The Effect Of Socioeconomic Status And High Blood Pressure Control On The Prevalence, Incidence And Mortality Of Stroke In Older Adults In China

Background: Stroke is one of the most serious chronic diseases affecting human health.It occurs suddenly and severely and its incidence, morbidity and mortality are high.Around the world, stroke is still one of the diseases with the highest mortality and themost disability adjusted life year. It has been shown that there were about2millionnew cases of cerebral apoplexy, about1.5million people died of cerebrovasculardisease and6~7million survival cases every year in China.3/4survival cases lostlabor ability at different level and40%were severely handicapped. Stroke has broughtheavy economic burden to China. At present, it costs at least10billion Yuan to treatstroke each year and the total cost of stroke is up to20billion Yuan a year.Objectives: A prospective cohort study was conducted in old adults to find out theprevalence, incidence and mortality of stroke among elderly people in5provinces ofChina, to find out the effect of high blood pressure control and socioeconomic status onstroke prevalence, incidence and mortality. So high risk population of stroke will befound and scientific basis for further discussing the prevention and control measures ofstroke among the elderly will be provided.Methods: Using cluster random sampling, old people aged60and more years wererecruited from an urban community and a rural community in Anhui province, Shanghaicity, Heilongjiang province, Shanxi province and Guangdong province, respectively.Baseline data was collected in2007-2009using a standard general health and riskfactors questionnaire by face to face interviewing the participants at home. In2011-2012we followed up the survivors within the cohort and conducted death cause survey by verbal autopsy. All the data were imputed into computers by Epidata4.0andSPSS18.0was used for data analysis. The prevalence, incidence and mortality rate ofstroke were calculated and standardized against the world population by CIA. Dataanalysis was conducted with Chi-square test, age-sex adjusted and multiple logisticregression model.Results:(1)6071questionnaires were obtained,225reported stroke. The prevalencerate of stroke was3.72%and world age standardized prevalence was3.42%;(2)4019people were revisited when we removed the original225cases after4years. There were151new cases of stroke and61cases died of stroke. The incidence rate of stroke was3.80%, and the mortality rate of stroke was0.90%. World age standardized incidenceand mortality was2.47%and0.75%respectively.(3) The multiple logistic regressionanalysis showed that: stroke prevalence increased with older age(OR=1.92;95%CI:1.22-3.03), men(OR=1.54;95%CI:1.11-2.15) and worker (OR=2.11;95%CI:1.36-3.28).The hypertensive patient who took medicine but still with high blood pressure(OR=3.44;95%CI:2.35-5.03), the hypertensive patient who didn’t take medicine(OR=3.01;95%CI:1.80-5.04) and the hypertensive patient whose blood pressure wascontrolled (OR=2.51;95%CI:1.56-4.04) were the high risk groups of stroke incidence;stroke incidence increased with men (OR=1.76;95%CI:1.25-2.48), the highest level offamily average income (OR=1.86;95%CI:1.10-3.12) and the lower level ofeducation(OR=2.38;95%CI:1.39-4.08). The hypertensive patient who took medicinebut still with high blood pressure (OR=2.86;95%CI:1.82-4.50), the hypertensive patientwho didn’t take medicine (OR=2.21;95%CI:1.14-4.31) and the hypertensive patientwhose blood pressure was controlled (OR=2.38;95%CI:1.34-4.25) were the high riskgroups of stroke incidence; The highest (OR=2.33;95%CI:1.01-5.40) and the lowest(OR=2.61;95%CI:1.02-6.68) group of annual income were the high risk groups ofstroke mortality. The hypertensive patient who took medicine but still with high bloodpressure (OR=3.95;95%CI:1.39-11.17) and the hypertensive patient whose blood pressure was controlled (OR=2.92;95%CI:1.13-7.52) were the high risk groups ofstroke mortality.Conclusions:(1) Stroke prevalence increased with older age, men and worker. Thestroke prevalence of people without hypertension is the lowest. The hypertensive patientwho took medicine but still with high blood pressure, the hypertensive patient whodidn’t take medicine and the hypertensive patient whose blood pressure was controlledwere the high risk groups of stroke incidence;(2) Stroke incidence increased with men, the highest level of family average income andthe lower level of education. The stroke incidence of people without hypertension is thelowest. The hypertensive patient who took medicine but still with high blood pressure,the hypertensive patient who didn’t take medicine and the hypertensive patient whoseblood pressure was controlled were the high risk groups of stroke incidence;(3) The highest and the lowest group of annual income were the high risk groups ofstroke mortality. The stroke mortality of people without hypertension is the lowest. Thehypertensive patient who took medicine but still with high blood pressure and thehypertensive patient whose blood pressure was controlled were the high risk groups ofstroke mortality.Recommendations:(1) More attention should be paid to high risk groups of stroke andcomprehensive intervention measures should be taken in those groups in communities,such as building residents’ health records.(2) Health education related to the prevention and intervention of stroke and highblood pressure control and prevention should be strengthened.(3)Staff in stroke prevention and control, social administration and health care ofstroke should be integrated effectively to achieve better primary prevention, secondaryprevention and tertiary prevention of stroke.