Stroke in China: advances and challenges in epidemiology, prevention, and management

Simiao Wu; Bo Wu; Ming Liu; Zhengming Chen; Wenzhi Wang; Craig S Anderson; Peter Sandercock; Yongjun Wang; Yining Huang; Liying Cui; Chuanqiang Pu; Jianping Jia; Tong Zhang; Xinfeng Liu; Suming Zhang; Peng Xie; Dongsheng Fan; Xunming Ji; Ka-Sing Lawrence Wong; Longde Wang; China Stroke Study Collaboration

doi:10.1016/S1474-4422(18)30500-3

Stroke in China: advances and challenges in epidemiology, prevention, and management

Lancet Neurol. 2019 Apr;18(4):394-405. doi: 10.1016/S1474-4422(18)30500-3.

Authors

Simiao Wu¹, Bo Wu¹, Ming Liu², Zhengming Chen³, Wenzhi Wang⁴, Craig S Anderson⁵, Peter Sandercock⁶, Yongjun Wang⁷, Yining Huang⁸, Liying Cui⁹, Chuanqiang Pu¹⁰, Jianping Jia¹¹, Tong Zhang¹², Xinfeng Liu¹³, Suming Zhang¹⁴, Peng Xie¹⁵, Dongsheng Fan¹⁶, Xunming Ji¹⁷, Ka-Sing Lawrence Wong¹⁸, Longde Wang¹⁹; China Stroke Study Collaboration

Collaborators

China Stroke Study Collaboration:
Simiao Wu, Bo Wu, Ming Liu, Zhengming Chen, Wenzhi Wang, Craig S Anderson, Peter Sandercock, Yongjun Wang, Yining Huang, Liying Cui, Chuanqiang Pu, Jianping Jia, Tong Zhang, Xinfeng Liu, Suming Zhang, Peng Xie, Dongsheng Fan, Xunming Ji, Ka-Sing Lawrence Wong, Longde Wang, Chenchen Wei, Yanan Wang, Yajun Cheng, Yunhai Liu, Xin Li, Qiang Dong, Jinsheng Zeng, Bin Peng, Yun Xu, Yi Yang, Yilong Wang, Gang Zhao, Wei Wang, Yuming Xu, Qingwu Yang, Zhiyi He, Shaoshi Wang, Chao You, Ying Gao, Dong Zhou, Li He, Zixiao Li, Jie Yang, Chunyan Lei, Yuhua Zhao, Junfeng Liu, Shuting Zhang, Wendan Tao, Zilong Hao, Deren Wang, Shihong Zhang

Affiliations

¹ Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
² Department of Neurology, West China Hospital, Sichuan University, Chengdu, China; Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, Chengdu, China; State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China. Electronic address: wyplmh@hotmail.com.
³ Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
⁴ Department of Neuroepidemiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
⁵ The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia; The George Institute China at Peking University Health Science Center, Beijing, China; Neurology Department, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
⁶ Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
⁷ Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
⁸ Department of Neurology, Peking University First Hospital, Beijing, China.
⁹ Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China.
¹⁰ Department of Neurology, Chinese PLA General Hospital, Beijing, China.
¹¹ Innovation Center for Neurological Disorders, Department of Neurology, Xuan Wu Hospital, Capital Medical University, Beijing, China.
¹² Faculty of Rehabilitation Medicine, Capital Medical University, Beijing, China; Neurorehabilitation Department, China Rehabilitation Research Center, Beijing, China.
¹³ Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
¹⁴ Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
¹⁵ Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
¹⁶ Department of Neurology, Peking University Third Hospital, Beijing, China; Key Laboratory for Neuroscience, Ministry of Education/National Health Commission, Peking University, Beijing, China.
¹⁷ Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China.
¹⁸ Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.
¹⁹ Stroke Prevention Project Committee of National Health Commission of the People's Republic of China, Beijing, China.

PMID: 30878104
DOI: 10.1016/S1474-4422(18)30500-3

Abstract

With over 2 million new cases annually, stroke is associated with the highest disability-adjusted life-years lost of any disease in China. The burden is expected to increase further as a result of population ageing, an ongoing high prevalence of risk factors (eg, hypertension), and inadequate management. Despite improved access to overall health services, the availability of specialist stroke care is variable across the country, and especially uneven in rural areas. In-hospital outcomes have improved because of a greater availability of reperfusion therapies and supportive care, but adherence to secondary prevention strategies and long-term care are inadequate. Thrombolysis and stroke units are accepted as standards of care across the world, including in China, but bleeding-risk concerns and organisational challenges hamper widespread adoption of this care in China. Despite little supporting evidence, Chinese herbal products and neuroprotective drugs are widely used, and the increased availability of neuroimaging techniques also results in overdiagnosis and overtreatment of so-called silent stroke. Future efforts should focus on providing more balanced availability of specialised stroke services across the country, enhancing evidence-based practice, and encouraging greater translational research to improve outcome of patients with stroke.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

China / epidemiology
Disease Management
Humans
Prevalence
Quality-Adjusted Life Years
Stroke / epidemiology*
Stroke / prevention & control
Stroke / therapy*

Abstract

Publication types

MeSH terms

Grants and funding