Peter Hannon, MD

Wang J, Ning X, Yang L, Tu J, Gu H, Zhan C, et al. Sex Differences in Trends of Incidence and Mortality of First-Ever Strokein Rural Tianjin, China, From 1992 to 2012. Stroke. 2014

Stroke is quickly rising the ranks around the world as a leading cause of death and disability. Gender differences in stroke incidence and outcomes have been documented for some time, however not in rural China. In this article by Wang et. al., the authors utilized a stroke surveillance program in Tianjin, China to monitor stroke incidence and comorbidities in 14,920 residents in a rural community over 20 years from 1992-2012. Per the authors, over one half of the population in China lives in rural settings, and previous to this study gender difference in stroke incidence and outcome had not been rigorously investigated and published. The population studied were primarily low-income farmers with illiteracy rates ranging 30-40%, and until 2008, very few residents were covered by national medical insurance.

Within this population, 908 patients had diagnosed strokes (TIAs were not included), with 40% being women. The incidence of stroke increased annually for both men and women, but more so for women (8% vs 5.8%). Outcomes were limited to mortality at 30 days, and authors did not find significant differences between the genders. The prevalence of HTN, DM, obesity and alcohol was significantly higher in 2011 than 1991, and the prevalence of obesity and diabetes was higher in women. In one small public health victory, the prevalence of smoking dropped from 43% to 37% among men.

This study highlights the increasing incidence of stroke in rural China, and in particular the burden of stroke on women in this population. As in other countries, the increased prevalence of historically “western” medical diseases such as HTN, DM and obesity seems to be playing a significant role in higher stroke rates. I would have been particularly interested in more detail regarding disability outcomes of the stroke patients in addition to the mortality numbers. While mortality rates were equivalent between the sexes in this study, would women have higher rate of disability as recently shown in other studies? It seems this would have been a nice opportunity to compare disability in this population to those in other studies as well.