Prevalence and factors influencing fear of disease progression in stroke patients: a systematic review and meta-analysis with a focus on China.

objectivesTo systematically estimate the prevalence and influencing factors of fear of disease progression (FoP) in patients who had a stroke, with a focus on China.

designSystematic review and meta-analysis of observational clinical studies. DATA SOURCES: Eight databases (China National Knowledge Infrastructure, Wanfang Database, Chinese Scientific Journal Database (VIP), CBM, Web of Science, PubMed, Cochrane Library, Embase) were searched from inception to March 2024, supplemented by manual reference screening. ELIGIBILITY CRITERIA: Cross-sectional studies reporting FoP incidence or influencing factors in Chinese stroke patients using the Fear of Progression Questionnaire-Short Form scale were included. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently screened studies, extracted data and assessed study quality using the Agency for Healthcare Research and Quality tool (score range: 0-11 points). Random-effects models were applied to address substantial heterogeneity. Stata 17.0 software was used for meta-analysis.

resultsA total of 20 studies (15 medium-quality, 5 high-quality) involving 7156 patients were included. The pooled incidence of FoP in Chinese stroke patients was 56% (95% CI=45% to 66%), derived from a random-effects model despite significant between-study heterogeneity (I²= 98.7%), with subgroup analyses and leave-one-out sensitivity analysis confirming result robustness. Subgroup analysis revealed that the incidence was highest in East China (70%, 95% CI=56% to 83%), followed by Central China (55%, 95% CI=36% to 73%) and North China (43%, 95% CI=38% to 47%). The incidence of FoP in haemorrhagic stroke (72%, 95% CI=49% to 95%) was higher than that in ischaemic stroke (45%, 95% CI=27% to 64%). The incidence of FoP after 2020 (59%, 95% CI=48% to 70%) was higher than that before 2020 (40%, 95% CI=32% to 47%). Meta-regression identified publication year (p=0.004) and research region (p=0.001) as key heterogeneity sources. The main influencing factors of FoP in Chinese stroke patients included age (OR=0.94, 95% CI=0.92 to 0.97, p<0.05), education level (OR=0.71, 95% CI=0.67 to 0.76, p<0.05), economic income (OR=0.74, 95% CI=0.69 to 0.78, p<0.05), body mass index (OR=1.22, 95% CI=1.04 to 1.43, p<0.05), social support (OR=0.75, 95% CI=0.63 to 0.90, p<0.05), illness perception (OR=1.41, 95% CI=1.37 to 1.45, p<0.05) and family intimacy (OR=0.80, 95% CI=0.67 to 0.96, p<0.05). No significant publication bias was detected (Egger's p=0.052, Begg's p=0.444), though funnel plot asymmetry suggested potential heterogeneity effects.

conclusionThe incidence of FoP in Chinese stroke patients is high (56%), influenced by age, education level, economic income, body mass index, social support, illness perception and family intimacy. Despite high heterogeneity, sensitivity analyses confirmed result robustness. Clinical staff should prioritise psychological screening for FoP and implement targeted interventions, such as cognitive-behavioural therapy for negative illness perception, social support programmes for low-income patients and family-centred education for younger patients. PROSPERO REGISTRATION NUMBER: CRD42024522147.