关键词: 脑血管病; 死亡率; 趋势分析; 期望寿命; Joinpoint回归

Abstract: Objective  To analyze the trends in cerebrovascular disease mortality and the impact on life expectancy in Shanghai from 2002 to 2021, and to provide evidence for the formulation of precision prevention and control strategies for cerebrovascular disease. 
Methods  Mortality data of cerebrovascular disease among registered residents in Shanghai from 2002 to 2021 were collected from the death registration information system of the Shanghai Municipal Center for Disease Control and Prevention. Joinpoint regression models were used to examine the trends in cerebrovascular disease mortality in the overall population and by sex, age group, region, and disease subtype. Arriaga’s life table decomposition method was employed to quantify the contributions of mortality declines from acute cerebrovascular disease and cerebrovascular disease sequelae to life expectancy gains by age group and sex.
Results  From 2002 to 2021, the crude mortality rate of cerebrovascular disease in Shanghai increased from 142.51/100 000 to 181.90/100 000 [average annual percent change (AAPC) 1.17%, P<0.001], while the standardized mortality rate decreased from 101.28/100 000 to 68.00/100 000 (AAPC -2.08%, P<0.001), with a slowdown in decline after 2010 [annual percent change (APC) changed from -2.88% to -1.50%]. The crude mortality rate of acute cerebrovascular disease in urban districts shifted from decreasing to increasing after 2013 (APC changed from -0.71% to 1.55%), whereas that in suburban districts showed a trend of continuous decline followed by a plateau, with an overall AAPC of -2.06% (P<0.001). The standardized mortality rates of acute cerebrovascular disease continued to decline in both urban and suburban areas, with AAPCs of –3.28% (P<0.001) and –5.39% (P<0.001), respectively. The crude mortality rates of cerebrovascular disease sequelae showed a continuous increase in both urban and suburban areas, with AAPCs of 3.34% (P<0.001) and 6.66% (P<0.001), respectively. The standardized mortality rate of cerebrovascular disease sequelae continued to rise in suburban areas (AAPC 3.08%, P<0.001), but shifted from a non-significant trend to a decreasing trend after 2012 in urban areas (APC –2.51%, P<0.001). Age‑specific crude mortality rates of acute cerebrovascular disease all showed a decreasing trend (all AAPC<0, P<0.001), whereas the trends for crude mortality rates of cerebrovascular disease sequelae varied across age groups. Different subtypes of cerebrovascular disease exhibited different mortality trends; notably, the crude mortality rate of ischemic stroke sequelae (AAPC 7.05%, P<0.001) and its standardized mortality rate (AAPC 3.49%, P<0.05) both increased. The decline in cerebrovascular disease mortality contributed 0.8814 years to the increase in life expectancy, with acute cerebrovascular disease contributing 0.9951 years and sequelae contributing –0.1137 years. The 75-84 years age group made the largest contribution (0.4696 years). The gain in total life expectancy attributed to the decline in acute cerebrovascular disease mortality was higher in males (1.0473 years) than in females (0.9571 years).
Conclusions  The standardized mortality rate of cerebrovascular disease in Shanghai declined continuously from 2002 to 2021 but slowed after 2010. Current major challenges include urban-suburban disparities, the continuously increasing mortality from cerebrovascular disease sequelae among young and middle-aged populations, the plateaued trend in the oldest-old group, and the rising mortality rate of ischemic stroke sequelae. Future prevention and control strategies should focus on strengthening the management of disease sequelae and building a life-course precision prevention and control system.

Key words: Cerebrovascular disease;   Mortality rate;   Trend analysis;   Life expectancy; Joinpoint regression