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. 2017 Apr;45(2):680-690.
doi: 10.1177/0300060516664241. Epub 2017 Mar 24.

Urban and rural stroke mortality rates in China between 1988 and 2013: An age-period-cohort analysis

Jingjing Li  1   2 , Boyang Li  3 , Fengfan Zhang  4 , Yang Sun  3
Affiliations

Urban and rural stroke mortality rates in China between 1988 and 2013: An age-period-cohort analysis

Jingjing Li et al. J Int Med Res. 2017 Apr.

Abstract

Objective To evaluate effects attributable to age, time period and birth cohort, on stroke mortality data from urban and rural regions in China between 1988 and 2013. Methods Mortality data were obtained from the Chinese Health Statistics Annual Report (1987-2001) and Chinese Health Statistics Yearbooks (2003-2014). Population data were obtained from population censuses (i.e. 1982, 1990, 2000 and 2010). Data were analysed using an age-period-cohort (APC) model and intrinsic estimation (IE) method. Results The age effect suggested that all older residents had higher stroke mortality risk than younger residents. Period effect showed that compared with figures for 1988, stroke mortality in 2013 was 1.8 times higher for urban regions and 2.4 times higher for rural regions. After controlling for age and period effects, cohorts born before the Chinese economic reform had a steady decline in stroke mortality. However, mortality rates increased and fluctuated in post-reform cohorts. Conclusions This APC-IE analysis identified a modest period effect with large age and cohort contributions to both the overall mortality and the disparity between urban and rural stroke mortality. Identifying early life and cumulative risk factors for stroke, improving equality in stroke prevention and care are needed to reduce the stroke mortality in China.

Keywords: China; age-period-cohort analysis; intrinsic estimator; mortality; rural; stroke; urban.

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Figures

Figure 1.
Figure 1.
Overall stroke mortality in China, 1987–2013.
Figure 2.
Figure 2.
Advanced age-period-cohort modelling analysis to examine temporal changes in adult stroke mortality from 1988 to 2013. Age-specific log stroke deaths per 100 000 of the population across the 13 age groups (a). Period-based effect on log stroke deaths per 100 000 of the population across the 13 different age groups over 1988–2013 (b). Cohort-based variation of age-specific log stroke deaths per 100 000 of the population for the 13 age groups (c).
Figure 2.
Figure 2.
Advanced age-period-cohort modelling analysis to examine temporal changes in adult stroke mortality from 1988 to 2013. Age-specific log stroke deaths per 100 000 of the population across the 13 age groups (a). Period-based effect on log stroke deaths per 100 000 of the population across the 13 different age groups over 1988–2013 (b). Cohort-based variation of age-specific log stroke deaths per 100 000 of the population for the 13 age groups (c).
Figure 3.
Figure 3.
Age-period-cohort effects on stroke mortality in China from 1988–2013.
See this image and copyright information in PMC

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