Differences in demographic and epidemiological risk factors for ischemic stroke across four hospitals at different altitudes in Northern China

China has the highest incidence of ischemic stroke, the leading cause of mortality among the Chinese population globally. We analyzed regional differences in ischemic stroke risk factors across different altitudes to improve prevention and control strategies. Retrospective demographic data and key epidemiological risk factors were examined in patients with acute ischemic stroke hospitalized over a 10-yr period in four large tertiary hospitals located at similar latitudes but different altitudes in northern China. Risk factors included sex, age, hypertension, diabetes mellitus, coronary artery disease, and hyperlipidemia. In total, 59,582 patients with acute ischemic stroke were included from the Qinghai Provincial People's Hospital (QHPPH; Xining; n = 7,393), General Hospital of Ningxia Medical University (GHNXMU; Yinchuan; n = 10,782), Second Hospital of Shanxi Medical University (SHSXMU; Taiyuan; n = 7,065), and Second Hospital of Hebei Medical University (SHHBMU; Shijiazhuang; n = 34,342). Across all hospitals, rates of ischemic stroke increased with age and were higher in males. GHNXMU had the highest proportion of young patients. The proportion of patients with a single epidemiological risk factor increased with age and was higher in males; however, after 60 yr, the proportion of hyperlipidemia decreased. As the number of combined risk factors increased, the male-to-female ratio decreased, approaching parity. Hypertension, coronary artery disease, and hyperlipidemia had the greatest impact in QHPPH, SHHBMU, and GHNXMU, respectively. Significant differences in major risk factors for ischemic stroke existed across cities at different altitudes. Tailored strategies targeting region-specific risk factors can enhance the precision of ischemic stroke prevention and management.NEW & NOTEWORTHY The study demonstrated that tailored strategies targeting region-specific risk factors could enhance the precision of ischemic stroke prevention and management.