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Background <p>Older adults with stroke frequently have coexisting hypertension and diabetes, a high-risk cardiometabolic profile that complicates prevention, long-term management, and health service planning. However, population-based evidence on the long-term incidence trajectory of stroke occurring with both conditions remains limited, particularly in rapidly urbanizing settings undergoing population ageing. This study examined long-term trends, age-period-cohort patterns, and future projections of incident stroke with comorbid hypertension and diabetes among older adults in Shenzhen, China.</p> Methods <p>This population-based retrospective surveillance study used data from the Shenzhen Cardiovascular and Cerebrovascular Disease Registry System. Incident stroke events registered between 1 January 2004 and 31 December 2023 among adults aged ≥ 60 years were identified, and 40,128 events with comorbid hypertension and diabetes were included. Crude incidence rates (CIRs) and age-standardized incidence rates (ASIRs) were calculated. Joinpoint regression, age-period-cohort analysis, and Bayesian age-period-cohort modeling were used to assess temporal trends, estimate age, period, and cohort effects, and project incidence trends from 2024 to 2033.</p> Results <p>From 2004 to 2023, the number of incident stroke events with comorbid hypertension and diabetes increased from 314 to 3,336, and the ASIR rose from 141.12 per 100,000 in 2004 to 414.78 per 100,000 in 2023. Joinpoint regression showed overall increasing trends in CIR and ASIR across the study period, with average annual percent changes of 5.44% and 6.14%, respectively, while identifying a late-period decline after 2017. Incidence levels were generally higher in males than in females. Age-period-cohort analysis showed marked age effects, elevated period-related risks in recent periods, and increasing cohort effects across successive birth cohorts. Bayesian projections suggested that both CIR and ASIR may increase from 2024 to 2033, with larger projected increases in males.</p> Conclusions <p>Among older adults in Shenzhen, the burden of stroke with comorbid hypertension and diabetes showed a long-term upward trajectory over the study period.</p> <p>Model-based projections suggested that the burden may increase from 2024 to 2033, particularly among males and older age groups. These findings provide population-level descriptive and projection evidence that may inform risk stratification and health service planning for ageing urban populations.</p>

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Long-term trends, age-period-cohort patterns, and future projections of incident stroke with comorbid hypertension and diabetes among older adults in Shenzhen, China: a population-based surveillance study

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  • 发表日期：

    2026年7月28日

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  • Ping Xu,
  • Zhixue Li,
  • Ying Xu,
  • Yunfeng Hou,
  • Dewang Wang,
  • Kaihao Lin,
  • Lin Lei

摘要

Background

Older adults with stroke frequently have coexisting hypertension and diabetes, a high-risk cardiometabolic profile that complicates prevention, long-term management, and health service planning. However, population-based evidence on the long-term incidence trajectory of stroke occurring with both conditions remains limited, particularly in rapidly urbanizing settings undergoing population ageing. This study examined long-term trends, age-period-cohort patterns, and future projections of incident stroke with comorbid hypertension and diabetes among older adults in Shenzhen, China.

Methods

This population-based retrospective surveillance study used data from the Shenzhen Cardiovascular and Cerebrovascular Disease Registry System. Incident stroke events registered between 1 January 2004 and 31 December 2023 among adults aged ≥ 60 years were identified, and 40,128 events with comorbid hypertension and diabetes were included. Crude incidence rates (CIRs) and age-standardized incidence rates (ASIRs) were calculated. Joinpoint regression, age-period-cohort analysis, and Bayesian age-period-cohort modeling were used to assess temporal trends, estimate age, period, and cohort effects, and project incidence trends from 2024 to 2033.

Results

From 2004 to 2023, the number of incident stroke events with comorbid hypertension and diabetes increased from 314 to 3,336, and the ASIR rose from 141.12 per 100,000 in 2004 to 414.78 per 100,000 in 2023. Joinpoint regression showed overall increasing trends in CIR and ASIR across the study period, with average annual percent changes of 5.44% and 6.14%, respectively, while identifying a late-period decline after 2017. Incidence levels were generally higher in males than in females. Age-period-cohort analysis showed marked age effects, elevated period-related risks in recent periods, and increasing cohort effects across successive birth cohorts. Bayesian projections suggested that both CIR and ASIR may increase from 2024 to 2033, with larger projected increases in males.

Conclusions

Among older adults in Shenzhen, the burden of stroke with comorbid hypertension and diabetes showed a long-term upward trajectory over the study period.

Model-based projections suggested that the burden may increase from 2024 to 2033, particularly among males and older age groups. These findings provide population-level descriptive and projection evidence that may inform risk stratification and health service planning for ageing urban populations.