He J. Klag MJ. Wu Z. Whelton PK.
Welch Center for Prevention, Epidemiology, and Clinical Research, Baltimore,
MD 21205-2223, USA.
Stroke in the People's
Republic of China. I. Geographic variations in incidence and risk factors.
Stroke. 26(12):2222-7, 1995 Dec.
BACKGROUND AND PURPOSE: Stroke is a major cause of death in
the People's Republic of China (PRC), and
the geographic distribution of stroke death
varies substantially. We conducted an ecological analysis to investigate
the relationship of prevalence of hypertension and
other risk factors with stroke incidence
and mortality in the PRC. METHODS: The
relationship between prevalence of risk factors and stroke
incidence and mortality in the PRC was assessed in 29
provinces by examining risk factor data from PRC national surveys and
incidence and mortality from the 1986 PRC National
Stroke Study. RESULTS: A highly statistically significant
correlation between prevalence of hypertension and stroke
incidence (r = .838, P < .001) and mortality (r = .841, P < .001) was
observed. Prevalence of hypertension explained over 70% of
the geographic variability in stroke
incidence (partial R2 = .703) and mortality (partial R2 = .707) in
the PRC. There was a north-south gradient,
with a higher prevalence of hypertension and stroke
incidence and mortality in the north compared with
the south of the country. In multiple
Poisson regression analysis, a 10% increase in the
prevalence of hypertension was associated with a 2.80-fold higher incidence
and 2.68-fold higher mortality from stroke, whereas a 10%
increase in the prevalence of alcohol consumption was
associated with a 29% higher incidence and a 16% higher mortality from
stroke. A 10% increase in the prevalence of
cigarette smoking was associated with a 19% higher mortality from
stroke. CONCLUSIONS: In the PRC,
the prevalence of hypertension is strongly associated with
the risk of stroke, and
the geographic variation in stroke
incidence and mortality is due mainly to differences in the
prevalence of hypertension.
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