Temporal trends and rural–urban disparities in cerebrovascular risk factors, in-hospital management and outcomes in ischaemic strokes in China from 2005 to 2015: a nationwide serial cross-sectional survey
Background Stroke is the leading cause of mortality in China, with limited evidence of in-hospital burden obtained from nationwide surveys. We aimed to monitor and track the temporal trends and rural–urban disparities in cerebrovascular risk factors, management and outcomes from 2005 to 2015.Methods...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
|
| Series: | Stroke and Vascular Neurology |
| Online Access: | https://svn.bmj.com/content/early/2022/08/18/svn-2022-001552.full |
| _version_ | 1828149278427578368 |
|---|---|
| author | Yongjun Wang Zixiao Li Xin Yang Ying Xian Hao Li Meng Wang Gregg C Fonarow Xia Meng Yong Jiang Guo-zhong Li Li-Ping Liu Yi-long Wang Yi Yang Lee H Schwamm Hong-Qiu Gu Janet Prvu Bettger Xing-Quan Zhao Chun-Juan Wang Bei-Sha Tang Yu-Ming Xu Chelsea Liu Winnie Yip Zhi-Yi He Xin-Miao Zhang Ke-Hui Dong Run-Qi Wangqin |
| author_facet | Yongjun Wang Zixiao Li Xin Yang Ying Xian Hao Li Meng Wang Gregg C Fonarow Xia Meng Yong Jiang Guo-zhong Li Li-Ping Liu Yi-long Wang Yi Yang Lee H Schwamm Hong-Qiu Gu Janet Prvu Bettger Xing-Quan Zhao Chun-Juan Wang Bei-Sha Tang Yu-Ming Xu Chelsea Liu Winnie Yip Zhi-Yi He Xin-Miao Zhang Ke-Hui Dong Run-Qi Wangqin |
| author_sort | Yongjun Wang |
| collection | DOAJ |
| description | Background Stroke is the leading cause of mortality in China, with limited evidence of in-hospital burden obtained from nationwide surveys. We aimed to monitor and track the temporal trends and rural–urban disparities in cerebrovascular risk factors, management and outcomes from 2005 to 2015.Methods We used a two-stage random sampling survey to create a nationally representative sample of patients admitted for ischaemic stroke in 2005, 2010 and 2015. We sampled participating hospitals with an economic-geographical region-stratified random-sampling approach first and then obtained patients with a systematic sampling approach. We weighed our survey data to estimate the national-level results and assess changes from 2005 to 2015.Results We analysed 28 277 ischaemic stroke admissions from 189 participating hospitals. From 2005 to 2015, the estimated national hospital admission rate for ischaemic stroke per 100 000 people increased (from 75.9 to 402.7, Ptrend<0.001), and the prevalence of risk factors, including hypertension, diabetes, dyslipidaemia and current smoking, increased. The composite score of diagnostic tests for stroke aetiology assessment (from 0.22 to 0.36, Ptrend<0.001) and secondary prevention treatments (from 0.46 to 0.70, Ptrend<0.001) were improved. A temporal decrease was found in discharge against medical advice (DAMA) (from 15.2% (95% CI 13.7% to 16.7%) to 8.6% (8.1% to 9.0%); adjusted Ptrend=0.046), and decreases in in-hospital mortality (0.7% in 2015 vs 1.8% in 2005; adjusted OR (aOR) 0.52; 95% CI 0.32 to 0.85) and the composite outcome of in-hospital mortality or DAMA (8.4% in 2015 vs 13.9% in 2005; aOR 0.65; 95% CI 0.47 to 0.89) were observed. Disparities between rural and urban hospitals narrowed; however, disparities persisted in in-hospital management (brain MRI: rural–urban difference from −14.4% to −11.2%; cerebrovascular assessment: from −20.3% to −16.7%; clopidogrel: from −2.1% to −10.3%; anticoagulant for atrial fibrillation: from −10.9% to −8.2%) and in-hospital outcomes (DAMA: from 2.7% to 5.0%; composite outcome of in-hospital mortality or DAMA: from 2.4% to 4.6%).Conclusions From 2005 to 2015, improvements in hospital admission and in-hospital management for ischaemic stroke in China were found. A temporal improvement in DAMA and improvements in in-hospital mortality and the composite outcome of in-hospital mortality or DAMA were observed. Disparities between rural and urban hospitals generally narrowed but persisted. |
| first_indexed | 2024-04-11T21:28:05Z |
| format | Article |
| id | doaj.art-eac4892498814c4c95723c8ec87f194d |
| institution | Directory Open Access Journal |
| issn | 2059-8696 |
| language | English |
| last_indexed | 2024-04-11T21:28:05Z |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Stroke and Vascular Neurology |
| spelling | doaj.art-eac4892498814c4c95723c8ec87f194d2022-12-22T04:02:20ZengBMJ Publishing GroupStroke and Vascular Neurology2059-869610.1136/svn-2022-001552Temporal trends and rural–urban disparities in cerebrovascular risk factors, in-hospital management and outcomes in ischaemic strokes in China from 2005 to 2015: a nationwide serial cross-sectional surveyYongjun Wang0Zixiao Li1Xin Yang2Ying Xian3Hao Li4Meng Wang5Gregg C Fonarow6Xia Meng7Yong Jiang8Guo-zhong Li9Li-Ping Liu10Yi-long Wang11Yi Yang12Lee H Schwamm13Hong-Qiu Gu14Janet Prvu Bettger15Xing-Quan Zhao16Chun-Juan Wang17Bei-Sha Tang18Yu-Ming Xu19Chelsea Liu20Winnie Yip21Zhi-Yi He22Xin-Miao Zhang23Ke-Hui Dong24Run-Qi Wangqin25China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China2 China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaCentre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK19 Neurology, Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA1 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Clinical Neurosciences & Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, CanadaInternal Medicine, Division of Cardiology, David Geffen School of Medicine, Los Angeles, CA, USA1 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China2 China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Neurology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China1 China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China1 China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China2 Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA1 China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaGlobal Health Institute, Duke University, Durham, North Carolina, USA1 China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China1 China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, ChinaDepartment of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, ChinaDepartment of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China5 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA4 Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USADepartment of Respiratory Medicine, The First Affiliated Hospital of Guangxi Medical University, Nanning, ChinaVascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beiing, ChinaVascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beiing, ChinaDepartment of Neurology, Duke Univeristy Medical Center, Durham, North Carolina, USABackground Stroke is the leading cause of mortality in China, with limited evidence of in-hospital burden obtained from nationwide surveys. We aimed to monitor and track the temporal trends and rural–urban disparities in cerebrovascular risk factors, management and outcomes from 2005 to 2015.Methods We used a two-stage random sampling survey to create a nationally representative sample of patients admitted for ischaemic stroke in 2005, 2010 and 2015. We sampled participating hospitals with an economic-geographical region-stratified random-sampling approach first and then obtained patients with a systematic sampling approach. We weighed our survey data to estimate the national-level results and assess changes from 2005 to 2015.Results We analysed 28 277 ischaemic stroke admissions from 189 participating hospitals. From 2005 to 2015, the estimated national hospital admission rate for ischaemic stroke per 100 000 people increased (from 75.9 to 402.7, Ptrend<0.001), and the prevalence of risk factors, including hypertension, diabetes, dyslipidaemia and current smoking, increased. The composite score of diagnostic tests for stroke aetiology assessment (from 0.22 to 0.36, Ptrend<0.001) and secondary prevention treatments (from 0.46 to 0.70, Ptrend<0.001) were improved. A temporal decrease was found in discharge against medical advice (DAMA) (from 15.2% (95% CI 13.7% to 16.7%) to 8.6% (8.1% to 9.0%); adjusted Ptrend=0.046), and decreases in in-hospital mortality (0.7% in 2015 vs 1.8% in 2005; adjusted OR (aOR) 0.52; 95% CI 0.32 to 0.85) and the composite outcome of in-hospital mortality or DAMA (8.4% in 2015 vs 13.9% in 2005; aOR 0.65; 95% CI 0.47 to 0.89) were observed. Disparities between rural and urban hospitals narrowed; however, disparities persisted in in-hospital management (brain MRI: rural–urban difference from −14.4% to −11.2%; cerebrovascular assessment: from −20.3% to −16.7%; clopidogrel: from −2.1% to −10.3%; anticoagulant for atrial fibrillation: from −10.9% to −8.2%) and in-hospital outcomes (DAMA: from 2.7% to 5.0%; composite outcome of in-hospital mortality or DAMA: from 2.4% to 4.6%).Conclusions From 2005 to 2015, improvements in hospital admission and in-hospital management for ischaemic stroke in China were found. A temporal improvement in DAMA and improvements in in-hospital mortality and the composite outcome of in-hospital mortality or DAMA were observed. Disparities between rural and urban hospitals generally narrowed but persisted.https://svn.bmj.com/content/early/2022/08/18/svn-2022-001552.full |
| spellingShingle | Yongjun Wang Zixiao Li Xin Yang Ying Xian Hao Li Meng Wang Gregg C Fonarow Xia Meng Yong Jiang Guo-zhong Li Li-Ping Liu Yi-long Wang Yi Yang Lee H Schwamm Hong-Qiu Gu Janet Prvu Bettger Xing-Quan Zhao Chun-Juan Wang Bei-Sha Tang Yu-Ming Xu Chelsea Liu Winnie Yip Zhi-Yi He Xin-Miao Zhang Ke-Hui Dong Run-Qi Wangqin Temporal trends and rural–urban disparities in cerebrovascular risk factors, in-hospital management and outcomes in ischaemic strokes in China from 2005 to 2015: a nationwide serial cross-sectional survey Stroke and Vascular Neurology |
| title | Temporal trends and rural–urban disparities in cerebrovascular risk factors, in-hospital management and outcomes in ischaemic strokes in China from 2005 to 2015: a nationwide serial cross-sectional survey |
| title_full | Temporal trends and rural–urban disparities in cerebrovascular risk factors, in-hospital management and outcomes in ischaemic strokes in China from 2005 to 2015: a nationwide serial cross-sectional survey |
| title_fullStr | Temporal trends and rural–urban disparities in cerebrovascular risk factors, in-hospital management and outcomes in ischaemic strokes in China from 2005 to 2015: a nationwide serial cross-sectional survey |
| title_full_unstemmed | Temporal trends and rural–urban disparities in cerebrovascular risk factors, in-hospital management and outcomes in ischaemic strokes in China from 2005 to 2015: a nationwide serial cross-sectional survey |
| title_short | Temporal trends and rural–urban disparities in cerebrovascular risk factors, in-hospital management and outcomes in ischaemic strokes in China from 2005 to 2015: a nationwide serial cross-sectional survey |
| title_sort | temporal trends and rural urban disparities in cerebrovascular risk factors in hospital management and outcomes in ischaemic strokes in china from 2005 to 2015 a nationwide serial cross sectional survey |
| url | https://svn.bmj.com/content/early/2022/08/18/svn-2022-001552.full |
| work_keys_str_mv | AT yongjunwang temporaltrendsandruralurbandisparitiesincerebrovascularriskfactorsinhospitalmanagementandoutcomesinischaemicstrokesinchinafrom2005to2015anationwideserialcrosssectionalsurvey AT zixiaoli temporaltrendsandruralurbandisparitiesincerebrovascularriskfactorsinhospitalmanagementandoutcomesinischaemicstrokesinchinafrom2005to2015anationwideserialcrosssectionalsurvey AT xinyang temporaltrendsandruralurbandisparitiesincerebrovascularriskfactorsinhospitalmanagementandoutcomesinischaemicstrokesinchinafrom2005to2015anationwideserialcrosssectionalsurvey AT yingxian temporaltrendsandruralurbandisparitiesincerebrovascularriskfactorsinhospitalmanagementandoutcomesinischaemicstrokesinchinafrom2005to2015anationwideserialcrosssectionalsurvey AT haoli temporaltrendsandruralurbandisparitiesincerebrovascularriskfactorsinhospitalmanagementandoutcomesinischaemicstrokesinchinafrom2005to2015anationwideserialcrosssectionalsurvey AT mengwang temporaltrendsandruralurbandisparitiesincerebrovascularriskfactorsinhospitalmanagementandoutcomesinischaemicstrokesinchinafrom2005to2015anationwideserialcrosssectionalsurvey AT greggcfonarow temporaltrendsandruralurbandisparitiesincerebrovascularriskfactorsinhospitalmanagementandoutcomesinischaemicstrokesinchinafrom2005to2015anationwideserialcrosssectionalsurvey AT xiameng temporaltrendsandruralurbandisparitiesincerebrovascularriskfactorsinhospitalmanagementandoutcomesinischaemicstrokesinchinafrom2005to2015anationwideserialcrosssectionalsurvey AT yongjiang temporaltrendsandruralurbandisparitiesincerebrovascularriskfactorsinhospitalmanagementandoutcomesinischaemicstrokesinchinafrom2005to2015anationwideserialcrosssectionalsurvey AT guozhongli temporaltrendsandruralurbandisparitiesincerebrovascularriskfactorsinhospitalmanagementandoutcomesinischaemicstrokesinchinafrom2005to2015anationwideserialcrosssectionalsurvey AT lipingliu temporaltrendsandruralurbandisparitiesincerebrovascularriskfactorsinhospitalmanagementandoutcomesinischaemicstrokesinchinafrom2005to2015anationwideserialcrosssectionalsurvey AT yilongwang temporaltrendsandruralurbandisparitiesincerebrovascularriskfactorsinhospitalmanagementandoutcomesinischaemicstrokesinchinafrom2005to2015anationwideserialcrosssectionalsurvey AT yiyang temporaltrendsandruralurbandisparitiesincerebrovascularriskfactorsinhospitalmanagementandoutcomesinischaemicstrokesinchinafrom2005to2015anationwideserialcrosssectionalsurvey AT leehschwamm temporaltrendsandruralurbandisparitiesincerebrovascularriskfactorsinhospitalmanagementandoutcomesinischaemicstrokesinchinafrom2005to2015anationwideserialcrosssectionalsurvey AT hongqiugu temporaltrendsandruralurbandisparitiesincerebrovascularriskfactorsinhospitalmanagementandoutcomesinischaemicstrokesinchinafrom2005to2015anationwideserialcrosssectionalsurvey AT janetprvubettger temporaltrendsandruralurbandisparitiesincerebrovascularriskfactorsinhospitalmanagementandoutcomesinischaemicstrokesinchinafrom2005to2015anationwideserialcrosssectionalsurvey AT xingquanzhao temporaltrendsandruralurbandisparitiesincerebrovascularriskfactorsinhospitalmanagementandoutcomesinischaemicstrokesinchinafrom2005to2015anationwideserialcrosssectionalsurvey AT chunjuanwang temporaltrendsandruralurbandisparitiesincerebrovascularriskfactorsinhospitalmanagementandoutcomesinischaemicstrokesinchinafrom2005to2015anationwideserialcrosssectionalsurvey AT beishatang temporaltrendsandruralurbandisparitiesincerebrovascularriskfactorsinhospitalmanagementandoutcomesinischaemicstrokesinchinafrom2005to2015anationwideserialcrosssectionalsurvey AT yumingxu temporaltrendsandruralurbandisparitiesincerebrovascularriskfactorsinhospitalmanagementandoutcomesinischaemicstrokesinchinafrom2005to2015anationwideserialcrosssectionalsurvey AT chelsealiu temporaltrendsandruralurbandisparitiesincerebrovascularriskfactorsinhospitalmanagementandoutcomesinischaemicstrokesinchinafrom2005to2015anationwideserialcrosssectionalsurvey AT winnieyip temporaltrendsandruralurbandisparitiesincerebrovascularriskfactorsinhospitalmanagementandoutcomesinischaemicstrokesinchinafrom2005to2015anationwideserialcrosssectionalsurvey AT zhiyihe temporaltrendsandruralurbandisparitiesincerebrovascularriskfactorsinhospitalmanagementandoutcomesinischaemicstrokesinchinafrom2005to2015anationwideserialcrosssectionalsurvey AT xinmiaozhang temporaltrendsandruralurbandisparitiesincerebrovascularriskfactorsinhospitalmanagementandoutcomesinischaemicstrokesinchinafrom2005to2015anationwideserialcrosssectionalsurvey AT kehuidong temporaltrendsandruralurbandisparitiesincerebrovascularriskfactorsinhospitalmanagementandoutcomesinischaemicstrokesinchinafrom2005to2015anationwideserialcrosssectionalsurvey AT runqiwangqin temporaltrendsandruralurbandisparitiesincerebrovascularriskfactorsinhospitalmanagementandoutcomesinischaemicstrokesinchinafrom2005to2015anationwideserialcrosssectionalsurvey |