RT Journal Article
SR Electronic
T1 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
JF Stroke and Vascular Neurology
JO Stroke Vasc Neurol
FD BMJ Publishing Group Ltd
SP 34
OP 50
DO 10.1136/svn-2022-001552
VO 8
IS 1
A1 Wang, Chun-Juan
A1 Gu, Hong-Qiu
A1 Zhang, Xin-Miao
A1 Jiang, Yong
A1 Li, Hao
A1 Bettger, Janet Prvu
A1 Meng, Xia
A1 Dong, Ke-Hui
A1 Wangqin, Run-Qi
A1 Yang, Xin
A1 Wang, Meng
A1 Liu, Chelsea
A1 Liu, Li-Ping
A1 Tang, Bei-Sha
A1 Li, Guo-Zhong
A1 Xu, Yu-Ming
A1 He, Zhi-Yi
A1 Yang, Yi
A1 Yip, Winnie
A1 Fonarow, Gregg C
A1 Schwamm, Lee H
A1 Xian, Ying
A1 Zhao, Xing-Quan
A1 Wang, Yi-Long
A1 Wang, Yongjun
A1 Li, Zixiao
YR 2023
UL http://svn.bmj.com/content/8/1/34.abstract
AB 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.Data are available upon reasonable request. Data are available upon reasonable request to the corresponding author.