Trends in the incidence of recurrent stroke at 5 years after the first-ever stroke in rural China: a population-based stroke surveillance from 1992 to 2017

Abstract

Recent data on the incidence and trends for recurrent strokes in China are scarce. We assessed the temporal trends in recurrent stroke incidence using in rural China. The age-standardized incidences of recurrent stroke, within 5 years of the incident stroke event, were estimated for 3 time periods: 1992–1998, 1999–2005, and 2006–2012. Among the 768 documented incident stroke cases, 26.3% of the patients experienced recurrent stroke within 5 years. The overall age-adjusted recurrent stroke incidence was 43.93 per 100,000 person-years (1992–2012). During the 2006–2012 period, the recurrent stroke incidence per 100,000 person-years was 107.79 in men, and 557.76 in individuals ≥65 years old. There were significant upward tendencies observed in this population across sex, age, or type of stroke (except for among individuals ≥65 years old with incident intracerebral hemorrhages). Compared with the recurrent stroke incidence observed in the 1992–1998 period, that observed during the 2006–2012 period was more than 3-fold higher; the greatest increase (6.8-fold) was observed in women. These findings suggest an urgent need to improve risk factor management and implement appropriate medical resources to contain this upward trend in recurrent stroke incidence and reduce the overall stroke burden in China.

Trends in ischemic stroke outcomes in a rural population in the United States

“…Contrary to most studies where the rate of oneyear recurrence declined [33,40,41], the recurrence rate in this study increased over the past fifteen years. The rise in stroke recurrence in a rural population as shown by this study is also similar to results from a study in rural China [42]. This disparity in the recurrent stroke trend between urban and rural populations should be further studied.…”

Corneal confocal microscopy identifies greater corneal nerve damage in patients with a recurrent compared to first ischemic stroke

“…Recurrent stroke occurs in 11.1% of stroke patients within one year of the initial stroke [1], and is associated with greater disability and mortality [2]. A recent study from China has shown that the incidence of recurrent stroke has increased 3-fold between 1992 and 2012 [3]. Age [4], dyslipidemia [5], smoking [6], diabetes, hypertension, homocysteine levels, atrial fibrillation [1], metabolic syndrome [7] and other risk factors [8][9][10] are associated with recurrent stroke.…”

Incidence and Etiologies of Stroke Mimics After Incident Stroke or Transient Ischemic Attack

“…Table 4 demonstrates 5-year recurrence rates reported in other studies. 15,160,172,173,176,188,194,198,201,207,[258][259][260][261][262][263][264] As for early recurrence, differences in study populations, follow-up, definitions of recurrence and inclusion of hemorrhagic stroke may explain some of the observed differences between studies.…”

“…Still, studies on stroke recurrence trends differ on whether recurrence rates are declining in industrialized countries. 168,265,266 Some studies from selected populations indicate a decline in recurrence rates, 175,[267][268][269] other have reported an increase in incidence, 263,270 but a recent metaanalysis estimated the annual recurrent stroke risk to be ≈4.26% without any observable decline over time. 266 A study from the Dijon Stroke Registry reported an increase in recurrent strokes due to improved stroke care and more stroke survivors with longer survival, which is relevant with populations ageing in industrialized countries.…”