Initial Establishment of a Stroke Management Model in China

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Initial Establishment of a Stroke Management Model in China: 10 Years (2011–2020) of the Stroke Prevention Project Committee, National Health Commission

Stroke is China’s leading cause of death—responsible for more lives lost than any other disease. It also brings crippling disability: one in three survivors faces long-term impairment, and the economic burden is staggering. But over the past decade, a national effort has transformed how China prevents, treats, and manages this crisis. From 2011 to 2020, the China Stroke Prevention Project Committee (CSPPC), under the National Health Commission, built a first-of-its-kind stroke management model—combining policy, technology, and community action—to save lives and reduce suffering.

The Stroke Burden in China: A Looming Crisis

Before the CSPPC launched, China’s stroke crisis was worsening. The 2020 Report on Nutrition and Chronic Disease Status of Chinese Residents found 88.5% of deaths came from chronic diseases, with stroke as the top killer. A 2018 study in The New England Journal of Medicine showed China’s lifetime risk of stroke (from age 25 onward) was 39.3%—far higher than the global average of 25%. By 2013, the National Epidemiological Survey of Stroke in China (NESS-China) estimated 11 million people were living with stroke, 2.4 million new cases each year, and 1.1 million stroke-related deaths. To make matters worse, stroke was striking younger: the average age of onset fell below 60.

The CSPPC’s 10-Year Mission: Prevention First, System Innovation

In 2011, the CSPPC was created to turn the tide. Its core strategy? “Prevention first, move the barrier forward”—a 32-word framework that prioritizes stopping stroke before it starts, uses layered care for different groups, and links hospitals, communities, and public health agencies. This approach wasn’t just a plan—it became national policy: stroke prevention was integrated into Healthy China 2030, the country’s decade-long blueprint for public health.

Building a National Stroke Network

The CSPPC rolled out the Technical Program for Screening and Comprehensive Intervention for High-Risk Stroke Populations, which reached 245 cities in 31 provinces—covering over 2% of the target population (adults over 40). It also built a tiered care network:

  • Core: 562 tertiary hospitals (top-level medical centers)
  • Middle: 990 district/county secondary hospitals
  • Grassroots: Over 1,000 community and township clinics

This network ensured high-risk people got screened, acute patients got fast care, and survivors got follow-up support—closing gaps in a country where medical access varies widely.

A Government-Led, Multi-Stakeholder System

The CSPPC’s biggest innovation was a stratified stroke management model led by governments and involving hospitals, the Centers for Disease Control and Prevention (CDC), and communities. Relying on 325 “base hospitals,” it covered the full lifecycle of care:

  1. Pre-hospital: Screening high-risk groups (e.g., people with hypertension or diabetes) and emergency care for acute stroke.
  2. In-hospital: Multidisciplinary teams (neurologists, surgeons, rehab specialists) for faster diagnosis and treatment.
  3. Post-hospital: Follow-up to manage risk factors and prevent recurrence.

The result? By 2020, estimated stroke cases were 17.88 million—3.48 million fewer than the World Bank’s 2011 forecast of 21.36 million.

Stroke Centers: Faster Care, Better Outcomes

A key pillar of the CSPPC’s work was building Chinese Stroke Centers—certified hospitals that prioritize “patient-centered” care and multidisciplinary collaboration. By the end of 2020, 380 centers were certified. These centers drove dramatic improvements in life-saving treatments:

  • Intravenous thrombolysis (clot-busting drugs): 36.8 times more cases in 2020 vs. 2010
  • Carotid endarterectomy (CEA) (clearing neck arteries): 31.7 times more cases
  • Carotid artery stenting (CAS) (opening blocked arteries): 32.1 times more cases
  • Interventional thrombectomy (removing large clots): 19.6 times more cases vs. 2015

Crucially, door-to-needle time (DNT)—the time from a patient arriving at the hospital to getting thrombolysis—dropped to a median of 41 minutes in advanced centers. That’s on par with developed countries like the U.S. and Japan. For patients, this speed means better survival and less disability:

  • Stroke center patients are twice as likely to get thrombolysis as those in non-certified hospitals.
  • Complications during hospitalization are cut by 50%.
  • The 3-month disability rate is 30% lower.

The China Stroke First Aid Map: Saving Minutes, Saving Lives

In 2017, the CSPPC launched the China Stroke First Aid Map—a mobile app that helps patients find the nearest hospital capable of stroke care. Combined with a “stroke green channel,” this created a “1-1-1 Golden Rescue Circle”:

  1. <1 hour from stroke onset to calling emergency services
  2. <1 hour from call to arrival at a stroke center
  3. <1 hour from hospital arrival to thrombolysis

By 2020, over 170 cities, 2,000 medical institutions, and emergency centers in 26 provinces joined the map—turning “time is brain” from a slogan into action.

Big Data: Tracking Progress, Improving Care

To scale its work, the CSPPC built the Bigdata Observatory Platform for Stroke of China (BOSC) (https://www.chinasdc.cn/), the nation’s largest cerebrovascular disease database. It integrates:

  • Screening data for 12.23 million adults over 40 (including 2.235 million high-risk individuals)
  • 3.935 billion follow-up records
  • Clinical data from 1,500+ stroke centers (nearly 1 million cases of thrombolysis, thrombectomy, and other treatments)

This platform lets policymakers track trends, refine interventions, and ensure equitable care across regions.

Saving Money—and Lives

The CSPPC’s work isn’t just medically effective—it’s cost-effective. Over 10 years, 12.23 million people over 40 joined the high-risk screening program. Using the Chinese Stroke Incidence Prediction Model, the CSPPC estimates this prevented 59,000 new strokes—saving 4.72 billion Chinese Yuan (CNY) in direct medical costs (each stroke costs ~80,000 CNY). The central government invested 1.38 billion CNY in the program—meaning every yuan spent saved nearly 3.4 yuan in future healthcare bills.

Challenges Ahead: Aging, Chronic Diseases, and Regional Gaps

Despite these gains, China’s stroke burden remains heavy. The population is aging fast: the number of adults over 40 grew by 100 million in 10 years. Chronic diseases like hypertension and diabetes—key stroke risk factors—are poorly controlled: over 270 million Chinese adults have high blood pressure, but only 16% keep it under control. Regional disparities also persist: rural areas and western provinces have fewer stroke centers and less access to advanced treatments.

The Next 10 Years: Scaling Up, Closing Gaps

The CSPPC’s future plans focus on three goals:

  1. Strengthen Regional Systems: Expand the “Stroke Recognition Action in Thousands of Counties and Ten Thousand Towns” and “Hundred Cities and Hundred Maps” to break down referral barriers and speed up patient transfers.
  2. Train Talent: Boost training for stroke treatment and first aid, especially in rural and ethnic regions. By 2022, every prefecture/county with over 300,000 people will have at least one secondary hospital doing thrombolysis.
  3. Improve Health Literacy: Increase public awareness of stroke signs (e.g., sudden face droop, arm weakness, speech difficulty) and risk factors (high blood pressure, diabetes). The CSPPC will also integrate traditional Chinese medicine (TCM) into prevention—leveraging TCM’s role in chronic disease management.

A Decade of Progress, A Future of Hope

Over 10 years, the CSPPC transformed China’s stroke care. From a fragmented system to a coordinated national network, from slow treatment to world-class speed, the model has saved millions of lives and reduced disability. But the work isn’t done. China’s size, aging population, and regional gaps mean the CSPPC must keep innovating—using policy, technology, and community engagement to turn “Healthy China 2030” into reality.

For millions of Chinese families, this work is personal: it’s about preventing a parent from suffering a disabling stroke, a child from losing a loved one, and a community from bearing the cost of untreated disease. The CSPPC’s 10-year journey shows that with commitment, collaboration, and innovation, even the biggest public health challenges can be met.

This article is based on research by Bao-Hua Chao, Wen-Jun Tu, and Long-De Wang (on behalf of the Stroke Prevention Project Committee, National Health Commission of the People’s Republic of China) published in the Chinese Medical Journal (2021;134:2418–2420).

doi:10.1097/CM9.0000000000001856

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