Incidence and mortality of ischemic stroke in China, 1990 – 2019: an age-period-cohort analysis
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摘要:
目的 了解中国居民1990 — 2019年缺血性脑卒中发病和死亡趋势，为我国缺血性脑卒中的防控提供参考依据。 方法 收集2019年全球疾病负担研究（GBD 2019）数据库中1990 — 2019年中国居民缺血性脑卒中发病和死亡相关数据，采用Joinpoint回归模型分析缺血性脑卒中发病率和死亡率变化趋势，并应用年龄 – 时期 – 队列（APC）模型分析缺血性脑卒中发病和死亡风险的年龄、时期和出生队列效应。 结果 中国总体居民、男性居民和女性居民缺血性脑卒中粗发病率分别从1990年的74.26/10万、64.58/10万和84.55/10万上升至2019年的201.74/10万、183.60/10万和220.59/10万，标化发病率分别从1990年的107.49/10万、 101.14/10万和113.72/10万上升至2019年的144.78/10万、141.10/10万和149.44/10万，标化发病率的平均年度变化百分比（AAPC）分别为1.04%、1.16%和0.94%（均P < 0.001）；中国总体居民、男性居民和女性居民缺血性脑卒中粗死亡率分别从1990年的32.08/10万、32.09/10万和32.06/10万上升至2019年的72.37/10万、79.89/10万和64.55/10万，中国总体居民和女性居民标化死亡率分别从1990年的64.32/10万和56.13/10万下降至2019年的62.18/10万和48.26/10万，男性居民标化死亡率从1990年的77.34/10万上升至2019年的83.55/10万，中国总体居民标化死亡率的AAPC为 – 0.12%（P = 0.463），男性居民和女性居民标化死亡率的AAPC分别为0.29%和 – 0.50%（均P < 0.05）。APC模型分析结果显示，中国35～89岁男性居民和45～89岁女性居民缺血性脑卒中发病率的局部漂移值均 > 0，75～94岁男性居民缺血性脑卒中死亡率的局部漂移值均 > 0；在同一出生队列中，男性居民和女性居民缺血性脑卒中发病率和死亡率的纵向年龄曲线均呈上升趋势；男性居民缺血性脑卒中发病风险在1990 — 2004年各时期组保持稳定，2005 — 2009年缓慢上升，在2010 — 2019年各时期组中快速上升；女性居民缺血性脑卒中发病风险在1990 — 2004年各时期组呈下降趋势，2005 — 2009年缓慢上升，2010 — 2014年发病风险快速上升，2015 — 2019年上升趋势极为平缓几乎保持平稳。中国男性和女性居民1990 — 2019年缺血性脑卒中死亡风险均随时期推移整体呈下降趋势，死亡风险均在2015 — 2019年达到最小值；中国男性和女性居民1990 — 2019年缺血性脑卒中发病风险均随出生队列推移呈先上升后下降的趋势，男性和女性居民发病风险的出生队列效应峰值分别出现在1973 — 1977年和1958 — 1962年；男性和女性居民1990 — 2019年缺血性脑卒中死亡风险均随出生队列推移整体呈下降趋势。 结论 中国居民1990 — 2019年缺血性脑卒中发病率呈上升趋势，年龄、时期和出生队列效应对不同性别居民发病风险均有一定程度影响；虽然死亡风险的时期和队列效应呈下降趋势，但由于持续增加的年龄效应使我国居民尤其是老年男性居民实际死亡负担较重。 Abstract:Objective To examine incidence and mortality trends of ischemic stroke (IS) among Chinese residents from 1990 to 2019 and to provide a reference for the prevention and control of IS in China. Methods The data on IS incidence and mortality among Chinese residents from 1990 to 2019 were collected from the Global Burden of Disease Study 2019 (GBD 2019). Joinpoint regression model was used to analyze changing trend of IS incidence and mortality. The age-period-cohort (APC) model was used to assess the effects of age, period, and birth cohort on the risk of IS incidence and mortality. Results The crude incidence rate (per 100 000 population) of IS increased from 74.26 in 1990 to 201.74 in 2019 for all Chinese residents; and the rate increased from 64.58 to 183.60 for the male residents and from 84.55 to 220.59 for the female residents. The standardized incidence rate (per 100 000 population) of IS also increased from 107.49 in 1990 to 144.78 in 2019 for all Chinese residents; for male and female residents, the standardized incidence rate increased from 101.14 and 113.72 to 141.10 and 149.44, respectively. During 30-year period, the average annual percentage change (AAPC) in standardized IS incidence rate for all, male and female Chinese residents were 1.04%, 1.16% and 0.94% (all P < 0.001). The crude IS mortality rate (per 100 000 population) for all, male and female Chinese residents increased from 32.08, 32.09 and 32.06 in 1990 to 72.37, 79.89 and 64.55 in 2019; the standardized IS mortality rate (per 100 000 population) for all and female Chinese residents decreased from 64.32 and 56.13 in 1990 to 62.18 and 48.26 in 2019; but the standardized IS mortality rate for male Chinese residents increased from 77.34 in1990 to 83.55 in 2019. During 30-year period, the AAPC in standardized IS mortality rate for all, male and female Chinese residents were – 0.12% (P = 0.463), 0.29% and – 0.50% (both P < 0.05). The results of the APC model analysis showed that the local drift values of IS incidence rate for male residents aged 35 – 89 years and female residents aged 45 – 89 years were greater than 0, and the local drift values of IS mortality rate for male residents aged 75 – 94 years were greater than 0. The longitudinal curve for age-specific IS incidence and mortality for both male and female residents in the same birth cohort showed an increasing trend. The IS risk of male residents remained stable in each period group from 1990 to 2004, then increased slowly from 2005 to 2009, and rapidly increased in each period group from 2010 to 2019. The IS risk of the female residents decreased in each period group from 1990 to 2004, and increased slowly from 2005 to 2009; from 2010 to 2014, the risk increased rapidly, and from 2015 to 2019, the increasing trend was very smooth and almost remained stable. From 1990 to 2019, the IS mortality risk of male and female Chinese residents showed a downward trend over the time period and the mortality risk reached the minimum from 2015 to 2019. From 1990 to 2019, the IS risk of male and female Chinese residents increased first and then decreased with the birth cohort. The peak of the birth cohort effect on IS in male residents occurred from 1973 to 1977, and that in female residents occurred from 1958 to 1962. The IS mortality risk in male and female Chinese residents from 1990 to 2019 showed an overall downward trend along with the birth cohort. Conclusion The incidence of ischemic stroke in Chinese residents showed an increasing trend from 1990 to 2019. Age, period, and birth cohort effect have a certain influence on the risk of ischemic stroke with gender disparity. Although the period and cohort effect on IS mortality risk showed a decline trend, the continuous increasing age effect made the actual burden of IS mortality much heavier among Chinese residents, especially among elderly male residents. -
Key words:
- ischemic stroke /
- incidence /
- mortality /
- trend /
- age-period-cohort model /
- Chinese residents
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图 1 中国不同性别居民1990 — 2019年缺血性脑卒中发病率和死亡率的局部漂移值变化情况
Figure 1. Changes in local drift values of ischemic stroke incidence and mortality among Chinese residents by gender, 1990 – 2019 based on the data from Global Burden of Disease Study 2019
图 2 中国不同性别居民1990 — 2019年缺血性脑卒中发病率和死亡率的年龄变化趋势
Figure 2. Age-specific trends in ischemic stroke incidence and mortality among Chinese residents by gender, 1990 – 2019 based on the data from Global Burden of Disease Study 2019
图 3 中国不同性别居民1990 — 2019年缺血性脑卒中发病和死亡风险的时期效应
Figure 3. Period effect on risk of ischemic stroke incidence and death by gender in Chinese residents, 1990 – 2019 based on the data from Global Burden of Disease Study 2019
图 4 中国不同性别居民1990 — 2019年缺血性脑卒中发病和死亡风险的队列效应
Figure 4. Cohort effect on risk of ischemic stroke incidence and death by sex in Chinese residents 1990 – 2019 based on the data from Global Burden of Disease Study 2019
表 1 中国居民1990 — 2019年缺血性脑卒中发病情况
Table 1. Year-specific crude and standardized incidence of ischemic stroke for all, male and female Chinese population, 1990 – 2019 based on the data from Global Burden of Disease Study 2019
年份 总体 男性 女性 发病数 粗发病率
（1/10万）标化发病率
（1/10万）发病数 粗发病率
（1/10万）标化发病率
（1/10万）发病数 粗发病率
（1/10万）标化发病率
（1/10万）1990 878948 74.26 107.49 394067 64.58 101.14 484881 84.55 113.72 1991 904917 75.50 107.85 407836 65.94 101.74 497082 85.70 113.87 1992 931983 76.86 108.30 421951 67.36 102.39 510032 87.01 114.14 1993 959992 78.32 108.80 436211 68.84 103.03 523781 88.46 114.52 1994 989700 79.93 109.32 451122 70.44 103.67 538577 90.09 114.97 1995 1020130 81.61 109.85 465953 72.06 104.27 554176 91.84 115.46 1996 1054189 83.59 110.57 481655 73.85 104.91 572534 94.03 116.31 1997 1092101 85.87 111.58 498186 75.78 105.68 593914 96.67 117.62 1998 1132501 88.34 112.70 515210 77.81 106.52 617292 99.60 119.09 1999 1174851 90.97 113.76 533565 80.06 107.40 641286 102.59 120.42 2000 1214621 93.40 114.58 551649 82.29 108.26 662971 105.21 121.31 2001 1254018 95.82 115.16 570943 84.72 109.16 683076 107.59 121.69 2002 1292811 98.21 115.62 590832 87.25 110.13 701979 109.81 121.81 2003 1332010 100.64 116.04 611226 89.86 111.10 720785 112.04 121.85 2004 1374611 103.36 116.47 633401 92.74 112.01 741210 114.56 121.94 2005 1419401 106.24 117.01 655610 95.63 112.80 763790 117.42 122.27 2006 1482325 110.46 118.29 683407 99.31 113.75 798919 122.20 123.88 2007 1566259 116.21 120.60 717504 103.86 115.09 848756 129.19 127.13 2008 1662746 122.84 123.43 755644 108.97 116.76 907102 137.41 131.09 2009 1765681 129.91 126.25 797895 114.65 118.67 967786 145.92 134.83 2010 1859870 136.30 128.59 839553 120.22 120.75 1020317 153.15 137.41 2011 1955206 142.74 130.63 885715 126.41 123.19 1069491 159.83 139.08 2012 2057240 149.55 132.84 936835 133.21 126.05 1120406 166.63 140.72 2013 2164559 156.64 135.08 990990 140.35 129.06 1173569 173.66 142.28 2014 2278688 164.19 137.20 1048739 147.97 131.95 1229949 181.12 143.70 2015 2389899 171.37 139.06 1104112 155.11 134.45 1285787 188.33 144.93 2016 2509358 178.88 140.69 1164268 162.66 136.66 1345090 195.76 145.88 2017 2626416 186.16 142.04 1222175 169.86 138.42 1404241 203.13 146.73 2018 2743089 193.57 143.33 1275307 176.52 139.78 1467782 211.29 147.90 2019 2869438 201.74 144.78 1330759 183.60 141.10 1538678 220.59 149.44 
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表 2 中国居民1990 — 2019年缺血性脑卒中死亡情况
Table 2. Year-specific crude and standardized mortality of ischemic stroke for all, male and female Chinese population, 1990 – 2019 based on the data from Global Burden of Disease Study 2019
年份 总体 男性 女性 死亡数 粗死亡率
（1/10）标化死亡率
（1/10万）死亡数 粗死亡率
（1/10）标化死亡率
（1/10万）死亡数 粗死亡率
（1/10）标化死亡率
（1/10万）1990 379697 32.08 64.32 195807 32.09 77.34 183890 32.06 56.13 1991 389085 32.46 63.90 202000 32.66 77.22 187086 32.26 55.48 1992 402310 33.18 64.16 209894 33.51 77.81 192416 32.83 55.49 1993 416170 33.95 64.52 216873 34.22 78.15 199297 33.66 55.88 1994 423142 34.17 64.02 221548 34.59 77.69 201594 33.72 55.22 1995 434389 34.75 64.02 230365 35.63 78.32 204024 33.81 54.58 1996 452095 35.85 64.69 240003 36.80 79.06 212092 34.83 55.11 1997 465984 36.64 64.66 247838 37.70 79.23 218146 35.51 54.94 1998 483276 37.70 64.89 258521 39.04 80.14 224755 36.26 54.73 1999 511581 39.61 66.43 270911 40.65 81.23 240670 38.50 56.56 2000 550118 42.30 68.86 289622 43.21 83.36 260497 41.34 59.05 2001 580342 44.34 70.12 305329 45.31 85.00 275013 43.32 60.12 2002 607623 46.16 70.52 318471 47.03 85.36 289153 45.23 60.70 2003 638488 48.24 71.13 333828 49.08 85.87 304660 47.36 61.42 2004 670538 50.42 72.12 353473 51.76 87.93 317065 49.00 61.74 2005 684265 51.22 71.50 363099 52.96 88.15 321166 49.37 60.66 2006 673779 50.21 68.17 356853 51.86 84.18 316926 48.48 57.87 2007 679159 50.39 66.35 362816 52.52 83.10 316343 48.15 55.72 2008 704116 52.02 66.39 380314 54.85 84.46 323802 49.05 54.98 2009 740485 54.48 67.34 404286 58.09 86.96 336199 50.69 55.02 2010 781690 57.29 68.66 430485 61.65 89.65 351206 52.72 55.45 2011 809912 59.13 68.63 448180 63.97 90.68 361732 54.06 55.01 2012 822934 59.82 66.99 464353 66.03 91.29 358581 53.33 52.35 2013 847175 61.31 66.24 480008 67.98 91.07 367167 54.33 51.40 2014 873057 62.91 65.35 496299 70.02 89.81 376758 55.48 50.48 2015 894650 64.15 64.16 511909 71.91 88.96 382741 56.06 49.05 2016 930044 66.30 63.87 531657 74.28 88.58 398387 57.98 48.76 2017 962834 68.25 63.32 546573 75.96 86.55 416261 60.22 48.72 2018 991398 69.96 62.51 558544 77.31 84.24 432854 62.31 48.49 2019 1029318 72.37 62.18 579054 79.89 83.55 450264 64.55 48.26
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