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A nationwide survey was conducted from October 2018 to September 2019 to assess the prevalence of hyperhomocysteinemia (Hhcy) and its influencing factors in China. A standardized questionnaire was used to collect information. Hhcy was defined as the level of serum homocysteine (HCY) ⩾ 15.0µmol/L. The H-type hypertension (HHYP) was defined as hypertension with an elevated serum HCY 15.0µmol/L). Finally, 110 551 residents ⩾ 40 years of age from 31 provinces in the mainland of China were included. Overall, the median serum HCY level was 10.9µmol/L (interquartile range 7.9-15.1). A total of 28 633 participants (25.9%) were defined as Hhcy. The Hhcy prevalence ranged from 7.9% in Shanghai to 56.8% in Tianjin. The data showed that serum HCY levels were associated with age, male gender, cigarette smoking, hypertension, diabetes, ethnicity, endurance in exercise (inverse), and fruit and vegetable intake (inverse). In addition, 15 486 participants were defined as HHYP, and the rate was 14.0%. HHYP was an independent predictor of stroke with an adjusted odds ratio of 1.752 (95% CI 1.338-2.105). The geographical distribution pattern of the Hhcy epidemic reflects dynamic differences, and national strategies should be carried out to further improve the care of patients with Hhcy across China.

Background Managing risk factors is crucial to prevent stroke. However, few cohort studies have evaluated socioeconomic factors together with conventional factors affecting incident stroke and its subtypes in China. Methods and Results A 2014 to 2016 prospective study from the China National Stroke Screening and Intervention Program comprised 437 318 adults aged ≥40 years without stroke at baseline. There were 2429 cases of first‐ever stroke during a median follow‐up period of 2.1 years, including 2206 ischemic strokes and 237 hemorrhagic strokes. The multivariable Cox regression analysis indicated that age 50 to 59 years (versus 40–49 years), primary school or no formal education (versus middle school), having >1 child (versus 1 child), living in Northeast, Central, East, or North China (versus Southwest China), physical inactivity, hypertension, diabetes mellitus, and obesity were positively associated with the risk of total and ischemic stroke, whereas age 60 to 69 years and living with spouse or children (versus living alone) were negatively associated with the risk of total and ischemic stroke. Men, vegetable‐based diet, underweight, physical inactivity, hypertension, living in a high‐income region, having Urban Resident Basic Medical Insurance, and New Rural Cooperative Medical System were positively associated with the risk of hemorrhagic stroke, whereas age 60 to 69 years was negatively associated with the risk of hemorrhagic stroke. Conclusions We identified socioeconomic factors that complement traditional risk factors for incident stroke and its subtypes, allowing targeting these factors to reduce stroke burden.

Anticoagulant therapy is an effective stroke prevention measurement for subjects with atrial fibrillation (AF) who are at high risk of ischemic stroke. However, it is reported that oral anticoagulants (OACs) are generally underused in clinical practice. A better awareness of current usage of anticoagulant therapy would enable prevention of stroke secondary to AF. Therefore, we determined the nationwide prevalence of AF and the frequency of OACs use among patients with ischemic stroke in China. Based on the China National Stroke Screening Survey, a representative nationwide sample of 1,252,703 adults over 40 years old during 2013 and 2014 was involved. Information on demographic data, diagnosis of stroke, behavioral risk factors, family history of stroke, related diseases, and medications was collected. The community-based survey data showed that 5,588 patients (12.0%) with ischemic stroke had previous, or newly diagnosed, AF. Therefore, more than 2.15 million ischemic stroke patients had AF in China. Among ischemic stroke patients with AF, the strongest risk factor was coronary heart disease (odds ratio = 2.53), whereas dyslipidemia accounted for the largest contribution (population-attributable risk proportion = 17.33%). Of ischemic stroke patients with AF, only 2.2% had taken OACs; of them, 98.2% had taken warfarin. In conclusion, a large number of ischemic stroke patients with AF are significantly undertreated with OACs in China. This highlights the need for improvement of prevention of ischemic stroke secondary to AF.

Background The lifestyle interventions are effective preventive measures for stroke in general population, and the stroke risk with lifestyle factors may be modified by gender, health conditions, etc. Therefore, we conducted a case-control study to investigate the gender-specific association between stroke risk and lifestyle factors in adults with diabetes based on the China National Stroke Screening Survey. Methods Structured questionnaires were used to collect demographic data and information regarding lifestyle factors, history of chronic medical conditions, and family history of stroke and the status of treatment. The case group comprised individuals diagnosed with first-ever stroke in 2013-2014 screening period. Their corresponding controls (frequency-matched for age group and urban/rural ratio) were randomly selected from individuals with diabetes without stroke. Results There were 170 total stroke cases (500 controls) and 152 ischemic stroke cases (456 controls) among men with diabetes, and 183 total stroke cases (549 controls) and 168 ischemic stroke cases (504 controls) among women with diabetes. We found that physical inactivity was significantly associated with increased risk of total stroke (odds ratio [OR] = 1.50, 95% confidence interval [CI] 1.02-2.21) and of ischemic stroke (OR = 1.57, 95% CI 1.04-2.36) in women with diabetes. We found no significant association of smoking, overweight/obesity, or physical inactivity with risk of total or ischemic stroke in men with diabetes. Conclusion Among the lifestyle factors of smoking, overweight/obesity, and physical inactivity, physical inactivity might increase the risk of total and ischemic stroke in women with diabetes.

Objective:To estimate the current prevalence, temporal incidence trends, and contribution of risk factors for stroke in China.Methods:The China National Stroke Screening Survey (CNSSS) is an ongoing nationwide population-based program. A representative sample of 1,292,010 adults over 40 years old with 31,188 identified stroke cases from the 2013 and 2014 CNSSS database was analyzed to provide descriptive statistics of the prevalence and risk factors for stroke in 2014. In addition, a retrospective evaluation of 12,526 first-ever stroke cases in 2002–2013 and stroke mortality data from the 2002–2013 China Public Health Statistical Yearbook was conducted to estimate the incidence rates.Results:In 2014, the adjusted stroke prevalence was 2.06% in adults aged 40 years and older. After full adjustments, all risk factors assessed showed significant associations with stroke (p < 0.01); the largest contributor was hypertension (population-attributable risk 53.2%), followed by family history, dyslipidemia, atrial fibrillation, diabetes, physical inactivity, smoking, and overweight/obesity. The incidence of first-ever stroke in adults aged 40–74 years increased from 189/100,000 individuals in 2002 to 379/100,000 in 2013—an overall annual increase of 8.3%. Stroke-specific mortality in adults aged 40–74 years has remained stable, at approximately 124 deaths/100,000 individuals in both 2002 and 2013.Conclusions:In 2002–2013, the incidence of stroke in China increased rapidly. Combined with a high prevalence, a trend toward a younger age, and stable mortality, this finding suggests that additional clinical and behavioral interventions for metabolic and lifestyle risk factors are necessary to prevent stroke, particularly in certain populations.

Background: Stroke places a considerable burden on human beings. Managing risk factors is crucial to prevent stroke. However, few cohort studies have evaluated socioeconomic factors together with conventional factors affecting incident stroke, particularly ­in China. Methods: A 2014-2016 cohort of the China National Stroke Screening and Intervention Program was studied, comprised 437 318 adults aged 40 years or older without stroke at baseline from 31 provinces. Cox regression yielded adjusted hazard ratios for risk factors related to the incidence of first-ever stroke and ischemic stroke. Findings: There were 2 429 cases of first-ever stroke during a median follow-up period of 2·1 years, including 2 206 ischemic strokes and 237 hemorrhagic strokes. The multivariable Cox regression analysis indicated that age 50–59 years (vs. 40-49 years), primary school or no formal education (vs. middle school), having more than one child (vs. one child), and living in Northeast, Central, East, or North China (vs. Southwest China), fruit consumption ≤4 days/week (vs.≥5 days/week), vegetable-based diet (vs. balance portion of vegetables and meat), physical inactivity, smoking (former, current, and passive), heavy drinking, hypertension, diabetes, obesity, family history (stroke, coronary heart disease, and hypertension) were positively associated with the risk of total and ischemic stroke, whereas age 60-69 years (vs. 40-49 years), living with spouse or children (vs. living alone), and vegetable consumption 3-4 days/week (vs.≥5 days/week) were negatively associated with the risk of total and ischemic stroke. The population-attributable risk of hypertension for stroke was the highest among all modifiable risk factors, followed by physical inactivity and smoking. Interpretation: We identified socioeconomic factors that complement traditional risk factors associated with incident stroke and ischemic stroke, allowing targeting these factors to reduce stroke burden. Funding Statement: The National Natural Science Foundation of China (No. 71532014). Declaration of Interests: The authors stated: "None." Ethics Approval Statement: The study was performed according to the Helsinki declaration and approved by the Ethics Committee of Xuanwu Hospital Institutional Review Board of Capital Medical University, located in Beijing, China. All participants were informed about the study and signed written informed consent.

Although short-term exposure to fine particulate matter (PM2.5) air pollution has been shown to induce elevated blood pressure (BP), limited evidence is available regarding the association between ambient PM2.5 and BP levels in nationwide China and how the association may change. This study sought to explore acute BP changes with exposure to PM2.5 at levels below China’s current National Ambient Air Quality Standards (NAAQS). Based on a spatiotemporal study of over 1 million adults, we linked BP measurements to daily estimates of PM2.5 from multiple sources (i.e. in situ observations, satellite measurements of aerosol and numeric simulations of air quality model) after adjusting for several individual-level covariates and further conduced the below-criteria models by restricting the analyses within subsets of individuals with short-term PM2.5 exposure below 75 μg m−3 (i.e. NAAQS of 24 h PM2.5 in China). We further explored variations in BP-PM2.5 associations by pollution level and for different demographic groups. With full adjustments, a 10 μg m−3 increase in PM2.5 was statistically significantly associated with a 0.049 mmHg (95% confidence interval, CI: 0.041, 0.057) increase in systolic BP, a 0.022 mmHg (95% CI: 0.017, 0.027) increase in diastolic BP and a 0.77% (95% CI: 0.62%, 0.92%) increased risk of hypertension (HPN). For both BP and HPN, the exposure-response curves were linear, with no threshold effects, at the low-concentration ends and sublinear at the high-concentration ends. Below the current NAAQS, the associations in population level remained statistically significant and were even stronger. A 10 μg m−3 increase in below-NAAQS PM2.5 was associated with a 1.95% (95% CI: 1.44%, 2.47%) increased risk of HPN. Specific subpopulations were more susceptible to PM2.5 exposure. These findings can help support decisions by policymakers to revise related environmental regulations to protect public health.

Background Population-based information about stroke incidence and prevalence is essential to inform health policy and practice. However, China's prevalence of stroke is unknown so far. To fill this important information gap, we did an epidemiological study of data from a large-scale national stroke screening survey. Methods From August, 2013, to May, 2014, the National Project Office of Stroke Prevention and Control organised a screening survey on 633 859 residents older than 40 years in 31 provinces. Following a random cluster sampling framework, structured questionnaires were used to collect information on risk factors, diagnosis history, treatment, and sociodemographic characteristics and were administered by community health workers trained by national and provincial specialists. A web-based reporting system was built for online data reporting. The institutional ethics committee approved the study protocol. Findings Among 633 859 surveyed subjects, 15 027 (2·37%) had stroke in 2013. The prevalence increases with age (0·54% of participants aged 40–50 years, 1·76% of those aged 50–60 years, 3·79% of those aged 60–70 years, and 8·87% of those older than 70 years). Prevalence seems to be higher in men than in women: the male:female ratio for all age groups combined is 1·23 (95% CI 1·21–1·26). The prevalence of stroke is slightly higher in rural residents than in urban residents (2·5% vs 2·2%). Interpretation Our study provided the first estimation of China's stroke prevalence on the basis of data from a large-scale survey. The estimated stroke prevalence and its association with age and sex are consistent with published findings from other developed countries. However, China's rural population has a higher probability of stroke than its urban counterpart, suggesting that the underlying socioeconomic disparities still persist. In view of the finding that the stroke prevalence of China, a developing country, is on par with that of developed countries, together with the rapid ageing, unhealthy lifestyle, and unmet medical need of the Chinese population, China's policy makers should pay more attention to effective prevention and control of stroke. Funding National Health and Family Planning Commission of China.