1990—2021年中国居民脑卒中及其亚型发病和死亡趋势分析

董文娇; 赖凤霞; 令垚; 金智美; 陈浩; 孔丹莉; 丁元林

doi:10.11847/zgggws1145478

1990—2021年中国居民脑卒中及其亚型发病和死亡趋势分析

Incidence and mortality trends of stroke and its subtypes among residents in China from 1990 to 2021: an analysis of GBD 2021 data

摘要

摘要:
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。

Abstract:
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.

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