Trends in cerebrovascular disease mortality in Singapore: 1970-1994.
BACKGROUND
Cerebrovascular disease has been the third leading cause of death in Singapore for the last 25 years. This study was carried out to examine recent trends in cerebrovascular disease mortality in Singapore, and to study corresponding changes in stroke risk factors in our population.


METHODS
The Registry of Births and Deaths, Singapore, publishes annual reports on births and deaths. The cause of death is coded using the International Classification of Diseases Revisions 8 (1969-1978) and 9 (1979 onwards). Data for this study were obtained using rubrics 430-438. Death rates were age- and sex-standardized to the World Standard Population, and separately for males and females. Cerebrovascular disease risk factor patterns were derived from national epidemiological health surveys conducted from 1970 and 1994.


RESULTS
The absolute number of deaths annually from cerebrovascular disease rose from 1041 in 1970 to 1692 in 1994. Crude death rates remained stable at 50-60 per 100000, accounting for 10-12% of all deaths. Standardized death rates showed a distinct fall from 99 per 100000 in 1976 to 59 per 100000 in 1994, 101 to 60 per 100000 in males and 95 to 57 per 100000 in females. National health surveys have shown a fall in the prevalence of undetected hypertension, smoking and hyperlipidaemia; the prevalence of obesity was unchanged, while that of diabetes mellitus rose over the same period. The mortality trends found in this study are unlikely to be due to changing fashions in coding or inadequate data collection.


CONCLUSIONS
As in many countries in the world, cerebrovascular disease mortality in Singapore has fallen over the last 25 years; this may in part be related to the decline in stroke risk factors in our population.
Venketasubramanian
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Department of Neurology, Tan Tock Seng Hospital, Singapore.
D017677:Age Distribution; D000368:Aged; D002423:Cause of Death; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000401:mortality*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D015995:Prevalence; D012042:Registries; D012307:Risk Factors; D017678:Sex Distribution; D012846:Singapore / Q000453:epidemiology; D012907:Smoking / Q000453:epidemiology; D015996:Survival Rate