How does social development influence life expectancy? A geographically weighted regression analysis in China

Multivariate Relationships Between Health Outcomes and Health System Performance Indicators: An Integrated Factor Analysis With Canonical Correlations

OBJECTIVES

This study aimed to investigate the relationships between sets of variables related to health system performance indicators and health outcomes.

METHODS

The relationships between a set of health outcomes and a set of health system performance indicators of a developing country were examined using multivariate statistical analysis techniques. A combinative strategy of explanatory factor analysis and the canonical correlation coefficient was used to define linear structural relationships between study variables. Province-based data were gathered from2 official statistical records of the Turkish Statistical Institute for the year 2019. Life expectancy at birth, infant mortality rate, and crude death rate were accepted as health outcome indicators.

RESULTS

The explanatory factor analysis indicated 2 independent variable groups, namely (1) health-related human resources and capacity and (2) health service utilization characteristics. The results of the canonical correlation analysis illustrated good performance to define sparse linear combinations of the 2 groups of variables. There existed strong positive correlations between health outcomes and health-related human resources and capacity indicators (rc = 0.83; P < .001) and health service utilization indicators (rc = 0.59; P < .001).

CONCLUSIONS

The results of this study support the view that there is a linear and strong positive relationship between health outcomes and health-related human resources and capacity indicators. Further studies will combine big data analytics with multivariate statistical analysis techniques by studying large health system performance data sets.

Living longer but in poor health: healthcare system responses to ageing populations in industrialised countries based on the Findings from the Global Burden of Disease Study 2019

OBJECTIVES

This study aimed to examine changes in life expectancy (LE), health-adjusted life expectancy (HALE), unhealthy years of life, and disease burden of older people in industrialised countries and associations with health systems.

METHODS

We used estimates of LE and HALE, unhealthy years of life, years of life loss (YLL), years lived with disability (YLD) for individuals aged 70 years and over in 33 industrialised countries from 1990 to 2019 from the Global Burden of Disease Study 2019. A linear regression analysis was conducted to examine the association of health outcomes with the Healthcare Access and Quality (HAQ) index.

RESULTS

LE and HALE increased with improved HAQ index from 1990 to 2019. However, the number of unhealthy years of life increased. An increased HAQ index was associated with decreases in YLL. However, changes in YLD were relatively small and were not correlated with HAQ index.

CONCLUSIONS

The healthcare system needs to more address the increased morbidity burden among older people. It should be designed to handle to healthcare needs of the ageing population.

Regional fauna-flora biodiversity and conservation strategy in China

Evolutionary and historical development and current profiles are essential to generating a tangible conservation strategy. It is also critical to distinguish the regions with vigorous potential growth from those meeting evolutionary development bottlenecks and those whose development has been severely devastated. We used two sizeable national data repositories of terrestrial fauna and flora of China to approach the issues. The results indicate that the Southwest and Coastal regions have the most significant terrestrial faunal-floral biodiversity (TFFB). Thus, they should be prioritized in conservation for great potential promotions. Although there has been remarkable evolutionary development, the Central region has been severely devastated. A solution is to uphold a balanced association between social-economic development and TFFB sustainability. As for the Northeast and the western Northwest, there is no need to invest heavily in conservation measures. This study sheds light on exploring more practical conservation strategies regionally, nationally, and globally to achieve pragmatic goals.

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Terrestrial faunal-floral biodiversity (TFFB) in China

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Regional variation assessment of TFFB in China

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China’s regional disparity in human impact and evolutionary development

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Regionalized conservation strategies in China

Spatial variations and social determinants of life expectancy in China, 2005-2020: A population-based spatial panel modelling study

BACKGROUND

Social determinants of health (SDOH) produce a broad range of life expectancy (LE) disparities. In China, limited literatures were found to report association between SDOH and LE at ecological level during a consecutive period of time from the spatial perspectives. This study aimed to determine the existence, quantify the magnitude, and interpret the association between SDOH and LE in China.

METHODS

Provincial-level LE were estimated from mortality records during 2005-2020 from National Mortality Surveillance System in China. A spatial panel Durbin model was used to investigate LE associated SDOH proxies. Spatial spillover effects were introduced to interpret direct and indirect effects caused by SDOH during long-term and short-term period on LE disparities.

FINDINGS

Nationwide, LE increased from 73.1 (95% confidence interval (CI): 71.3, 74.4) years to 77.7 (95%CI: 76.5, 78.7) years from 2005 to 2020. Unequally spatial distribution of LE with High-High clustering in coastal areas and Low-Low clustering in western regions were observed. Locally, it was estimated that SDOH proxies statistically significant related to an increase of LE, including GDP (coefficient: 0.02, 95%CI: 0.00, 0.03), Gini index (coefficient: 2.35, 95%CI: 1.82, 2.88), number of beds in health care institutions (coefficient: 0.02, 95%CI: 0.00, 0.05) and natural growth rate of resident population (coefficient: 0.02, 95%CI: 0.01, 0.02). Direct and indirect effects decomposition during long-term and short-term of LE associated SDOH proxies demonstrated that GDP, urbanization rate, unemployment rate, education attainment, Gini index, number of beds in health care institutions, sex ratio, gross dependence ratio and natural growth rate of resident population not only affected local LE, but also exerted spatial spillover effects towards geographical neighbors.

INTERPRETATION

Spatial variations of LE existed at provincial-level in China. SDOH regarding socioeconomic development and equity, healthcare resources, as well as population characteristics not only affected LE disparities at local scale but also among nearby provinces. Externalities of policy of those SDOH proxies should be took into consideration to promote health equity nationally. Comprehensive approaches on the basis of population strategy should be consolidated to optimize supportive socioeconomic environment and narrow the regional gap to reduce health disparities and increase LE.

FUNDING

National Key Research & Development Program of China (Grant No.2018YFC1315301); Ministry of Education of China Humanities and Social Science General Program (Grant No.18YJC790138).

Modelling geographical heterogeneity of diabetes prevalence and socio-economic and built environment determinants in Saudi City - Jeddah

Type-2 diabetes is a growing lifestyle disease mainly due to increasing physical inactivity but also associated with various other variables. In Saudi Arabia, around 58.5% of the population is deemed to be physically inactive. Against this background, this study attempts explore the spatial heterogeneity of Type-2 diabetes prevalence in Jeddah and to estimate various socio-economic and built environment variables contributing to the prevalence of this disease based on modelling by ordinary least squares (OLS), weighted regression (GWR) and multi-scale geographically weighted (MGWR). Our OLS results suggest that income, population density, commercial land use and Saudi population characteristics are statistically significant for Type-2 diabetes prevalence. However, by the GWR model, income, commercial land use and Saudi population characteristics were significantly positive while population density was significantly negative in this model for 70.6%, 9.1%, 26.6% and 58.7%, respectively, out of 109 districts investigated; by the MGWR model, the corresponding results were 100%, 22%, 100% and 100% of the districts. With the given data, the corrected Akaike information criterion (AICc), the adjusted R2, the log-likelihood and the residual sum of squares (RSS) indices demonstrated that the MGWR model outperformed the GWR and OLS models explaining 29% more variance than the OLS model, and 10.2% more than the GWR model. These results support the development of evidence-based policies for the spatial allocation of health associated resources for the control of Type-2 diabetes in Jeddah and other cities in the Arabian Gulf.

Spatiotemporal Differentiation and Driving Force Analysis of the High-Quality Development of Urban Agglomerations along the Yellow River Basin

The ecological protection and high-quality development (HQD) of the Yellow River Basin (YRB) have been promoted as national strategies. An urban agglomeration is the basic unit of the YRB used to participate in international competitions. Taking seven urban agglomerations covering 70 cities along the YRB as the sample, this paper establishes a high-quality evaluation system and uses the entropy method and exploratory spatial data analysis (ESDA) to analyze the HQD levels of the seven urban agglomerations along the YRB from 2009 to 2018. In addition, geographically-weighted regression (GWR) is adopted to analyze the influencing factors. The results show that: (1) the gap in the HQD of the seven urban agglomerations gradually narrows, showing a spatial pattern of "high in the east, low in the west, and depression in the middle"; (2) the HQD levels of the seven urban agglomerations have a strong spatial correlation, and the patterns of cold and hot spots have not changed substantially, showing the spatial distribution of "hot in the east, cold in the west"; (3) the degree of influence of each driving factor on the HQD differs among the seven urban agglomerations. The order is as follows: industrial structure upgrading index > proportion of R&D expenditure > urbanization rate > internet penetration rate > proportion of urban construction area > proportion of days reaching the air standard. These findings show that advanced industrial structure and technology are the two core driving forces for the HQD of the urban agglomerations along the YRB.

Spatiotemporal trends in life expectancy and impacts of economic growth and air pollution in 134 countries: A Bayesian modeling study

Life expectancy (LE) varies across countries in space and time, and economic growth and air pollution are two important influence factors to LE. This study mainly aims to investigate spatiotemporal trends in LE in 134 countries from 1960 to 2016 by using Bayesian spatiotemporal modeling. Further, the relations between per capita gross domestic product (GDP_pc) and population-weighted fine particulate matter (pwPM_2.5) and LE are investigated from a global perspective from 1998 to 2016 by using the Bayesian regression model. The results illustrated the heterogeneity of spatiotemporal trends in LE globally. Specifically, Africa and South-East Asia show much lower LE levels, and the Americas, European, and Western Pacific exhibit a relatively higher LE level compared to the overall level. The countries with low overall levels of LE show a relatively stronger upward trend than the overall upward trend and vice versa. In addition, this study demonstrates that the spatial differences in effects of influence factors on LE in the six WHO regions in the 134 countries. Africa shows the highest positive regression coefficient of GDP_pc and lowest negative regression coefficient of pwPM_2.5 on LE than other regions in the world. Furthermore, it shows the complexity of the interaction between economic growth and air pollution on LE across six WHO regions. Our findings suggest the public policies to reduce the health damage caused by air pollution, especially in Africa, Eastern Mediterranean, and Europe where the pwPM_2.5 negatively affect the LE benefits from economic growth.

Cancer death and potential years of life lost in Feicheng City, China: Trends from 2013 to 2018

This study aimed to evaluate the impact of cancer-related mortality on life expectancy in Feicheng City.We extracted the death records and population data of Feicheng City from 2013 to 2018 through the Feicheng Center for Disease Control and Prevention. The mortality, premature mortality, cause-eliminated life expectancy, potential years of life lost (PYLL), average potential years of life lost (APYLL), annual change percentage (APC), and other indicators of cancer were calculated. The age-standardized rates were calculated using the sixth national census (2010).From 2013 to 2018, the mortality rate of cancer in Feicheng City was 221.55/100,000, and the standardized mortality rate was 166.37/100,000. The standardized mortality rate increased from 2013 to 2014 and then decreased annually. The premature mortality of cancer was 8.98% and showed a downward trend (APC = -2.47%, t = -3.10, P = .04). From 2013 to 2018, the average life expectancy of residents in Feicheng City was 78.63 years. Eliminating the impact of cancer, life expectancy could increase by 3.72 years. The rate of life loss caused by cancer in men was higher than that in women. The total life loss caused by cancer deaths was 126,870.50 person-years, the potential life loss rate was 22.51‰, and the average potential life loss was 13.30 years. The standardized potential years of life lost rate showed a downward trend (APC = -2.96%, t = -3.72, P = .02), and APYLL decreased by 1.98% annually (t = -5.44, P = .01). The top 5 malignant tumors in APYLL were leukemia, breast cancer, brain tumor, liver cancer, and ovarian cancer.Lung cancer, esophageal cancer, female breast cancer, and childhood leukemia have a great impact on the life expectancy of residents in Feicheng City. Effective measures need to be taken to reduce the disease burden of malignant tumors.

Diagnosis of Arrhythmia for Patients with Occult Coronary Heart Disease Guided by Intracavitary Electrocardiogram under Data Mining Algorithm

The objective of this study was to explore the application value of intracavitary electrocardiogram- (IEGM-) guided diagnosis of occult heart disease and conventional electrocardiogram (EGM) in the diagnosis of occult coronary heart disease (CHD) based on the classification and regression tree (CART) mining algorithm, hoping to provide a more effective basis for clinical diagnosis of the occult CHD. In this study, 100 patients with occult CHD admitted to our hospital from February 2016 to December 2020 were selected as the research objects. Based on the random number table method, 100 patients were randomly rolled into two groups, each with 50 cases. The patients diagnosed with conventional ECG were set as the control group, and patients in the experimental group were diagnosed with IEGM under the data mining algorithms. The diagnostic effects of the two groups were compared. The results showed that the processing effect of the CART algorithm (94%) was much better than that of the multiple linear regression algorithm (78%) and the random forest algorithm (69%) (P < 0.05), the agreement between the results of the experimental group and the results of coronary angiography (80%) and Kappa (0.7) was higher than those of the control group (55%, 0.45), and the difference was statistically significant (P < 0.05). In addition, the sensitivity (93%) and accuracy (80%) of the experimental group were obviously higher than those of the control group (62% and 55%), and the differences were remarkably significant (P < 0.05). In conclusion, the consistency ratio of the IEGM examination was higher, showing high accuracy; the intracavitary examination was invasive, so IEGM was not recommended when the diagnosis result of the examination may cause more harm than good.

The nexus between health status and health expenditure, energy consumption and environmental pollution: empirical evidence from SAARC-BIMSTEC regions

Background

The COVID-19 pandemic has highlighted the need for the betterment of health status, while also considering health expenditure, energy, and environmental issues. This paper examines the nexus between health status and health expenditure (both public and private), energy consumption and environmental pollution in the SAARC-BIMSTEC region.

Methods

We utilized the panel autoregressive distributed lag (ARDL) model, the heterogeneous panel causality test, the cross sectional dependence test, the cointegration test and the Pesaran cross sectional dependent (CADF) unit root test for obtaining estimated results from data over 16 years (2002–2017).

Results

Our results authorize the cointegration among the variables used, where the coefficients of energy consumption, public and private health expenditures, and economic growth are 0.027, 0.014, 0.030, and 0.029, respectively, and indicating positive and statistically significant effects. The coefficient of environmental pollution is − 0.085, implying significant negative effect on the health status of these regions in the long-run. However, no panel wise significant impact is found in the short-run. Bidirectional and unidirectional causal links between the studied variables and the health status are also identified..

Conclusions

The improved health status in the SAARC-BIMSTEC region needs to be protected by articulating the effective policies. The attained results are theoretically and empirically consistent, and have important policy implications in the health sector.

Cardiovascular Risk Factors and Social Development Index

Cardiovascular diseases (CVD) are the leading causes of morbidity and mortality worldwide. The complex etiology of CVD is known to be significantly affected by environmental and social factors. There is, however, a lag in our understanding of how population level components may be related to the onset and severity of CVD, and how some indicators of unsatisfied basic needs might be related to known risk factors. Here, we present a cross-sectional study aimed to analyze the association between cardiovascular risk factors (CVRF) and Social Development Index (SDI) in adult individuals within a metropolitan urban environment. The six components of SDI as well as socioeconomic, anthropometric, clinical, biochemical, and risk behavior parameters were explored within the study population. As a result, several CVRF (waist circumference, waist-to-height ratio, body mass index, systolic blood pressure, glucose, lower high-density lipoprotein cholesterol, triglycerides, and sodium) were found in a higher proportion in the low or very low levels of the SDI, and this pattern occurs more in women than in men. Canonical analysis indicates a correlation between other socioeconomic features and anthropometric, clinical, and biochemical factors (canonical coefficient = 0.8030). Further studies along these lines are needed to fully establish how to insert such associations into the design of health policy and interventions with a view to lessen the burden of cardiovascular diseases, particularly in metropolitan urban environments.

The Relative Importance of Globalization and Public Expenditure on Life Expectancy in Europe: An Approach Based on MARS Methodology

BACKGROUND

There has been a widespread debate about the overall impact of globalization on population, not just economically, but also in terms of health status. Moreover, the current health crisis is going to force governments to review the structure of the public budget to most effectively alleviate the negative economic and health effects on the population.

OBJECTIVE

The aim of this paper is to analyze the relative importance of globalization and the public budget composition-specifically the participation of public expenditure on healthcare, social services and environment in gross domestic product (GDP)-on life expectancy at birth in European countries during the period 1995-2017.

METHODS

The Multivariate Adaptive Regression Splines (MARS) methodology was applied to analyze the socioeconomic determinants of life expectancy at birth.

RESULTS

Our findings show that globalization has no relative importance as an explanatory variable of life expectancy in European countries, while government expenditure on social protection is the most relevant followed by public expenditure on health, gross national income per capita, education level of the population and public expenditure on environmental protection.

CONCLUSION

European strategies intended to impact on health outcome should spend more attention to the composition of public budget.

Life Expectancy in Chinese Cities: Spatially Varied Role of Socioeconomic Development, Population Structure, and Natural Conditions

Improving life expectancy, as well as people's health and wellbeing, is an important goal both for the Chinese government and the United Nations. Therefore, to analyze the main factors influencing life expectancy in prefecture-level cities in China, this study uses classical ordinary least-squares regression and geographical weighted regression on the data of the latest census. Moreover, regional differences induced by each influencing factor are also depicted in this study. The results demonstrate that there is significant heterogeneity and spatial positive correlation among the distribution of life expectancy in prefecture-level cities, with a generally higher life expectancy in the provincial capitals and eastern China, and lower in western China. The geographically weighted regression analysis shows that the economic development level, medical conditions, demographic structure, natural environment, and city attributes all affect the distribution of life expectancy, but that their effects have significant spatial heterogeneity. Life expectancy of the less developed areas in Western China is affected dominantly by economic development level, whereas medical services and education are of great importance in determining the life expectancy in Northern and Southern China, respectively. Thus, it is crucial to solve health problems based on local conditions, especially focusing on the improvement of health and health care in underdeveloped areas. Meanwhile, for the eastern developed areas, special attention should be paid to environmental protection in the economic process, while striving to achieve high-quality development.

Patterns and changes in life expectancy in China, 1990-2016

Objective

To achieve the goal of “healthy China 2030”, reasonable health policies must be developed based on the changes of death spectrum. We aim to investigate the temporal patterns of life expectancy (LE) and age/cause-specific contributions from 1990 to 2016.

Methods

Joinpoint regression model was used with Arriaga’s decomposition method.

Results

LE in China has reached to 76.3 years in 2016 with an increase of 9.44 years from 1990. From 1990 to 2002, a remarkable reduction in infant mortality accounted for an increase of 1.27 years (35.39%) to LE which mainly resulted from diarrhea, lower respiratory, and other common infectious diseases (1.00 years, 27.79%). After 2002, those aged 65+ years contributed most to increased LE and the most prominent causes included cardiovascular diseases (0.67 years, 23.36%), chronic respiratory diseases (0.54 years, 18.76%) and neoplasms (0.39 years, 13.44%). Moreover, the effects of transport injuries changed from negative to positive. After 2007, contributions of transport and unintentional injuries increased especially for males. And for females contributions of cardiovascular diseases sharply increased LE by 1.17 years (32.26%).

Conclusion

More attention should be paid to cardiovascular diseases, chronic respiratory diseases and neoplasms which were mainly attributed to the increase of LE, especially for males and elderly population.

Spatial Characteristics of Life Expectancy and Geographical Detection of Its Influencing Factors in China

Life expectancy (LE) is a comprehensive and important index for measuring population health. Research on LE and its influencing factors is helpful for health improvement. Previous studies have neither considered the spatial stratified heterogeneity of LE nor explored the interactions between its influencing factors. Our study was based on the latest available LE and social and environmental factors data of 31 provinces in 2010 in China. Descriptive and spatial autocorrelation analyses were performed to explore the spatial characteristics of LE. Furthermore, the Geographical Detector (GeoDetector) technique was used to reveal the impact of social and environmental factors and their interactions on LE as well as their optimal range for the maximum LE level. The results show that there existed obvious spatial stratified heterogeneity of LE, and LE mainly presented two clustering types (high-high and low-low) with positive autocorrelation. The results of GeoDetector showed that the number of college students per 100,000 persons (NOCS) could mainly explained the spatial stratified heterogeneity of LE (Power of Determinant (PD) = 0.89, p < 0.001). With the discretization of social and environmental factors, we found that LE reached the highest level with birth rate, total dependency ratio, number of residents per household and water resource per capita at their minimum range; conversely, LE reached the highest level with consumption level, GDP per capita, number of college students per 100,000 persons, medical care expenditure and urbanization rate at their maximum range. In addition, the interaction of any two factors on LE was stronger than the effect of a single factor. Our study suggests that there existed obvious spatial stratified heterogeneity of LE in China, which could mainly be explained by NOCS.

Life Expectancy at Birth in Europe: An Econometric Approach Based on Random Forests Methodology

The objective of this work is to identify and classify the relative importance of several socioeconomic factors which explain life expectancy at birth in the European Union (EU) countries in the period 2008–2017, paying special attention to greenhouse gas emissions and public environmental expenditures. Methods: The Random Forests methodology was employed, which allows classification of the socioeconomic variables considered in the analysis according to their relative importance to explain health outcomes. Results: Per capita income, the educational level of the population, and the variable AREA (which reflects the subdivision of Europe into four relatively homogeneous areas), followed by the public expenditures on environmental and social protection, are the variables with the highest relevance in explaining life expectancy at birth in Europe over the perip.1 he peusto el correo e inciod 2008–2017. Conclusions: We have identified seven sectors as the main sources of greenhouse gas emissions: Electricity, gas, steam, and air conditioning supply; manufacturing; transportation and storage; agriculture, forestry, and fishing; construction; wholesale and retail trade, repair of motor vehicles and motorcycles; and mining and quarrying. Therefore, any public intervention related to environmental policy should be aimed at these economic sectors. Furthermore, it will be more effective to focus on public programs with higher relevance to the health status of the population, such as environmental and social protection expenditures.

Epidemiological features and trends of influenza incidence in mainland China: A population-based surveillance study from 2005 to 2015

OBJECTIVES

To investigate epidemiological features and trends of influenza incidence with 1,173,640 cases in mainland China from 2005 to 2015.

METHODS

Incidence and mortality data for influenza from 2005 to 2015 were provided by the data-center of China public health science and covered a population of about 1.3 billion people from 31 provinces and regions in mainland China. Joinpoint regression and exploratory spatial data analyses were used to examine the incidence trends from 2005 to 2015.

RESULTS

The first upsurge in influenza cases occurred in 2009, and the highest incidence of influenza occurred in 2014 (15.9045 cases/100,000 people). The average incidence per year from 2009 to 2015 was threefold higher than that from 2005 to 2008 (10.5308 vs 3.4589 cases/100,000 people; incidence rate ratio=3.0446). The joinpoint regression results showed that there was an increasing influenza incidence trend from 2005 to 2015 (annual change in percentage=13.6%, 95%CI 2.2-26.3, p=0.0236). The seasonal pattern analysis showed that influenza typically occurred in winter and spring during each monitoring year, peaking from November to March the next year.

CONCLUSIONS

This study will help governments to make valuable decisions in allocating scarce resources and providing strategies to limit the spread of influenza.

A Causal Analysis of Life Expectancy at Birth. Evidence from Spain

BACKGROUND

From a causal point of view, there exists a set of socioeconomic indicators concerning life expectancy. The objective of this paper is to determine the indicators which exhibit a relation of causality with life expectancy at birth.

METHODS

Our analysis applies the Granger causality test, more specifically its version by Dumitrescu-Hurlin, starting from the information concerning life expectancy at birth and a set of socioeconomic variables corresponding to 17 Spanish regions, throughout the period 2006-2016. To do this, we used the panel data involving the information provided by the Spanish Ministry of Health, Consumer Affairs and Social Welfare (MHCSW) and the National Institute of Statistics (NIS).

RESULTS

Per capita income, and the rate of hospital beds, medical staff and nurses Granger-cause the variable "life expectancy at birth", according to the Granger causality test applied to panel data (Dumitrescu-Hurlin's version).

CONCLUSIONS

Life expectancy at birth has become one of the main indicators able to measure the performance of a country's health system. This analysis facilitates the identification of those factors which exhibit a unidirectional Granger-causality relationship with life expectancy at birth. Therefore, this paper provides useful information for the management of public health resources from the point of view of the maximization of social benefits.

Prevalence and risk factors of stroke in the elderly in Northern China: data from the National Stroke Screening Survey

Background

The overall global burden of stroke is considerable and increasing. In China, stroke is the leading cause of death and disability.

Methods

For this study, we used data from the National Stroke Screening Survey in 2012 and the 2010 Chinese population from sixth National Census of Populations to calculate a standardized (by age, gender, and education) stroke prevalence. Prevalence, risk factors, and management of stroke were compared by gender, age, and site.

Findings

The standardized prevalence rate of survival stroke patients in study population aged 60 and older was 4.94% in total. Hypertension was the most prevalent risk factor for stroke. Compared to men, women were more likely to have diabetes, obesity, elevated low-density lipoprotein cholesterol (LDL-C), and atrial fibrillation (P < 0.05). Men were far more likely to drink and smoke than women (P < 0.05). The rates of diabetes and atrial fibrillation were substantially higher in urban than those in rural stroke survivors (P < 0.05). Rural stroke survivors exhibited higher rates of smoking and alcohol consumption than urban stroke survivors (P < 0.05).

Interpretation

The stroke prevalence in China is in line with median worldwide stroke prevalence. Traditional risk factors remain highly prevalent in stroke survivors, among which hypertension was the most common. Stroke prevalence rates and risk factors varied by age, sex, and sociogeological factors.

Electronic supplementary material

The online version of this article (10.1007/s00415-019-09281-5) contains supplementary material, which is available to authorized users.