Disparities in the burden of stroke in China and its relevance to emerging economies

With an estimated 5.7 million deaths from stroke each year, stroke is the second leading cause of mortality worldwide. However, there are significant disparities in the burden of chronic, non-communicable diseases such as stroke across the world. Whilst rates of stroke and cardiovascular disease have remained relatively stable or have been declining over the past 10 years in developed countries, recent demographic transitions and economic developments have resulted in developing countries witnessing an escalation in the rates of these diseases that now top lists of leading causes of death and disability along with historic communicable diseases. Of the developing countries, Brazil, Russia, India, Indonesia, China, and the Republic of South Africa — the star performing emerging economies, are projected to have the highest potential for economic grth in the coming decades. Much of the success witnessed in these countries has been attributable to trade liberalisation and market opening reforms; however, these reforms have also inadvertently triggered extensive demographic, social and health transitions in the vast, heterogeneous populations of these countries. Notably, the people in these countries have been increasingly exposed to unhealthy diets and sedentary lifestyles, typical of urban metropolises, ways of life that have inflamed the progression of atheromatous and ischaemic disease. With one-fifth of the world’s population, China experiences nearly 60% of all the stroke deaths from the 6 major emerging economies, one third of stroke deaths worldwide, and has stroke listed as a leading cause of death and disability, making it an optimal candidate for examination of the evolving epidemiology of stroke in these countries. As in many developing nations, limited epidemiological data exist on stroke in China. The aim of this thesis was therefore firstly to examine the burden of stroke in China in relation to the changing epidemiology of its two predominant subtypes: ischaemic stroke and intracerebral haemorrhage (ICH); secondly to explore disease burden in terms of mortality, morbidity and cost by type of stroke; and thirdly, to identify points of disparity in the management of stroke, in order to facilitate the appropriate design and implementation of future interventions aimed at reducing this burden. The majority of this work is based on analyses of the ChinaQUEST (QUality Evaluation of Stroke Care and Treatment) study which used a multi-centre, prospective, hospital registry design to collect data from 62 hospitals in 37 cities across mainland China. Chinese hospitals are classified as Level 1 (community hospitals with only the most basic facilities and very limited inpatient capacity), Level 2 (hospitals with at least 100 inpatient beds providing acute medical care and preventative care services to populations of at least 100,000), and Level 3 (major tertiary referral centres in provincial capitals and major cities). Statistical analyses as appropriate to each section of work were undertaken using STATA (StataCorp LP, College Station, TX)