Macroeconomic Development and Dramatic Increase in Stroke Burden in Rural China: A 25-Year Population-Based Study

Background: To explore the quantitative association between macroeconomic development and stroke burden in rural China. Methods: In this population-based, prospective study (1992–2016), gross domestic product annually adjusted for purchasing power parity (PPP-aGDP) and per capita net income (PCNI) in rural China were collected to assess the association with first-ever stroke incidence over 25-year prospective study. Findings: During the 25-year study period, there were 1185 stroke events and 362,296 person-years of surveillance. First-ever stroke incidence increased by an average of 10·7% per 1000 USD increase in overall PPP-aGDP and by 12·0% per 1000 Yuan increase in PCNI; respectively. These same changes in PPP-aGDP and PCNI also resulted in increases in the first-ever stroke incidences across sex and stroke types. Similarly, in men, the age of onset of intracerebral hemorrhage decreased by 0·96 years for each 1000 USD increase in PPP-aGDP and by 1·08 years for each 1000 Yuan increase in PCNI. Interpretation: These findings suggested that enhancing health-care investments is crucial for containing the stroke burden during this remarkable economic development in China. Our findings imply the guiding function for other developing countries on the timely control of stroke risk factors and reductions in stroke burden during the initial stages of economic development. Funding Statement: The authors stated: "None." Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: The study protocol was approved by the ethics committee of Tianjin Medical University General Hospital (TMUGH), and written informed consent was obtained from each participant.