Objective:To present the epidemiological characteristics of ≤28 days case fatality in both hemorrhagic stroke (HS) and ischemic stroke (IS) patients in national cardiovascular disease surveillance areas from 2015 to 2019.Methods:Data on all new patients with stroke and ≤28 days outcomes from 2015 to 2019 were from the China Registry of Cardiovascular Events, which was established in 2014, covering 100 counties (cities, districts) in 31 provinces in China. Poisson regression was used to analyze the annual trend of ≤28 days case fatality. The age-standardized case fatality was directly calculated based on all new stroke onset.Results:In total, 112 069 deaths in HS patients ≤28 days after the onset, as well as 94 373 in IS patients, were identified during the study period. In 2019, the ≤28 days case fatality rate in HS patients was 4.75 times that of IS patients (37.08% vs. 7.80%), as well as that 4.06 times in urban areas (30.13% vs. 7.43%) and 5.30 times in rural areas (42.63% vs. 8.05%), respectively. Thus, in rural areas, HS patients showed 41.49% higher ≤28 days case fatality rate than that in urban areas, as well as 8.34% higher in IS patients. Those ≤28 days case fatality in both stroke subtypes onset increased with age and reached the highest level in those aged 85 years and over. During the study period, HS and IS patients in each age group displayed significant decrease trend in ≤28 days case fatality rate (trend P<0.001). Compared with that in 2015, the age-standardized ≤28 days case-fatality in HS patients in 2019 decreased by 28.52%, which was more in urban areas (-34.27%) than that in rural areas (-23.19%). Meanwhile, IS patients experienced a 39.90% reduction in ≤28 days case fatality, which was much lower in urban areas (-31.62%) than in rural areas (-45.10%, all trend P<0.001). Conclusions:From 2015 to 2019, ≤28 days case fatality in both HS and IS patients decreased in China. Wide variations of ≤28 days case-fatality were evident in the level and trend in stroke subtype, age of patients, as well as urban and rural areas. More precise and comprehensive strategies for stroke prevention, treatment, and post-stroke management are urgently required in China.

Objective:To analyze the characteristics and changes in incidence and mortality of ischemic and hemorrhagic stroke among Chinese residents from 2015 to 2019.Methods:The incidence and mortality data of ischemic and hemorrhagic stroke from 2015 to 2019 were collected from the China Registry of Cardiovascular Events (China RACE), which was established in 2014 and covered 100 counties (cities and districts) in 31 provinces in China. The age-standardized incidence rate (ASIR) was calculated using the Seventh National Census data as the standard population. The ratio of the incidence rate of ischemic stroke to hemorrhagic stroke was calculated. The subtype-specific mortality-to-incidence ratio (M/I) was calculated by the ratio of the number of deaths to the reported incidence cases. The relative ratio (RR) of M/I for ischemic to hemorrhagic stroke was calculated. The Joinpoint model was used to analyze the annual percentage change (APC) and trend of the incidence rate of stroke.Results:From 2015 to 2019, a total of 1 354 614 new stroke cases were reported, including 1 077 244 (79.52%) ischemic stroke and 277 370 (20.48%) hemorrhagic stroke cases, respectively. A total of 248 620 stroke deaths were reported, including 119 819 (48.19%) ischemic stroke deaths and 128 801 (51.81%) hemorrhagic stroke deaths. The incidence ratio of ischemic/hemorrhagic stroke from 2015 to 2019 was 3.50∶1, 3.76∶1, 3.63∶1, 4.23∶1, and 4.35∶1, respectively. From 2015 to 2019, there was no statistically significant annual trend of ASIR of ischemic stroke in overall, urban and rural areas and males ( Ptrend>0.05), while there was a downward trend in females (APC=-1.02%, Ptrend=0.042). The incidence of hemorrhagic stroke in the whole population, rural areas, males and females showed a downward trend ( Ptrend<0.05). Patients aged 45-49 years had an upward trend in the incidence rate of ischemic stroke (APC=3.82%, Ptrend=0.011), while those aged 70-74 years (APC=-7.37%, Ptrend=0.034), 80-84 years (APC=-9.75%, Ptrend=0.001) and 85 years and over (APC=-11.22%, Ptrend=0.017) presented a downward trend in the incidence of hemorrhagic stroke. During the period, the overall relative ratio of M/I (RR) for ischemic to hemorrhagic stroke was 4.2∶1, which was lower in urban than in rural areas (3.8 vs. 4.3). The largest gap between urban and rural areas was in the 55-59 age group (6.8 vs. 9.3). Conclusion:The incidence and mortality of ischemic and hemorrhagic stroke among Chinese residents are severe from 2015 to 2019, and there are regional and population differences.

Objective:To present the epidemiological characteristics of ≤28 days case fatality in both hemorrhagic stroke (HS) and ischemic stroke (IS) patients in national cardiovascular disease surveillance areas from 2015 to 2019.Methods:Data on all new patients with stroke and ≤28 days outcomes from 2015 to 2019 were from the China Registry of Cardiovascular Events, which was established in 2014, covering 100 counties (cities, districts) in 31 provinces in China. Poisson regression was used to analyze the annual trend of ≤28 days case fatality. The age-standardized case fatality was directly calculated based on all new stroke onset.Results:In total, 112 069 deaths in HS patients ≤28 days after the onset, as well as 94 373 in IS patients, were identified during the study period. In 2019, the ≤28 days case fatality rate in HS patients was 4.75 times that of IS patients (37.08% vs. 7.80%), as well as that 4.06 times in urban areas (30.13% vs. 7.43%) and 5.30 times in rural areas (42.63% vs. 8.05%), respectively. Thus, in rural areas, HS patients showed 41.49% higher ≤28 days case fatality rate than that in urban areas, as well as 8.34% higher in IS patients. Those ≤28 days case fatality in both stroke subtypes onset increased with age and reached the highest level in those aged 85 years and over. During the study period, HS and IS patients in each age group displayed significant decrease trend in ≤28 days case fatality rate (trend P<0.001). Compared with that in 2015, the age-standardized ≤28 days case-fatality in HS patients in 2019 decreased by 28.52%, which was more in urban areas (-34.27%) than that in rural areas (-23.19%). Meanwhile, IS patients experienced a 39.90% reduction in ≤28 days case fatality, which was much lower in urban areas (-31.62%) than in rural areas (-45.10%, all trend P<0.001). Conclusions:From 2015 to 2019, ≤28 days case fatality in both HS and IS patients decreased in China. Wide variations of ≤28 days case-fatality were evident in the level and trend in stroke subtype, age of patients, as well as urban and rural areas. More precise and comprehensive strategies for stroke prevention, treatment, and post-stroke management are urgently required in China.

Objective:To analyze the characteristics and changes in incidence and mortality of ischemic and hemorrhagic stroke among Chinese residents from 2015 to 2019.Methods:The incidence and mortality data of ischemic and hemorrhagic stroke from 2015 to 2019 were collected from the China Registry of Cardiovascular Events (China RACE), which was established in 2014 and covered 100 counties (cities and districts) in 31 provinces in China. The age-standardized incidence rate (ASIR) was calculated using the Seventh National Census data as the standard population. The ratio of the incidence rate of ischemic stroke to hemorrhagic stroke was calculated. The subtype-specific mortality-to-incidence ratio (M/I) was calculated by the ratio of the number of deaths to the reported incidence cases. The relative ratio (RR) of M/I for ischemic to hemorrhagic stroke was calculated. The Joinpoint model was used to analyze the annual percentage change (APC) and trend of the incidence rate of stroke.Results:From 2015 to 2019, a total of 1 354 614 new stroke cases were reported, including 1 077 244 (79.52%) ischemic stroke and 277 370 (20.48%) hemorrhagic stroke cases, respectively. A total of 248 620 stroke deaths were reported, including 119 819 (48.19%) ischemic stroke deaths and 128 801 (51.81%) hemorrhagic stroke deaths. The incidence ratio of ischemic/hemorrhagic stroke from 2015 to 2019 was 3.50∶1, 3.76∶1, 3.63∶1, 4.23∶1, and 4.35∶1, respectively. From 2015 to 2019, there was no statistically significant annual trend of ASIR of ischemic stroke in overall, urban and rural areas and males ( Ptrend>0.05), while there was a downward trend in females (APC=-1.02%, Ptrend=0.042). The incidence of hemorrhagic stroke in the whole population, rural areas, males and females showed a downward trend ( Ptrend<0.05). Patients aged 45-49 years had an upward trend in the incidence rate of ischemic stroke (APC=3.82%, Ptrend=0.011), while those aged 70-74 years (APC=-7.37%, Ptrend=0.034), 80-84 years (APC=-9.75%, Ptrend=0.001) and 85 years and over (APC=-11.22%, Ptrend=0.017) presented a downward trend in the incidence of hemorrhagic stroke. During the period, the overall relative ratio of M/I (RR) for ischemic to hemorrhagic stroke was 4.2∶1, which was lower in urban than in rural areas (3.8 vs. 4.3). The largest gap between urban and rural areas was in the 55-59 age group (6.8 vs. 9.3). Conclusion:The incidence and mortality of ischemic and hemorrhagic stroke among Chinese residents are severe from 2015 to 2019, and there are regional and population differences.

Objectives:To present the epidemiological characteristics of stroke incidence and stroke-related mortality among the whole population in national cardiovascular disease surveillance areas from 2015 to 2019. Methods:Data of stroke incidence and stroke-related mortality from 2015 to 2019 were collected from the China Registry of Cardiovascular Events(China RACE),which was established in 2014,covering 100 counties(cities,districts)in 31 provinces in China.The Joinpoint model was used to analyze the annual percentage changes(APC)and trends of stroke incidence rate.The age-standardized incidence rate(ASIR)was calculated using the Seventh National Census data as the standard population.With annual reported stroke events and stroke-related deaths,the mortality to incidence ratio(M/I)were examined. Results:From 2015 to 2019,an increase of 9.41%(APC=2.12%,95%CI:1.43%-2.82%,Ptrend<0.01)resulted in the overall stroke crude incidence rate(CIR)of 468.48/100 000 in 2019 among the whole population,with relatively higher in male and in rural area.The more sharply elevating of CIR appeared in males(11.26%[APC=2.53%,95%CI:1.83%-3.24%,Ptrend<0.01])rather than in females(7.26%[APC=1.63%,95%CI:0.81%-2.46%,Ptrend<0.01]).Meanwhile,the general ASIR decreased 7.47%(APC=-1.72%,95%CI:-3.23%--0.20%,Ptrend<0.05),reaching 523.82/100 000 in 2019.The females generally showed significant descending trend(9.56%[APC=-2.27%,95%CI:-3.99%--0.52%,Ptrend<0.05]),as well as more reduction than that in the males(15.82%vs.11.40%)in urban area.The crude incidence rate of stroke increased with age.From 2015 to 2019,the CIR in 45-49 age group increased 12.48%(APC=3.18%,95%CI:1.67%-4.72%,Ptrend<0.01),compared with an reduction of 15.76%(APC=-4.39%,95%CI:-7.63%--1.04%,Ptrend<0.05)in 80-84 age group.Over the monitoring years,the overall M/I was 0.19,with an age-specific U-shaped distribution.The lowest of M/I(0.10)appeared in those aged 50-54 and 55-59,while the highest(0.45)detected in those aged 85 and over.The M/I of all age in urban areas were consistently lower than that in rural areas. Conclusions:Stroke incidence burden increased from 2015-2019 in the national surveillance areas in China,along with the unfavorable geographic diversity and age-specific divergence.Further efforts are required to improve health care covering all ages and regions in China to reduce the incidence of stroke and stroke-related mortality.

Objectives:The present study aims to investigate the incidence and mortality feature of acute myocardial infarction(AMI)from 2015 to 2019 in China by utilizing national registry data. Methods:Data of AMI incidence and mortality in the surveillance area during 2015 to 2019 were abstracted from China Registry of Acute Cardiovascular Event(China RACE),which was established in 100 counties from 31 provincial regions in China.Incidence rate,age standardized incidence rate(ASIR)and mortality to incidence ratio(M/I)was estimated in AMI cases.A Joinpoint regression was executed and annual percent change(APC)was examined to identify trends in incidence. Results:From 2015 to 2019,a total of 257 686 acute myocardial infarction incidence and 149 169 deaths were registered.The annual incidence rate of AMI in 2019 was 82.76 per 100 000.Over the study period,the incidence rate of AMI increased by 6.05%for men(APC=1.30%,95%CI:0.56%to 2.02%)but decreased by 11.80%for women(APC=-3.10%,95%CI:-4.54%to-1.68%),resulting a steady trend for AMI crude incidence rate for the overall population.The overall ASIR of AMI declined by 16.59%(APC=-4.32%,95%CI:-5.32%to-3.34%)from 113.68 per 100 000 in 2015 to 94.82 per 100 000 in 2019.The ASIR of AMI declined by 11.04%(APC=-2.72%,95%CI:-3.78%to-1.67%)for men,23.96%(APC=-6.56%,95%CI:-8.57%to-4.58%)for women,12.57%(APC=-3.08%,95%CI:-6.01%to-0.08%)for the urban areas,and 19.24%(APC=-5.18%,95%CI:-10.19%to 0.03%)for rural areas respectively.The incidence rate of AMI increases gradually with age in both men and women.The incidence of AMI in urban men of 35-44 and 45-54 year age groups increased by 77.16%(APC=13.52%,95%CI:3.29%to 24.57%)and 26.36%(APC=5.71%,95%CI:-0.95%to 12.68%)over time.However,the incidence of AMI fell in the population above 65 year old,by 26.58%(APC=-6.68%,95%CI:-11.98%to-1.01%),19.85%(APC=-5.64%,95%CI:-11.57%to 0.65%)and 14.53%(APC=-4.44%,95%CI:-7.75%to-1.04%)in the 65-74 year age,75-84 year age and≥85year age groups respectively from 2015 to 2019.The mortality to incidence ratio of AMI was 0.58 over time,higher in women than in men,and higher in rural areas than in urban areas.The M/I ratio of AMI decreased from 0.62 in 2015 to 0.52 in 2019(APC=-4.28%,95%CI:-5.75%to-2.83%).There was a declined trends in M/I of AMI in urban residents of both male and female,and in the rural male residents(all P<0.05),while a steady trend in the rural female residents(P>0.05). Conclusions:The overall incidence of AMI remains steady during 2015 to 2019 in the national surveillance areas in China.Yet,downward trends in elder and female residents and increased trend in middle-aged urban males in AMI incidence are observed.The mortality of AMI in these period are age,sex and urban-rural dependent.Targeted mitigation strategies on AMI prevention and treatment need to be strengthened to reduce its incidence and mortality.

Objective:To assess the trends in case-fatality rates for acute myocardial infarction (AMI) in China from 2015 to 2019.Methods:This study employed a population-based surveillance. Data from the China Registry of Acute Cardiovascular Event (China RACE) were utilized, including AMI cases reported by Grade Ⅱ and Grade Ⅲ hospitals at the disease surveillance sites across China from January 1 st 2015 to December 31 st 2019. The 28-day mortality outcome for reported AMI events was obtained by linking to the national death certificate registry system. The study analyzed the overall and age-standardized case-fatality rates, as well as their annual percent change (APC), during the study period, stratified by gender, age, and region. Results:The overall 28-day case fatality rate for AMI was 28.97% (22 532/77 764) from 2015 to 2019. The age-standardized case-fatality rate for AMI declined significantly from 37.53% in 2015 to 18.58% in 2019, with an APC of -14.33% ( P=0.018). We observed a significant downward trend in case-fatality rates of AMI in both genders (both P<0.05). Among males, the case-fatality rate decreased more steeply in younger males compared to elder counterparts. The most marked decreases were seen in males aged<35 years and 35 to 44 years, with APC of -27.63% ( P=0.007) and -22.65% ( P=0.004), respectively. In females, we observed a relatively stable decrease in case-fatality across age groups. The age-standardized case-fatality rate of AMI in eastern and central China decreased significantly from 2015 to 2019, with the APC of -19.22% ( P=0.006) and -15.62% ( P=0.032) respectively. However, the age-standardized case-fatality rate of AMI in western China remained stable ( P=0.227). Conclusions:The prognosis of AMI has considerably improved from 2015 to 2019 in China, regardless of ages and gender. Inequality in case-fatality rates among geographic regions highlights the need for targeted strategies in AMI prevention in western regions.

Objective: To analyze the association between 24 h urinary sodium excretion and microalbuminuria (MAU) among Chinese people aged from 18 to 69 years old. Methods: 2 400 subjects aged from 18 to 69 years old were selected form Gaomi and Fushan sites of Shandong Province and Xinyi and Ganyu sites of Jiangsu Province in 2013 by using multi-stage stratified cluster random sampling method. Questionnaire survey, physical measurement and 24 h urine collection were conducted. 2 262 subjects were finally included in the analysis. According to the quartile of 24 h urinary sodium, all subjects were divided into Q1-Q4 groups and the levels of urinary microalbumin and MAU among different groups were compared. The relationship between urinary sodium and MAU was analyzed by multivariate logistic regression analysis. Results: The age of subjects was (42.1±13.5) years old, including 1 124 males (49.7%). The 24 h urine volume, urinary sodium, urine albumin M (P₂₅, P₇₅) and MAU detection rate were (1 411±495) ml, (166.4±71.6) mmol/d, 12.5 (9.6, 17.4) mg/d and 9.0% (203 cases), respectively. With the increase of urinary sodium level, the level of urinary albumin increased (P_trend<0.001), and the prevalence of MAU also showed an upward trend (P_trend<0.001). Multivariate logistic regression analysis showed that after adjusting for age, gender, smoking, alcohol consumption, BMI, hypertension and diabetes, the risk of MAU in Q4 group increased by 174% compared with Q1 group, and OR (95%CI) value was 2.74 (1.80-4.16). Conclusion 24 h urinary sodium is associated with the prevalence of MAU and salt reduction can help reduce MAU.

Objective To analyze the association between 24 h urinary sodium excretion and microalbuminuria (MAU) among Chinese people aged from 18 to 69 years old. Methods 2 400 subjects aged from 18 to 69 years old were selected form Gaomi and Fushan sites of Shandong Province and Xinyi and Ganyu sites of Jiangsu Province in 2013 by using multi?stage stratified cluster random sampling method. Questionnaire survey, physical measurement and 24 h urine collection were conducted. 2 262 subjects were finally included in the analysis. According to the quartile of 24 h urinary sodium, all subjects were divided into Q1-Q4 groups and the levels of urinary microalbumin and MAU among different groups were compared. The relationship between urinary sodium and MAU was analyzed by multivariate logistic regression analysis. Results The age of subjects was (42.1 ± 13.5) years old, including 1 124 males (49.7%). The 24 h urine volume, urinary sodium, urine albumin M (P25, P75) and MAU detection rate were (1 411±495) ml, (166.4± 71.6) mmol/d, 12.5 (9.6, 17.4) mg/d and 9.0% (203 cases), respectively. With the increase of urinary sodium level, the level of urinary albumin increased (Ptrend<0.001), and the prevalence of MAU also showed an upward trend (Ptrend<0.001). Multivariate logistic regression analysis showed that after adjusting for age, gender, smoking, alcohol consumption, BMI, hypertension and diabetes, the risk of MAU in Q4 group increased by 174% compared with Q1 group, and OR (95%CI ) value was 2.74 (1.80-4.16). Conclusion 24 h urinary sodium is associated with the prevalence of MAU and salt reduction can help reduce MAU.

Objective To investigate the association between microalbuminuria and cardiovascular risk factors in a general Chinese population.Methods A multi-stage cluster randomized sampling method was used to select 2400 residents (18-69 years old) in four counties in Shandong and Jiangsu provinces in October 2013 to March 2014.24-hour MAU were measured for each subject.The prevalence of MAU in different groups was analyzed.The relationship between the aggregation of risk factors and MAU was analyzed.Logistic regression analysis was used to evaluate the association between MAU and cardiovascular risk factors.Results A total of 2265 subjects were included in the analysis.The prevalence of MAU was 8.96％ (203/2265,95％ CI:7.82-10.21).The prevalence of MAU in obesity,hypertension,diabetes,hypertriglyceridemia,and low HDL-C group were 14.65％ (63/430),12.53％ (104/830),20.22％ (36/178),15.57％ (64/411),11.99％ (53/442) respectively,which were significantly higher than the corresponding healthy population (all P ＜ 0.01).Multivariate logistic regression analysis showed that obesity,hypertension,diabetes,and hypertriglyceridemia were risk factors for MAU.The OR(95％ CI) values were 1.491(1.016-2.265),1.660(1.190-2.314),2.291 (1.494-3.515) and 1.734(1.205-2.495) respectively.With the increase in the number of influencing factors,urinary albumin levels and the prevalence of MAU all showed an upward trend.Conclusion MAU was associated with cardiovascular risk factors such as obesity,hypertension,diabetes,and hypertriglyceridemia.