Disparity and its time trends in stroke mortality between urban and rural populations in China 1987 to 2001 - Changing patterns and their implications for public health policy

Background and Purpose - The purposes of this study were to describe stroke mortality in urban and rural populations in China and to monitor the transition using the best available surveillance data during the past 2 decades. Methods - Age- and sex-specific mortality data were obtained from the death registration and classification system covering 100 million population in selected urban and rural areas in China. The age-adjusted stroke mortality and its time trends for population at aged 35 years and over were compared between urban and rural populations during the period of 1987 to 2001. Results - The age-adjusted stroke mortality was higher in urban than in rural populations until the end of 1990s. The urban: rural ratio was 1: 16 for men and 1: 21 for women in 1987, but this dropped to 0: 77 and 0: 79, respectively, in 2001 due to a remarkable decrease in stroke mortality in urban areas (-2.0% for men and -2.5% for women annually, P < 0.001), but with little change in rural men (P < 0.969) and women (-0.7%, P=0.021) over the period. The decrease is mainly observed in the elderly population. It increased in the population aged 35 to 54 years for all area - gender groups except for urban women. Conclusions - The heavier burden of stroke shifted from urban to rural areas where a larger population resides and healthcare services are less developed than in urban areas in China. The increasing trend in the younger population will impose a greater burden in the near future. Healthcare policymakers need to focus their attention on this situation and take suitable measures to cope with the challenges it poses.