This Article Full Text Full Text (PDF) All Versions of this Article: 34/9/2091    most recent 01.STR.0000087149.42294.8Cv1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Zhang, L.-F. Articles by Wu, Y.-F. Search for Related Content PubMed PubMed Citation Articles by Zhang, L.-F. Articles by Wu, Y.-F. Pubmed/NCBI databases Medline Plus Health Information Stroke Related Collections Acute Cerebral Hemorrhage Acute Cerebral Infarction Intracerebral Hemorrhage Epidemiology

(Stroke. 2003;34:2091.)
© 2003 American Heart Association, Inc.

Original Contributions

Proportion of Different Subtypes of Stroke in China

Lin-Feng Zhang, MD; Jun Yang, MD; Zhen Hong, MD; Guang-Gu Yuan, MD; Bei-Fan Zhou, MD; Lian-Cheng Zhao, MD; Yi-Ning Huang, MD; Jie Chen, MD Yang-Feng Wu, MD, PhD for the Collaborative Group of China Multicenter Study of Cardiovascular Epidemiology

From the Department of Epidemiology, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (L.-F.Z., J.Y., L.-C.Z., B.-F.Z., Y.-F.W); Department of Neurology, Huashan Hospital, Medical College of Fudan University, Shanghai (Z.H.); Department of Neurology, West China Hospital, Sichuan University, Sichuan (G.-G.Y.); Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing (Y.-N.H.); and National Office for Cardiovascular Disease Control and Research (J.C.), People’s Republic of China.

Reprint requests to Dr Yang-Feng Wu, MD, PhD, Department of Epidemiology, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Bei Li Shi Rd 167, Beijing, 100037, People’s Republic of China. E-mail tsq{at}public.east.net.cn

Background and Purpose— The goal of this article is to clarify the proportion of stroke subtypes in China, where stoke is the most common cause of death.

Methods— A total of 16 031 first-ever strokes in subjects 25 years of age were identified in 1991 to 2000 from 17 Chinese populations through a community-based cardiovascular disease surveillance program in the China Multicenter Collaborative Study of Cardiovascular Epidemiology. World Health Organization diagnosis criteria were used for classification of stroke subtypes.

Results— CT scan rate of stroke cases reached a satisfactorily high level only after 1996 in the study populations. In 8268 first-ever stroke events from 10 populations with CT scan rate >75% in 1996 to 2000, 1.8% were subarachnoid hemorrhage, 27.5% were intracerebral hemorrhage, 62.4% were cerebral infarction, and 8.3% were undetermined stroke. The proportion of intracerebral hemorrhage varied from 17.1% to 39.4% and that for cerebral infarction varied from 45.5% to 75.9% from population to population. The ratio of ischemic to hemorrhagic stroke ranged from 1.1 to 3.9 and averaged 2.0). The 28-day fatality rate was 33.3% for subarachnoid hemorrhage, 49.4% for intracerebral hemorrhage, 16.9% for cerebral infarction, and 64.6% for undetermined stroke.

Conclusions— In our study, ischemic stroke was more frequent and its proportion was higher than hemorrhagic stroke in Chinese populations. Although hemorrhagic stroke was more frequent in Chinese than in Western populations, the variation in the proportion of stroke subtypes among Chinese populations could be as large as or larger than that between Chinese and Western populations.

Key Words: China • epidemiology • stroke

This article has been cited by other articles:

				E. Heeley, C. S. Anderson, Y. Huang, S. Jan, Y. Li, M. Liu, J. Sun, E. Xu, Y. Wu, Q. Yang, et al. Role of Health Insurance in Averting Economic Hardship in Families After Acute Stroke in China Stroke, June 1, 2009; 40(6): 2149 - 2156. [Abstract] [Full Text] [PDF]

				X. Wang, S. Cheng, V. H. Brophy, H. A. Erlich, C. Mannhalter, K. Berger, W. Lalouschek, W. S. Browner, Y. Shi, E. B. Ringelstein, et al. A Meta-Analysis of Candidate Gene Polymorphisms and Ischemic Stroke in 6 Study Populations: Association of Lymphotoxin-Alpha in Nonhypertensive Patients Stroke, March 1, 2009; 40(3): 683 - 695. [Abstract] [Full Text] [PDF]

				T. N. Kelly, D. Gu, J. Chen, J.-f. Huang, J.-c. Chen, X. Duan, X. Wu, C. L. Yau, P. K. Whelton, and J. He Hypertension Subtype and Risk of Cardiovascular Disease in Chinese Adults Circulation, October 7, 2008; 118(15): 1558 - 1566. [Abstract] [Full Text] [PDF]

				T. Truelsen and R. Bonita Epidemiological Transition of Stroke in China? Stroke, June 1, 2008; 39(6): 1653 - 1654. [Full Text] [PDF]

				T. N. Kelly, D. Gu, J. Chen, J.-f. Huang, J.-c. Chen, X. Duan, X. Wu, C.-S. Chen, and J. He Cigarette Smoking and Risk of Stroke in the Chinese Adult Population Stroke, June 1, 2008; 39(6): 1688 - 1693. [Abstract] [Full Text] [PDF]

				C. Tzourio, H. Arima, S. Harrap, C. Anderson, O. Godin, M. Woodward, B. Neal, M-G Bousser, J. Chalmers, F. Cambien, et al. APOE genotype, ethnicity, and the risk of cerebral hemorrhage Neurology, April 15, 2008; 70(16): 1322 - 1328. [Abstract] [Full Text] [PDF]

				M. Zhou, A. Offer, G. Yang, M. Smith, G. Hui, G. Whitlock, R. Collins, Z. Huang, R. Peto, and Z. Chen Body Mass Index, Blood Pressure, and Mortality From Stroke: A Nationally Representative Prospective Study of 212 000 Chinese Men Stroke, March 1, 2008; 39(3): 753 - 759. [Abstract] [Full Text] [PDF]

				X.-H. Zhang, T. Guan, J. Mao, and L. Liu Disparity and Its Time Trends in Stroke Mortality Between Urban and Rural Populations in China 1987 to 2001: Changing Patterns and Their Implications for Public Health Policy Stroke, December 1, 2007; 38(12): 3139 - 3144. [Abstract] [Full Text] [PDF]

				Y. Wu, X. Liu, X. Li, Y. Li, L. Zhao, Z. Chen, Y. Li, X. Rao, B. Zhou, R. Detrano, et al. Estimation of 10-Year Risk of Fatal and Nonfatal Ischemic Cardiovascular Diseases in Chinese Adults Circulation, November 21, 2006; 114(21): 2217 - 2225. [Abstract] [Full Text] [PDF]

				G. Xu, X. Liu, B. Jiang, and W.-z. Wang Has Stroke Shifted From Hemorrhagic to Ischemic in China? Stroke, April 1, 2006; 37(4): 941 - 942. [Full Text] [PDF]

				B. Jiang, W.-z. Wang, H. Chen, Z. Hong, Q.-d. Yang, S.-p. Wu, X.-l. Du, and Q.-j. Bao Incidence and Trends of Stroke and Its Subtypes in China: Results From Three Large Cities Stroke, January 1, 2006; 37(1): 63 - 65. [Abstract] [Full Text] [PDF]

				Asia Pacific Cohort Studies Collaboration{dagger} Smoking, quitting, and the risk of cardiovascular disease among women and men in the Asia-Pacific region Int. J. Epidemiol., October 1, 2005; 34(5): 1036 - 1045. [Abstract] [Full Text] [PDF]

				D. L. Brown and L. B. Morgenstern Stopping the Bleeding in Intracerebral Hemorrhage N. Engl. J. Med., February 24, 2005; 352(8): 828 - 830. [Full Text] [PDF]

				X. Zhang, X. O. Shu, G. Yang, H. L. Li, Y. B. Xiang, Y.-T. Gao, Q. Li, and W. Zheng Association of Passive Smoking by Husbands with Prevalence of Stroke among Chinese Women Nonsmokers Am. J. Epidemiol., February 1, 2005; 161(3): 213 - 218. [Abstract] [Full Text] [PDF]

				T. O. Cheng Influence of Dietary Patterns on Stroke Risk in China Stroke, February 1, 2005; 36(2): 228 - 228. [Full Text] [PDF]

				F. A. Khan, E. Zia, L. Janzon, and G. Engstrom Incidence of Stroke and Stroke Subtypes in Malmo, Sweden, 1990-2000: Marked Differences Between Groups Defined by Birth Country Stroke, September 1, 2004; 35(9): 2054 - 2058. [Abstract] [Full Text] [PDF]

				K. He, Y. Song, M. L. Daviglus, K. Liu, L. Van Horn, A. R. Dyer, U. Goldbourt, and P. Greenland Fish Consumption and Incidence of Stroke: A Meta-Analysis of Cohort Studies Stroke, July 1, 2004; 35(7): 1538 - 1542. [Abstract] [Full Text] [PDF]

				T. O. Cheng Stroke in China Stroke, February 1, 2004; 35 (2): e24 - e24. [Full Text] [PDF]