Cerebral small vessel disease among rural-dwelling Chinese older adults: prevalence, distribution, and associated factors

Epidemiological characteristics of cerebral small vessel disease (cSVD) in the general population, especially among rural older adults, are poorly defined. Here, we reported the prevalence, distribution, and associated factors of cSVD in a rural-dwelling older population in China. This population-based cross-sectional study included 1272 older adults (age ≥60 years; mean age 69.43 years; 58.57% women) who underwent structural brain MRI scans (3.0T) in 2018-2020. MRI markers of cSVD were assessed following the Standards for Reporting Vascular Changes on Neuroimaging-1 criteria. We performed descriptive and regression analyses. The overall prevalence was 20.31% for cerebral microbleeds (CMBs), 26.87% for lacunes, 60.06% for basal ganglia perivascular spaces (PVS), 76.31% for centrum semiovale PVS, 95.74% for deep white matter hyperintensities (WMHs), and 94.17% for periventricular WMHs. The prevalence increased with advancing age for all cSVD markers, except PVS in the centrum semiovale. The prevalence of moderate-to-severe deep WMHs was higher in women than in men (<i>P</i> = 0.005). Older age and hypertension were associated with increased likelihoods of all cSVD markers. A higher body mass index was linked to more WMHs. Coronary heart disease (CHD) was associated with WMHs, CMBs, and lacunes. Our study suggests that cSVD, especially WMHs and PVS, was highly prevalent among rural Chinese older adults. Older age, hypertension, and CHD are associated with distinct cSVD. Future prospective cohort studies are warranted to determine incidence and major risk factors of cSVD, which could facilitate preventive interventions to reduce the burden of cSVD in resource-limited settings.