An Integrated Analysis of Disease Burden and Economic Burden of Stroke in China

doi:10.3969/j.issn.1673-5765.2025.05.005

Abstract

Abstract: Objective To conduct an integrated analysis of the disease burden and economic burden of various types of stroke in China.
Methods Based on published literature and public databases, including data from the 2013 national epidemiological survey of stroke in China, the annual report on cardiovascular health and diseases in China, the China health statistical yearbook, and the 2021 GBD study, a comprehensive analysis was conducted on the indicators reflecting the disease burden and economic burden of various types of stroke in China, such as the incidence, death, prevalence, DALYs, number of discharged patients, average hospitalization cost per visit, and the total hospitalization cost for patients with stroke.
Results (1) Current situation: from 2021 to 2022, the surveillance of cardiovascular and cerebrovascular events among Chinese residents revealed that the age-standardized incidence rate of stroke among individuals aged 18 and above in China was 338.6/100 000. According to the China health statistical yearbook, the crude death rate of stroke among urban residents in China in 2021 was 140.02/100 000, accounting for 21.71% of total urban deaths. Among rural residents, the crude death rate of stroke was 175.58/100 000, representing 23.62% of total rural deaths. The 2021 GBD study indicated that the age-standardized prevalence rate of stroke in China in 2021 was 1301.4/100 000, with ischemic stroke at 1018.8/100 000, intracerebral hemorrhage at 222.1/100 000, subarachnoid hemorrhage at 68.9/100 000, and the age-standardized DALYs rate for stroke was 2648.0/100 000. (2) Trends: the 2021 GBD study showed that compared to 1990, the age-standardized incidence rate of stroke decreased by 9.8%, the age-standardized death rate decreased by 43.0%, the age-standardized prevalence rate increased by 11.5%, and the age-standardized DALYs rate decreased by 45.2%. The age-standardized incidence and prevalence rates of ischemic stroke continued to exhibit an upward trend. In contrast, the downward trends in the age-standardized death rate and DALYs rate were not statistically significant. Further gender-specific analysis indicated that the age-standardized death rate and DALYs rate of ischemic stroke in females showed a statistically significant downward trend, while the corresponding trend in males was not statistically significant. (3) Economic burden: in 2020, the total hospitalization cost of ischemic stroke in China amounted to 74.77 billion yuan, and for intracerebral hemorrhage reached 30.91 billion yuan. The average hospitalization cost per visit was 9824.9 yuan for ischemic stroke and 20 397.6 yuan for intracerebral hemorrhage, respectively. After excluding the effects of price fluctuations, since 2004, the average annual growth rates of total hospitalization costs for ischemic stroke and intracerebral hemorrhage were 16.8% and 12.8%, respectively. Meanwhile, the average annual growth rates of the average hospitalization cost per visit were 1.1% and 4.4%, respectively.
Conclusions From 1990 to 2021, the age-standardized incidence rate, age-standardized death rate, and DALYs rate of stroke in China exhibited a downward trend. However, the age-standardized incidence and prevalence rates of ischemic stroke continued to exhibit an upward trend. From 2004 to 2020, the average hospitalization cost per visit for ischemic stroke and intracerebral hemorrhage in China increased substantially. With the rapid process of population aging in China, the future disease burden and economic burden attributable to stroke will continue to rise.

Key words: Stroke; Disease burden; Incidence rate; Death rate; Prevalence rate; Disability-adjusted life year; Economic burden

摘要： 目的对中国各类型卒中的疾病负担和经济负担进行整合分析。
方法基于已发表文献和公共数据库，包括2013年中国卒中流行病学调查、中国心血管健康与疾病报告、中国卫生健康统计年鉴、2021年GBD研究等数据信息，对中国各类型卒中的发病、死亡、患病和DALYs、出院人次、次均住院费用和住院总费用等反映疾病负担和经济负担的指标进行综合分析。
结果 ①现状：2021—2022年，中国居民心脑血管事件监测显示，18岁及以上居民卒中年龄标化发病率为338.6/10万。根据中国卫生健康统计年鉴，2021年中国城市居民卒中粗死亡率为140.02/10万，占城市总死亡人数的21.71%，农村居民卒中粗死亡率为175.58/10万，占农村总死亡人数的23.62%。2021年GBD研究显示，2021年中国卒中年龄标化患病率为1301.4/10万，其中缺血性卒中为1018.8/10万，脑出血为222.1/10万，蛛网膜下腔出血为68.9/10万，卒中年龄标化DALYs率为2648.0/10万。②变化趋势：2021年GBD研究显示，与1990年相比，卒中的年龄标化发病率下降了9.8%，年龄标化死亡率下降了43.0%，年龄标化患病率上升了11.5%，年龄标化DALYs率下降了45.2%。但其中缺血性卒中的年龄标化发病率和患病率仍呈上升趋势，年龄标化死亡率和DALYs率的下降趋势无统计学意义；进一步的性别分析发现，女性缺血性卒中的年龄标化死亡率和DALYs率呈明显下降趋势，而男性这些指标的下降趋势无统计学意义。③经济负担：2020年，中国的缺血性卒中住院总费用为747.7亿元，脑出血为309.1亿元，次均住院费用分别为9824.9元和20 397.6元。校正物价影响，2004年以来，缺血性卒中、脑出血的住院总费用年均增长速度分别为16.8%和12.8%，次均住院费用年均增长速度分别为1.1%和4.4%。
结论 1990—2021年，中国的卒中总年龄标化发病率、年龄标化死亡率和DALYs率呈现下降趋势。但缺血性卒中的年龄标化发病率和患病率仍呈现上升趋势。2004—2020年，中国的缺血性卒中和脑出血次均住院费用均明显上升。随着人口老龄化的快速进程，未来卒中造成的疾病负担和经济负担仍将继续攀升。

关键词: 卒中; 疾病负担; 发病率; 死亡率; 患病率; 伤残调整生命年; 经济负担

CLC Number:

ZHAI Yi, YANG Fan, LI Tianqi, XIE Yuting, LIU Gaifen. An Integrated Analysis of Disease Burden and Economic Burden of Stroke in China[J]. Chinese Journal of Stroke, 2025, 20(5): 566-580.

翟屹, 杨帆, 李天琪, 谢瑀婷, 刘改芬. 中国卒中疾病负担与经济负担的整合分析[J]. 中国卒中杂志, 2025, 20(5): 566-580.

References

[1] 中国疾病预防控制中心慢性非传染性疾病预防控制中心，国家卫生健康委员会统计信息中心. 中国死因监测数据集2021[M]. 北京：中国科学技术出版社，2022.
Chronic and Non-Communicable Disease Prevention and Control Center，Chinese Center for Disease Control and Prevention；National Health Commission Statistical Information Center. China cause-of-death surveillance dataset 2021[M]. Beijing：China Science and Technology Press，2022.
[2] FEIGIN V L，OWOLABI M O. Pragmatic solutions to reduce the global burden of stroke：a World Stroke Organization-Lancet Neurology Commission[J]. Lancet Neurol，2023，22（12）：1160-1206.
[3] WANG W Z，JIANG B，SUN H X，et al. Prevalence，incidence，and mortality of stroke in China：results from a nationwide population-based survey of 480 687 adults[J]. Circulation，2017，135（8）：759-771.
[4] 国家心血管病中心. 中国心血管健康与疾病报告2022[M]. 北京：中国协和医科大学出版社，2023.
National Center for Cardiovascular Diseases. Annual report on cardiovascular health and diseases in China（2022）[M]. Beijing：Peking Union Medical College Press，2023.
[5] 国家心血管病中心. 中国心血管健康与疾病报告2023[M]. 北京：中国协和医科大学出版社，2024.
National Center for Cardiovascular Diseases. Annual report on cardiovascular health and diseases in China（2023）[M]. Beijing：Peking Union Medical College Press，2024.
[6] 国家卫生健康委员会. 2022中国卫生健康统计年鉴[M]. 北京：中国协和医科大学出版社，2022.
National Health Commission. 2022 China health statistical yearbook[M]. Beijing：Peking Union Medical College Press，2022.
[7] Institute for Health Metrics and Evaluation. GBD，GBD results[EB/OL]. [2025-03-05]. https://vizhub.healthdata.org/gbd-results/.
[8] AHO K，HARMSEN P，HATANO S，et al. Cerebrovascular disease in the community：results of a WHO collaborative study[J]. Bull World Health Organ，1980，58（1）：113-130.
[9] FEIGIN V，NORRVING B，SUDLOW C L M，et al. Updated criteria for population-based stroke and transient ischemic attack incidence studies for the 21st century[J]. Stroke，2018，49（9）：2248-2255.
[10] GU H Q，YANG X，WANG C J，et al. Clinical characteristics，management，and in-hospital outcomes in patients with stroke or transient ischemic attack in China[J/OL]. JAMA Network Open，2021，4（8）：e2120745[2025-03-05]. https://doi.org/10.1001/jamanetworkopen.2021.20745.
[11] WANG M，WANG C J，GU H Q，et al. Sex differences in short-term and long-term outcomes among patients with acute ischemic stroke in China[J]. Stroke，2022，53（7）：2268-2275.
[12] GBD 2019 Stroke Collaborators. Global，regional，and national burden of stroke and its risk factors，1990—2019：a systematic analysis for the global burden of disease study 2019[J]. Lancet Neurol，2021，20（10）：795-820.
[13] HALL E W，VAUGHAN A S，RITCHEY M D，et al. Stagnating national declines in stroke mortality mask widespread county-level increases，2010—2016[J]. Stroke，2019，50（12）：3355-3359.
[14] SHAH R，WILKINS E，NICHOLS M，et al. Epidemiology report：trends in sex-specific cerebrovascular disease mortality in Europe based on WHO mortality data[J]. Eur Heart J，2019，40（9）：755-764.
[15] CABRAL N L，FREIRE A T，CONFORTO A B，et al. Increase of stroke incidence in young adults in a middle-income country：a 10-year population-based study[J]. Stroke，2017，48（11）：2925-2930.
[16] EKKER M S，VERHOEVEN J I，VAARTJES I，et al. Stroke incidence in young adults according to age，subtype，sex，and time trends[J/OL]. Neurology，2019，92（21）：e2444-e2454[2025-03-05]. https://doi.org/10.1212/WNL.0000000000007533.
[17] BÉJOT Y，DELPONT B，GIROUD M. Rising stroke incidence in young adults：more epidemiological evidence，more questions to be answered[J/OL]. J Am Heart Assoc，2016，5（5）：e003661[2025-03-05]. https://doi.org/10.1161/JAHA.116.003661.
[18] 中国疾病预防控制中心. 2018年中国成人烟草调查结果发布——我国15岁及以上人群吸烟率呈下降趋势[EB/OL].（2019-05-30）[2025-03-05].
https://www.chinacdc.cn/jksj/jksj04/202407/t20240731_287863.html.
[19] BARKER-COLLO S，BENNETT D A，KRISHNAMURTHI R V，et al. Sex differences in stroke incidence，prevalence，mortality and disability-adjusted life years：results from the global burden of disease study 2013[J]. Neuroepidemiology，2015，45（3）：203-214.
[20] 中国疾病预防控制中心，中国疾病预防控制中心慢性非传染性疾病预防控制中心. 中国慢性病及危险因素监测报告2018[M]. 北京：人民卫生出版社，2021.
Chinese Center for Disease Control and Prevention；Chronic and Non-Communicable Disease Prevention and Control Center，Chinese Center for Disease Control and Prevention. Report on chronic disease risk factor surveillance in China 2018[M]. Beijing：People’s Medical Publishing House，2021.
[21] LINDSAY P，FURIE K L，DAVIS S M，et al. World Stroke Organization global stroke services guidelines and action plan[J/OL]. Int J Stroke，2014，9 Suppl A100：4-13[2025-03-05]. https://doi.org/10.1111/ijs.12371.
[22] World Health Organization. Intersectoral global action plan on epilepsy and other neurological disorders 2022—2031[EB/OL]. [2025-03-05]. https://iris.who.int/bitstream/handle/10665/371495/9789240076624-eng.pdf?sequence=1.
[23] LIU S W，WU X L，LOPEZ A D，et al. An integrated national mortality surveillance system for death registration and mortality surveillance，China[J]. Bull World Health Organ，2016，94（1）：46-57.
[24] 陈晓荣，颜流霞，厚磊，等. 2015—2019年中国居民脑卒中发病与死亡特征分析[J]. 中国循环杂志，2024，39（5）：470-476.
CHEN X R，YAN L X，HOU L，et al. Trends of stroke incidence and mortality from 2015 to 2019 in China[J]. Chinese Circulation Journal，2024，39（5）：470-476.
[25] 颜流霞，陈晓荣，覃玉，等. 2015—2019年中国居民心脑血管事件报告数据质量分析[J]. 疾病监测，2021，36（12）：1341-1346.
YAN L X，CHEN X R，TAN Y，et al. Data quality of acute stroke and myocardial infarction events registry in China，2015—2019[J]. Disease Surveillance，2021，36（12）：1341-1346.
[26] 李振三，杨期东，苏启庚，等. 中国农村脑血管病流行病学调查[J]. 中华神经外科杂志，1989（S1）：9-13.
LI Z S，YANG Q D，SU Q G，et al. Epidemiological investigation of cerebrovascular diseases in rural China[J]. Chin J Neurosurg，1989（S1）：9-13.
[27] 薛广波，于秉学，王笑中，等. 中国城乡脑血管病的流行病学研究[J]. 第二军医大学学报，1991（3）：201-207.
XUE G B，YU B X，WANG X Z，et al. Study on epidemiology of cerebrovascular diseases in urban and rural areas of China[J]. Academic Journal of Second Military Medical University，1991（3）：201-207.
[28] 殷鹏，周脉耕. 未来之路：中国疾病负担研究的新展望[J]. 中国慢性病预防与控制，2024，32（12）：881-883.
YIN P，ZHOU M G. The road ahead：new prospects for disease burden research in China[J]. Chin J Prev Contr Chron Dis，2024，32（12）：881-883.
[29] 宋子伟，张梅，王志会，等. 大数据背景下的脑卒中疾病负担研究方法概述[J]. 中华流行病学杂志，2021，42（9）：1695-1699.
SONG Z W，ZHANG M，WANG Z H，et al. Summary of research methods of stroke disease burden in big data era[J]. Chin J Epidemiol，2021，42（9）：1695-1699.
[30] SMITH S C，Jr，COLLINS A，FERRARI R，et al. Our time：a call to save preventable death from cardiovascular disease（heart disease and stroke）[J]. J Am Coll Cardiol，2012，60（22）：2343-8244.