污染903.24
3高钠饮食685.60高钠饮食697.47吸烟717.51吸烟710.04
4吸烟595.10室内空气污染657.14高钠饮食696.63高钠饮食702.37
5高血糖386.14室外空气污染578.30高血糖545.29高体质量指数575.69
6室外空气污染353.19高血糖480.72高体质量指数485.08高血糖529.63
7高体质量指数285.24高体质量指数382.66室内空气污染394.56红肉摄入过多347.41
8水果摄入不足274.22低温280.18红肉摄入过多310.81高低密度脂
蛋白胆固醇
311.29
9低温266.80水果摄入不足265.54低温288.06低温280.22
10红肉摄入过多206.27红肉摄入过多250.02低密度脂蛋白胆固醇252.03饮酒263.60
缺血性脑卒中1高收缩压322.38高收缩压423.73高收缩压593.86高收缩压766.11
2室内空气污染211.65吸烟204.95室外空气污染293.17室外空气污染403.40
3高低密度脂
蛋白胆固醇
164.53高低密度脂
蛋白胆固醇
200.19高低密度脂
蛋白胆固醇
252.03高低密度脂
蛋白胆固醇
311.29
4高钠饮食159.88室内空气污染185.15吸烟238.79吸烟293.36
5吸烟148.76高钠饮食181.00高血糖225.92高钠饮食279.77
6高血糖114.27室外空气污染172.80高钠饮食221.77高血糖257.83
7室外空气污染94.96高血糖163.99室内空气污染133.71高体质量指数191.42
8肾脏功能受损64.86高体质量指数82.17高体质量指数127.30红肉摄入过多138.94
9低温63.19低温76.51肾脏功能受损103.63肾脏功能受损129.79
10高体质量指数54.70肾脏功能受损75.01红肉摄入过多99.71低温115.15
出血性脑卒中1高收缩压745.73高收缩压899.93高收缩压1 015.65高收缩压908.28
2室内空气污染481.34吸烟446.31室外空气污染467.59室外空气污染450.23
3高钠饮食408.70高钠饮食432.51吸烟442.67高钠饮食381.15
4吸烟351.25室内空气污染389.67高钠饮食437.06吸烟378.53
5高血糖211.61室外空气污染340.76高体质量指数325.91高体质量指数342.97
6室外空气污染201.17高血糖266.75高血糖296.45高血糖246.54
7高体质量指数177.59高体质量指数250.04室内空气污染239.48饮酒214.01
8水果摄入不足173.90饮酒182.00饮酒216.28红肉摄入过多187.22
9饮酒160.72水果摄入不足175.72红肉摄入过多193.23低温150.40
10低温156.43低温170.11低温177.09肾脏功能受损128.43
), ArticleFig(id=1321170877526426025, tenantId=1146029695717560320, journalId=1319373219989389464, articleId=1321170564102861032, language=CN, label=表3, caption=

1990—2019年中国居民脑卒中、缺血性脑卒中和出血性脑卒中10种危险因素DALYs率顺位表

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项目顺位1990年2000年2010年2019年
危险因素DALYs率/
(1/10万)
危险因素DALYs率/
(1/10万)
危险因素DALYs率/
(1/10万)
危险因素DALYs率/
(1/10万)
脑卒中1高收缩压1 283.27高收缩压1 498.39高收缩压1 694.81高收缩压1 770.05
2室内空气污染837.85吸烟734.77室外空气污染801.57室外空气污染903.24
3高钠饮食685.60高钠饮食697.47吸烟717.51吸烟710.04
4吸烟595.10室内空气污染657.14高钠饮食696.63高钠饮食702.37
5高血糖386.14室外空气污染578.30高血糖545.29高体质量指数575.69
6室外空气污染353.19高血糖480.72高体质量指数485.08高血糖529.63
7高体质量指数285.24高体质量指数382.66室内空气污染394.56红肉摄入过多347.41
8水果摄入不足274.22低温280.18红肉摄入过多310.81高低密度脂
蛋白胆固醇
311.29
9低温266.80水果摄入不足265.54低温288.06低温280.22
10红肉摄入过多206.27红肉摄入过多250.02低密度脂蛋白胆固醇252.03饮酒263.60
缺血性脑卒中1高收缩压322.38高收缩压423.73高收缩压593.86高收缩压766.11
2室内空气污染211.65吸烟204.95室外空气污染293.17室外空气污染403.40
3高低密度脂
蛋白胆固醇
164.53高低密度脂
蛋白胆固醇
200.19高低密度脂
蛋白胆固醇
252.03高低密度脂
蛋白胆固醇
311.29
4高钠饮食159.88室内空气污染185.15吸烟238.79吸烟293.36
5吸烟148.76高钠饮食181.00高血糖225.92高钠饮食279.77
6高血糖114.27室外空气污染172.80高钠饮食221.77高血糖257.83
7室外空气污染94.96高血糖163.99室内空气污染133.71高体质量指数191.42
8肾脏功能受损64.86高体质量指数82.17高体质量指数127.30红肉摄入过多138.94
9低温63.19低温76.51肾脏功能受损103.63肾脏功能受损129.79
10高体质量指数54.70肾脏功能受损75.01红肉摄入过多99.71低温115.15
出血性脑卒中1高收缩压745.73高收缩压899.93高收缩压1 015.65高收缩压908.28
2室内空气污染481.34吸烟446.31室外空气污染467.59室外空气污染450.23
3高钠饮食408.70高钠饮食432.51吸烟442.67高钠饮食381.15
4吸烟351.25室内空气污染389.67高钠饮食437.06吸烟378.53
5高血糖211.61室外空气污染340.76高体质量指数325.91高体质量指数342.97
6室外空气污染201.17高血糖266.75高血糖296.45高血糖246.54
7高体质量指数177.59高体质量指数250.04室内空气污染239.48饮酒214.01
8水果摄入不足173.90饮酒182.00饮酒216.28红肉摄入过多187.22
9饮酒160.72水果摄入不足175.72红肉摄入过多193.23低温150.40
10低温156.43低温170.11低温177.09肾脏功能受损128.43
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1990—2019年中国居民脑卒中及其危险因素疾病负担变化趋势分析
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付祥锐 1 , 朱广涵 1 , 田文心 1 , 李文 1 , 肖文博 1 , 芦文丽 1, 2 , 王媛 1, 2, *, *
中国公共卫生 | 专题报道——疾病负担研究 2025,41(3): 257-262
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中国公共卫生 |专题报道——疾病负担研究 2025 , 41 (3) : 257 -262
1990—2019年中国居民脑卒中及其危险因素疾病负担变化趋势分析
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付祥锐1, 朱广涵1, 田文心1, 李文1, 肖文博1, 芦文丽1, 2, 王媛1, 2, *, *
作者信息
  • 1天津医科大学公共卫生学院流行病与卫生统计学系,天津 300070
  • 2天津市环境营养与人群健康重点实验室/环境营养与人群健康国际联合研究中心,天津 300070
通讯作者:
王媛,E-mail:
作者简介:

付祥锐(1998—),硕士在读,研究方向:流行病与卫生统计学

The trends in stroke burden and its associated risk factors among Chinese residents from 1990 to 2019
Xiangrui FU1, Guanghan ZHU1, Wenxin TIAN1, Wen LI1, Wenbo XIAO1, Wenli LU1, 2, Yuan WANG1, 2
Affiliations
  • 1Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, Tianjin 300070, China
  • 2Tianjin Key Laboratory of Environment, Nutrition and Public Health/Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin 300070, China
  • Corresponding Author:
    WANG Yuan, E-mail:
出版时间: 2025-03-10 doi: 10.11847/zgggws1144703
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目的

分析1990—2019年中国居民脑卒中及其危险因素疾病负担变化趋势,为制定有针对性的脑卒中防治策略提供科学依据。

方法

收集2019年全球疾病负担研究(GBD 2019)中1990、2000、2010和2019年中国居民脑卒中的疾病负担相关数据,采用伤残调整寿命年(DALYs)、DALYs率和人群归因分值(PAF)等指标对1990—2019年中国居民脑卒中及其危险因素疾病负担的变化趋势进行分析。

结果

2019年中国居民脑卒中、缺血性脑卒中和出血性脑卒中的DALYs率均随年龄增长而升高,其中以≥70岁年龄组最高,分别为21 061.26/10万、11 858.11/10万和8 505.17/10万;男性居民脑卒中、缺血性脑卒中和出血性脑卒中的DALYs率分别为3 739.30/10万、1 627.23/10万和1924.07/10万,均高于女性居民的2 701.81/10万、1 376.19/10万和1 184.82/10万;1990—2019年中国居民脑卒中和缺血性脑卒中的DALYs率均有所上升(年均增长率分别为0.44%和2.39%),出血性脑卒中的DALYs率有所下降(年均增长率为–0.08%);2019年DALYs、PAF和DALYs率居于脑卒中前3位的危险因素依次为高收缩压(2 517.63万人年、54.80%和1 770.05/10万)、室外空气污染(1 284.73万人年、27.95%和903.24/10万)、吸烟(1 009.93万人年、21.96%和710.04/10万),居于缺血性脑卒中前3位的危险因素依次为高收缩压(1 089.68万人年、50.94%和766.11/10万)、室外空气污染(573.78万人年、26.81%和403.40/10万)、高低密度脂蛋白胆固醇(442.77万人年、20.69%和311.29/10万),居于出血性脑卒中前3位的危险因素依次为高收缩压(1 291.90万人年、58.18%和908.28/10万)、室外空气污染(640.39万人年、28.82%和450.23/10万)、高钠饮食(542.13万人年、24.40%和381.15/10万);1990—2019年中国居民脑卒中、缺血性脑卒中、出血性脑卒中危险因素PAF上升的和下降的分别为8种和2种、6种和4种、8种和2种,其中室外空气污染的PAF上升幅度均最大(年均增长率分别为2.83%、2.65%、2.90%),高钠饮食的PAF下降幅度均最大(年均增长率分别为–0.36%、–0.43%、–0.16%)。

结论

1990—2019年中国居民脑卒中的疾病负担仍然较高,DALYs率呈上升趋势,高收缩压始终是造成脑卒中及其亚型疾病负担的首位危险因素。

脑卒中  /  缺血性卒中  /  出血性卒中  /  危险因素  /  疾病负担  /  变化趋势  /  中国居民
Objective

To analyze the trends in the burden of stroke and its risk factors among Chinese residents from 1990 to 2019, and to provide a scientific basis for formulating targeted stroke prevention and control strategies.

Methods

Data on the burden of stroke among Chinese residents in 1990, 2000, 2010, and 2019 were collected from the 2019 Global Burden of Disease Study (GBD 2019). Indicators such as disability-adjusted life years (DALYs), DALY rates, and population attributable fractions (PAFs) were used to analyze the trends in the burden of stroke and its risk factors among Chinese residents from 1990 to 2019.

Results

In 2019, the DALY rates of stroke, ischemic stroke, and hemorrhagic stroke among Chinese residents increased with age, with the highest rates observed in the ≥70 age group (21 061.26/100 000, 11 858.11/100 000, and 8 505.17/100 000, respectively). The DALY rates of stroke, ischemic stroke, and hemorrhagic stroke were higher in men (3 739.30/100 000, 1 627.23/100 000, and 1 924.07/100 000, respectively) than in women (2 701.81/100 000, 1 376.19/100 000, and 1 184.82/100 000, respectively). From 1990 to 2019, the DALY rates of stroke and ischemic stroke increased (with average annual growth rates of 0.44% and 2.39%, respectively), while the DALY rate of hemorrhagic stroke decreased (with an average annual growth rate of –0.08%). In 2019, the top three risk factors for stroke in terms of DALYs, PAFs, and DALY rates were high systolic blood pressure (251763 million person-years, 54.80%, and 1 770.05/100 000, respectively), ambient air pollution (128473 million person-years, 27.95%, and 903.24/100 000, respectively), and smoking (10.099 3 million person-years, 21.96%, and 710.04/100 000, respectively). The top three risk factors for ischemic stroke were high systolic blood pressure (10.896 8 million person-years, 50.94%, and 766.11/100 000, respectively), ambient air pollution (5.737 8 million person-years, 26.81%, and 403.40/100 000, respectively), and high LDL cholesterol (4.427 7 million person-years, 20.69%, and 311.29/100 000, respectively). The top three risk factors for hemorrhagic stroke were high systolic blood pressure (12.919 0 million person-years, 58.18%, and 908.28/100 000, respectively), ambient air pollution (6.403 9 million person-years, 28.82%, and 450.23/100 000, respectively), and high-sodium diet (5.421 3 million person-years, 24.40%, and 381.15/100 000, respectively). From 1990 to 2019, the PAFs of eight risk factors for stroke increased and two decreased, six risk factors for ischemic stroke increased and four decreased, and eight risk factors for hemorrhagic stroke increased and two decreased. Among these, the PAF of ambient air pollution showed the largest increase (with average annual growth rates of 2.83%, 2.65%, and 2.90%, respectively), while the PAF of high-sodium diet showed the largest decrease (with average annual growth rates of –0.36%, –0.43%, and –0.16%, respectively).

Conclusions

The burden of stroke among Chinese residents remained high from 1990 to 2019, with an increasing trend in DALY rates. High systolic blood pressure remained the leading risk factor for stroke and its subtypes.

stroke  /  ischemic stroke  /  hemorrhagic stroke  /  risk factors  /  disease burden  /  trends  /  Chinese residents
付祥锐, 朱广涵, 田文心, 李文, 肖文博, 芦文丽, 王媛. 1990—2019年中国居民脑卒中及其危险因素疾病负担变化趋势分析. 中国公共卫生, 2025 , 41 (3) : 257 -262 . DOI: 10.11847/zgggws1144703
Xiangrui FU, Guanghan ZHU, Wenxin TIAN, Wen LI, Wenbo XIAO, Wenli LU, Yuan WANG. The trends in stroke burden and its associated risk factors among Chinese residents from 1990 to 2019[J]. Chinese Journal of Public Health, 2025 , 41 (3) : 257 -262 . DOI: 10.11847/zgggws1144703
脑卒中指急性脑血管病引起的局部脑功能障碍且临床症候持续>24 h,包括缺血性卒中和出血性卒中两类[1]。据统计,全球脑卒中患病数约1.01亿,脑卒中已成为全球第二大死亡原因和伤残调整生命年(disability-adjusted life years, DALYs)的第三大原因,同时也是中国疾病致死和DALYs的首位原因[2–3]。由于脑卒中的高发病率、高致残率、高死亡率和高复发率等特点以及中国社会人口结构的变化,目前我国脑卒中的疾病负担日益增加[3–5]。有研究表明,脑卒中是可防可控的,良好的生活习惯和有效的药物干预可以有效预防脑卒中的发生[6]。脑卒中的防控重点是“关口前移”,即以治疗为主前移至以预防为主,其中干预危险因素和早诊早治等一级预防是降低脑卒中发生率的关键[7]。为分析1990—2019年中国居民脑卒中及其危险因素疾病负担变化趋势,为制定有针对性的脑卒中防治策略提供科学依据,本研究收集2019年全球疾病负担研究(The Global Burden of Disease Study 2019,GBD 2019)中1990、2000、2010和2019年中国居民脑卒中的疾病负担相关数据,采用DALYs、DALYs率和人群归因分值(population attributable faction,PAF)等指标对1990—2019年中国居民脑卒中及其危险因素疾病负担的变化趋势进行了分析。结果报告如下。
资料来源于GBD 2019,该研究对不同地区、性别和年龄等人群的疾病、伤害和危险因素进行了科学、全面的评估,全面估计了1990—2019年204个国家和地区369种疾病或伤害、86种危险因素的疾病负担[2]。具体数据可利用全球健康数据交换(Global Health Data Exchange,GHDx)网站(http://ghdx.healthdata.org/gbd-results-tool)查询下载。本研究提取了其中1990、2000、2010和2019年中国居民脑卒中、缺血性卒中和出血性卒中及其相关危险因素的疾病负担数据进行分析。
采用《疾病和有关健康问题的国际统计分类(第十次修订本 )》(International Classification of Diseases and Related Health Problems 10th Version 10, ICD-10)[8]对疾病进行分类和编码,脑卒中包括缺血性卒中和出血性卒中两大类,其中缺血性卒中的编码为:G45~G46.8、I63~I63.9、I65~I66.9、I67.2~I67.3、I67.5~I67.6、I69.3,出血性卒中的编码为:I61~I62、I62.1~I62.9、I68.1~I68.2、I69.1~I69.2。应用Excel 2019软件对数据进行整理和统计分析,采用DALYs、DALYs率和PAF对中国不同年份、性别和年龄脑卒中、缺血性脑卒中、出血性脑卒中的疾病负担进行描述,同时结合PAF探讨脑卒中、缺血性脑卒中和出血性脑卒中归因于10种危险因素的疾病负担,用年均增长率来表示1990—2000年、2000—2010年、2010—2019和1990—2019年疾病负担指标的变化幅度和趋势。
中国居民2019年脑卒中、缺血性脑卒中和出血性脑卒中的DALYs率分别为3 230.51/10万、1 504.12/10万和1 561.54/10万,DALYs率均随年龄增长而升高,且≥70岁年龄组最高;2019年中国男性居民的脑卒中、缺血性脑卒中和出血性脑卒中DALYs率均高于女性居民。1990—2019年中国居民脑卒中、缺血性脑卒中和出血性脑卒中DALYs率的年均增长率分别为0.44%、2.39%和–0.08%,其中1990—2000年的年均增长率分别为0.67%、2.08%和0.93%,2000—2010年的年均增长率分别为0.28%、2.46%和0.17%,2010—2019年的年均增长率分别为0.37%、2.67%和–1.48%,脑卒中和出血性脑卒中DALYs率的年均增长率有所下降,而缺血性脑卒中DALYs率的年均增长率有所上升。
1990—2019年中国居民有8种脑卒中危险因素的PAF上升,其中高收缩压、室外空气污染、高体质量指数、红肉摄入过多、高低密度脂蛋白胆固醇和饮酒6种危险因素的PAF均持续上升,以高收缩压PAF的上升幅度最大(年均增长率为2.83%);高钠饮食和低温2种危险因素的PAF均持续下降,以高钠饮食PAF的下降幅度最大(年均增长率为–0.36%)。1990—2019年中国居民有6种缺血性脑卒中危险因素的PAF上升,其中高收缩压、室外空气污染、高体质量指数和红肉摄入过多4种危险因素的PAF均持续上升,以室外空气污染PAF的上升幅度最大(年均增长率为2.65%);在PAF下降的4种危险因素中,高低密度脂蛋白胆固醇、高钠饮食和低温3种危险因素的PAF均持续下降,以高钠饮食PAF的下降幅度最大(年均增长率为–0.43%)。1990—2019年中国居民有8种出血性脑卒中危险因素的PAF上升,其中高收缩压、室外空气污染、高体质量指数、饮酒和红肉摄入过多5种危险因素的PAF均持续上升,以外室空气污染PAF的上升幅度最大(年均增长率为2.90%);在PAF下降的2种危险因素中,高钠饮食的PAF持续下降且下降幅度最大(年均增长率为–0.16%)。与1990年相比,2019年室外空气污染、吸烟、高体质量指数和红肉摄入过多4种脑卒中危险因素的DALYs率顺位上升,分别上升了4、1、2和3位,高钠饮食和高血糖2种脑卒中危险因素的DALYs率顺位下降,均下降了1位;2019年室外空气污染、吸烟和高体质量指数3种缺血性脑卒中危险因素的DALYs率顺位上升,分别上升了5、1和3位,高钠饮食、肾功能受损和低温3种缺血性脑卒中危险因素的DALYs率顺位下降,均下降了1位;2019年室外空气污染、高体质量指数、饮酒和低温4种出血性脑卒中危险因素的DALYs率顺位上升,分别上升了4、2、2和1位,仅高血糖1种出血性脑卒中危险因素的DALYs率顺位下降,下降了1位;1990、2000、2010和2019年,高收缩压的DALYs率始终居于脑卒中、缺血性脑卒中和出血性脑卒中危险因素的第1位。
脑卒中是导致死亡和致残的主要原因,特别是在低收入和中等收入国家[9]。本研究结果显示,2019年中国脑卒中、缺血性脑卒中和出血性脑卒中的DALYs率分别为3 230.51/10万、1 504.12/10万和1 561.54/10万,均高于全球脑卒中、缺血性脑卒中和出血性脑卒中平均水平的1 851.15/10万、820.40/10万和886.24/10万[2],提示我国脑卒中防治形势十分严峻,需采取有效措施降低其疾病负担[10]。本研究结果还显示,1990—2019年中国出血性脑卒中DALYs率均高于缺血性脑卒中,提示出血性脑卒中仍是我国疾病负担最为严重的卒中类型。但1990—2019年出血性脑卒中DALYs率的年均增长率有所下降,而缺血性脑卒中DALYs率的年均增长率有所上升,且在2019年接近出血性脑卒中,提示在强调重视出血性脑卒中预防的同时不能忽视缺血性脑卒中所造成的疾病负担。
不同性别和年龄居民的脑卒中疾病负担有所差异,本研究中2019年中国男性居民的脑卒中、缺血性脑卒中和出血性脑卒中的DALYs率均高于女性居民,这可能与男性在吸烟和饮酒等不良生活习惯方面的发生率较高有关,还可能与职业暴露、生理差异及其对疾病的认知程度等多重因素密切相关[11–12]。此外,2019年脑卒中、缺血性脑卒中和出血性脑卒中的DALYs率均随年龄的增长而升高,以≥70岁年龄组为最高。脑卒中的主要发病人群为老年人群可能与我国独特的社会人口结构有关,在未来的一段时间内,我国人口老龄化趋势日益严重,脑卒中的疾病负担仍将呈上升趋势[13–14],提示需要加强对中老年人群的健康宣传教育,尤其是对中老年男性人群更应普及脑卒中的预防知识以降低其脑卒中的疾病负担。
本研究结果还显示,高收缩压的疾病负担始终位于中国1990—2019年脑卒中、缺血性脑卒中和出血性脑卒中危险因素首位,提示应重视高血压相关的健康宣传教育,提倡健康的生活方式,并养成定期测量血压的习惯 [15–16]。高钠饮食的PAF持续下降,则可能是因为我国居民健康意识持续增强,人均每日烹调用盐9.3 g,与2015年相比下降了1.2 g[17]。近年来,室外空气污染的DALYs逐年增长且涨幅最高,这可能与我国经济快速发展,城市化进程加快,碳排放量逐年增加,空气质量恶化有关[18]。此外,我国1990—2019年高体质量指数、红肉摄入过多、高低密度脂蛋白胆固醇所致DALYs涨幅均较高,这可能与我国社会经济的发展,居民膳食模式正在逐渐改变,蔬菜、水果消费不足,脂肪供能比不断上升,居民超重率持续上升等因素有关[19–20],提示今后应加大宣传力度,提倡健康膳食模式并普及平衡膳食宝塔,以降低此类脑卒中危险因素的疾病负担。脑卒中的亚型不同,危险因素亦有所不同,如,2019年缺血性脑卒中的危险因素中高低密度脂蛋白胆固醇所致DALYs为442.77万人年,位居第3位,但其并不是出血性脑卒中的主要危险因素;而2019年出血性脑卒中的危险因素中饮酒所致DALYs为304.40万人年,位居第7位,但其并不是缺血性脑卒中的主要危险因素。提示今后在预防不同卒中亚型时应采取具有针对性的措施以降低公共卫生医疗资源成本。
综上所述,1990—2019年中国居民的脑卒中疾病负担仍然较高,我国脑卒中防治形势严峻,今后可通过普及脑卒中预防知识、提倡健康膳食模式、加强环境管理与监测和建立脑卒中防治网络等措施降低脑卒中的疾病负担,对于不同卒中亚型还可采取具有针对性的防治措施来降低卫生资源成本。此外,不同性别和年龄脑卒中危险因素的影响有所不同,因此还应根据目标人群制定相应的防治策略以有效降低脑卒中的疾病负担。本研究的局限之处在于数据来源于GBD 2019,未能获取中国各省份的脑卒中疾病负担数据,无法对中国不同地区的脑卒中疾病负担情况进行对比分析,因此今后应着重关注各个省份的疾病监测系统数据,对比分析中国不同地区居民脑卒中及其危险因素的疾病负担变化趋势。

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2025年第41卷第3期
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doi: 10.11847/zgggws1144703
  • 接收时间:2024-04-14
  • 首发时间:2026-10-25
  • 出版时间:2025-03-10
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  • 收稿日期:2024-04-14
  • 修回日期:2024-09-05
  • 录用日期:2024-11-19
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    1天津医科大学公共卫生学院流行病与卫生统计学系,天津 300070
    2天津市环境营养与人群健康重点实验室/环境营养与人群健康国际联合研究中心,天津 300070

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2种不同金属材料的力学参数
科
Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)
属
Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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