Zhongguo quanke yixue (Jan 2024)
Prevalence and Trends for Post-stroke Fatigue in China: a Meta-analysis
Abstract
Background Post-stroke fatigue (PSF) has a significant impact on patients' prognostic recovery and is an independent risk factor for stroke recurrence and post-stroke death. Therefore, understanding the current epidemiological status of PSF is of great significant in promoting stroke prevention and treatment in China. Objective To systematically evaluate the current situation and development trend of PSF in China, in order to provide a reference basis for the relevant departments to formulate targeted stroke prevention and treatment strategies. Methods PubMed, Web of Science, Embase, CNKI, Wanfang Data, VIP, and CBM were searched by computer to collect cross-sectional studies on the prevalence of PSF in China from inception to 2023-05-20. Meta-analysis was performed using Stata 16.0 software after 2 investigators independently screened the literature, extracted information and evaluated the risk of bias of the included studies. Results A total of 57 cross-sectional studies involving 19 provinces/autonomous regions/municipalities directly under the central government and special administrative regions of China, with a total sample size of 13 621 individuals, including 5 764 individuals with PSF. Meta-analysis showed that the prevalence of PSF in China was 43.5% (95%CI=40.0%-47.0%). The results of subgroup analysis showed that the prevalence was 38.4% (95%CI=34.3%-42.5%) for men and 45.2% (95%CI=40.7%-49.7%) for women by gender grouping; the prevalence was 40.0% (95%CI=32.3%-48.0%) for those under 60 years of age, 67.9% (95%CI=54.2%-80.1%) for those aged 60-75 years by age grouping and 71.9% (95%CI=48.9%-90.5%) for those aged 75 years and above; the prevalence was 40.0% (95%CI=35.0%-45.2%) in North China, 41.0% (95%CI=29.5%-53.0%) in Northeast China, 49.5% (95%CI=43.1%-55.8%) in East China, 40.3% (95%CI=34.9%-45.8%) in Central China, 40.0% (95%CI=28.4%-52.2%) in South China, 59.3% (95%CI=54.0%-65.0%) in Southwest China, and 46.2% (95%CI=38.3%-54.2%) in Northwest China by regional grouping; the prevalence was 56.3% (95%CI=42.8%-69.4%) for hemorrhagic stroke and 40.0% (95%CI=36.7%-43.4%) for ischemic stroke by stroke nature grouping; the prevalence was 41.4% (95%CI=37.0%-45.8%) for acute phase and 46.4% (95%CI=40.8%-52.1%) for recovery phase by stroke duration grouping; the prevalence was 56.0% (95%CI=43.7%-67.9%) for elementary school and below, 46.7% (95%CI=39.6%-53.8%) for junior high school, 46.8% (95%CI=40.3%-53.4%) for senior high school, and 43.6% (95%CI=35.7%-51.6%) for college and above by education level grouping; the prevalence was 45.8% (95%CI=40.8%-50.9%) for those with a spouse and 53.6% (95%CI=47.4%-59.8%) for those without a spouse by marital status; the prevalence was 45.0% (95%CI=33.2%-57.0%) for those who were employed and 53.8% (95%CI=40.1%-67.2%) for those who were unemployed or retired by work status grouping; the prevalence was 41.8% (95%CI=38.3%-45.3%) for those who applied the Fatigue Severity Scale (FSS), 65.8% (95%CI=57.1%-74.0%) for those who applied the Check List Individual Strength (CIS), 50.5% (95%CI=44.6%-56.5%) for those who applied the Chinese version of the Neurological Fatigue Index for Stroke (NFI-stroke), 52.7% (95%CI=43.1%-62.1%) for those who applied the Chinese version of the Fatigue Assessment Scale (C-FAS), and 48.9% (95%CI=43.6%-54.2%) for those who applied the Mental Fatigue Self-Rating Scale (MFS). Additionally, in terms of age distribution, the prevalence of PSF in China increased gradually with age (χ2trend=87.081, r=0.209, P<0.01) ; in terms of cultural background, the trend of correlation between the prevalence of PSF in China and education level was not statistically significant (χ2trend=0.333, P=0.564) ; and in terms of spatial distribution, the prevalence of PSF (40.0%-59.3%) varied significantly among the seven regions of the country (χ2=122.615, P<0.01), and the prevalence of PSF (23.3%-74.2%) also varied significantly among 19 provincial-level administrative regions in China (χ2=504.294, P<0.01) ; from the perspective of the publication time, the prevalence of PSF in China fluctuated in 32.4% to 53.9% from January 2013 to May 2023 (χ2trend=48.011, P<0.01) . Conclusion The results of this study have shown a high overall prevalence of PSF in China, with significant differences among regions and provinces. The highest prevalence was found in Southwest China and Guizhou Province, whereas the lowest prevalence was observed in North China, South China, and Tianjin City. Additionally, PSF was found to be more prevalent among certain groups, including females, advanced age, no spouse, low education level, unemployed or retired work status, recovery phase of stroke, and hemorrhagic stroke.
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