title: Trends in Stroke Incidence and 28-Day Case Fatality in a Nationwide Stroke Registry of a Multiethnic Asian Population.
abstract: OBJECTIVE
  This study investigated trends in stroke incidence and case fatality overall and according to sex, age, ethnicity, and stroke subtype in a multiethnic Asian population.
  
  
  METHODS
  The Singapore Stroke Registry identifies all stroke cases in all public hospitals using medical claims, hospital discharge summaries, and death registry data. Age-standardized incidence rates and 28-day case-fatality rates were calculated for individuals aged ≥15 years between 2006 and 2012. To estimate the annual percentage change of the rates, a linear regression model was fitted to the log rates, and a Wald test was performed to test for trend. P values <0.05 were considered significant.
  
  
  RESULTS
  A total of 40 623 cases were recorded. The total stroke incidence fell by ≈12.0%, and case fatality fell by 17.2% in the study. Declining trends in stroke incidence were stronger in women (female: -2.94; 95% confidence interval [CI], -3.43 to -2.44; male: -1.80; 95% CI, -2.58 to -1.02); in the older age groups (≥65 years: -3.62; 95% CI, -4.30 to -2.94; 50-64 years: -1.26; 95% CI, -1.97 to -0.55; <50 years: 3.33; 95% CI, 1.49 to 5.20), in Chinese (-2.64; 95% CI, -3.15 to -2.13), Indians (-3.78; 95% CI, -5.93 to -1.58), and others (-12.73; 95% CI, -18.93 to -6.06) compared with Malays (2.58; 95% CI, 1.17 to 4.02); and in ischemic stroke subtype (ischemic: -2.43; 95% CI, -3.13 to -1.73; hemorrhagic: -1.02; 95% CI, -2.04 to 0.01). Subgroup-specific findings for case fatality were similar.
  
  
  CONCLUSIONS
  This is the first countrywide hospital-based registry study in a multiethnic Asian population, and it revealed marked overall reductions in stroke incidence and case fatality. However, it also identified important population groups with less favorable trends, especially younger adults and those of Malay ethnicity.
authors.affiliation: From the Saw Swee Hock School of Public Health, National University Health System, Singapore (C.S.T., F.M.-R., S.H.X.N., G.C.-H.K.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (F.M.-R., P.Z.T., G.C.-H.K.); Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Centre, Berlin, Germany (F.M.-R.); Division of Neurology, National University Hospital, National University Health System, Singapore (B.P.L.C.); Tang Neurology & Medical Clinic, Mount Elizabeth Medical Centre, Singapore (K.-F.T.); Medicine Department, Jurong Health, Singapore (A.A.); Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore (K.H.K.); National Neuroscience Institute, Singapore General Hospital Campus, Singapore (H.M.C.); National Registry of Disease Office, Health Promotion Board, Singapore (K.Y.C.); and Raffles Neuroscience Centre, Raffles Hospital, Singapore (N.V.).
authors.forename: Chuen Seng
authors.initials: CS
authors.lastname: Tan
authors.affiliation: From the Saw Swee Hock School of Public Health, National University Health System, Singapore (C.S.T., F.M.-R., S.H.X.N., G.C.-H.K.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (F.M.-R., P.Z.T., G.C.-H.K.); Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Centre, Berlin, Germany (F.M.-R.); Division of Neurology, National University Hospital, National University Health System, Singapore (B.P.L.C.); Tang Neurology & Medical Clinic, Mount Elizabeth Medical Centre, Singapore (K.-F.T.); Medicine Department, Jurong Health, Singapore (A.A.); Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore (K.H.K.); National Neuroscience Institute, Singapore General Hospital Campus, Singapore (H.M.C.); National Registry of Disease Office, Health Promotion Board, Singapore (K.Y.C.); and Raffles Neuroscience Centre, Raffles Hospital, Singapore (N.V.).
authors.forename: Falk
authors.initials: F
authors.lastname: Müller-Riemenschneider
authors.affiliation: From the Saw Swee Hock School of Public Health, National University Health System, Singapore (C.S.T., F.M.-R., S.H.X.N., G.C.-H.K.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (F.M.-R., P.Z.T., G.C.-H.K.); Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Centre, Berlin, Germany (F.M.-R.); Division of Neurology, National University Hospital, National University Health System, Singapore (B.P.L.C.); Tang Neurology & Medical Clinic, Mount Elizabeth Medical Centre, Singapore (K.-F.T.); Medicine Department, Jurong Health, Singapore (A.A.); Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore (K.H.K.); National Neuroscience Institute, Singapore General Hospital Campus, Singapore (H.M.C.); National Registry of Disease Office, Health Promotion Board, Singapore (K.Y.C.); and Raffles Neuroscience Centre, Raffles Hospital, Singapore (N.V.).
authors.forename: Sheryl Hui Xian
authors.initials: SH
authors.lastname: Ng
authors.affiliation: From the Saw Swee Hock School of Public Health, National University Health System, Singapore (C.S.T., F.M.-R., S.H.X.N., G.C.-H.K.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (F.M.-R., P.Z.T., G.C.-H.K.); Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Centre, Berlin, Germany (F.M.-R.); Division of Neurology, National University Hospital, National University Health System, Singapore (B.P.L.C.); Tang Neurology & Medical Clinic, Mount Elizabeth Medical Centre, Singapore (K.-F.T.); Medicine Department, Jurong Health, Singapore (A.A.); Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore (K.H.K.); National Neuroscience Institute, Singapore General Hospital Campus, Singapore (H.M.C.); National Registry of Disease Office, Health Promotion Board, Singapore (K.Y.C.); and Raffles Neuroscience Centre, Raffles Hospital, Singapore (N.V.).
authors.forename: Pei Zheng
authors.initials: PZ
authors.lastname: Tan
authors.affiliation: From the Saw Swee Hock School of Public Health, National University Health System, Singapore (C.S.T., F.M.-R., S.H.X.N., G.C.-H.K.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (F.M.-R., P.Z.T., G.C.-H.K.); Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Centre, Berlin, Germany (F.M.-R.); Division of Neurology, National University Hospital, National University Health System, Singapore (B.P.L.C.); Tang Neurology & Medical Clinic, Mount Elizabeth Medical Centre, Singapore (K.-F.T.); Medicine Department, Jurong Health, Singapore (A.A.); Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore (K.H.K.); National Neuroscience Institute, Singapore General Hospital Campus, Singapore (H.M.C.); National Registry of Disease Office, Health Promotion Board, Singapore (K.Y.C.); and Raffles Neuroscience Centre, Raffles Hospital, Singapore (N.V.).
authors.forename: Bernard P L
authors.initials: BP
authors.lastname: Chan
authors.affiliation: From the Saw Swee Hock School of Public Health, National University Health System, Singapore (C.S.T., F.M.-R., S.H.X.N., G.C.-H.K.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (F.M.-R., P.Z.T., G.C.-H.K.); Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Centre, Berlin, Germany (F.M.-R.); Division of Neurology, National University Hospital, National University Health System, Singapore (B.P.L.C.); Tang Neurology & Medical Clinic, Mount Elizabeth Medical Centre, Singapore (K.-F.T.); Medicine Department, Jurong Health, Singapore (A.A.); Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore (K.H.K.); National Neuroscience Institute, Singapore General Hospital Campus, Singapore (H.M.C.); National Registry of Disease Office, Health Promotion Board, Singapore (K.Y.C.); and Raffles Neuroscience Centre, Raffles Hospital, Singapore (N.V.).
authors.forename: Kok-Foo
authors.initials: KF
authors.lastname: Tang
authors.affiliation: From the Saw Swee Hock School of Public Health, National University Health System, Singapore (C.S.T., F.M.-R., S.H.X.N., G.C.-H.K.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (F.M.-R., P.Z.T., G.C.-H.K.); Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Centre, Berlin, Germany (F.M.-R.); Division of Neurology, National University Hospital, National University Health System, Singapore (B.P.L.C.); Tang Neurology & Medical Clinic, Mount Elizabeth Medical Centre, Singapore (K.-F.T.); Medicine Department, Jurong Health, Singapore (A.A.); Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore (K.H.K.); National Neuroscience Institute, Singapore General Hospital Campus, Singapore (H.M.C.); National Registry of Disease Office, Health Promotion Board, Singapore (K.Y.C.); and Raffles Neuroscience Centre, Raffles Hospital, Singapore (N.V.).
authors.forename: Aftab
authors.initials: A
authors.lastname: Ahmad
authors.affiliation: From the Saw Swee Hock School of Public Health, National University Health System, Singapore (C.S.T., F.M.-R., S.H.X.N., G.C.-H.K.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (F.M.-R., P.Z.T., G.C.-H.K.); Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Centre, Berlin, Germany (F.M.-R.); Division of Neurology, National University Hospital, National University Health System, Singapore (B.P.L.C.); Tang Neurology & Medical Clinic, Mount Elizabeth Medical Centre, Singapore (K.-F.T.); Medicine Department, Jurong Health, Singapore (A.A.); Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore (K.H.K.); National Neuroscience Institute, Singapore General Hospital Campus, Singapore (H.M.C.); National Registry of Disease Office, Health Promotion Board, Singapore (K.Y.C.); and Raffles Neuroscience Centre, Raffles Hospital, Singapore (N.V.).
authors.forename: Keng He
authors.initials: KH
authors.lastname: Kong
authors.affiliation: From the Saw Swee Hock School of Public Health, National University Health System, Singapore (C.S.T., F.M.-R., S.H.X.N., G.C.-H.K.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (F.M.-R., P.Z.T., G.C.-H.K.); Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Centre, Berlin, Germany (F.M.-R.); Division of Neurology, National University Hospital, National University Health System, Singapore (B.P.L.C.); Tang Neurology & Medical Clinic, Mount Elizabeth Medical Centre, Singapore (K.-F.T.); Medicine Department, Jurong Health, Singapore (A.A.); Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore (K.H.K.); National Neuroscience Institute, Singapore General Hospital Campus, Singapore (H.M.C.); National Registry of Disease Office, Health Promotion Board, Singapore (K.Y.C.); and Raffles Neuroscience Centre, Raffles Hospital, Singapore (N.V.).
authors.forename: Hui Meng
authors.initials: HM
authors.lastname: Chang
authors.affiliation: From the Saw Swee Hock School of Public Health, National University Health System, Singapore (C.S.T., F.M.-R., S.H.X.N., G.C.-H.K.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (F.M.-R., P.Z.T., G.C.-H.K.); Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Centre, Berlin, Germany (F.M.-R.); Division of Neurology, National University Hospital, National University Health System, Singapore (B.P.L.C.); Tang Neurology & Medical Clinic, Mount Elizabeth Medical Centre, Singapore (K.-F.T.); Medicine Department, Jurong Health, Singapore (A.A.); Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore (K.H.K.); National Neuroscience Institute, Singapore General Hospital Campus, Singapore (H.M.C.); National Registry of Disease Office, Health Promotion Board, Singapore (K.Y.C.); and Raffles Neuroscience Centre, Raffles Hospital, Singapore (N.V.).
authors.forename: Khuan Yew
authors.initials: KY
authors.lastname: Chow
authors.affiliation: From the Saw Swee Hock School of Public Health, National University Health System, Singapore (C.S.T., F.M.-R., S.H.X.N., G.C.-H.K.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (F.M.-R., P.Z.T., G.C.-H.K.); Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Centre, Berlin, Germany (F.M.-R.); Division of Neurology, National University Hospital, National University Health System, Singapore (B.P.L.C.); Tang Neurology & Medical Clinic, Mount Elizabeth Medical Centre, Singapore (K.-F.T.); Medicine Department, Jurong Health, Singapore (A.A.); Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore (K.H.K.); National Neuroscience Institute, Singapore General Hospital Campus, Singapore (H.M.C.); National Registry of Disease Office, Health Promotion Board, Singapore (K.Y.C.); and Raffles Neuroscience Centre, Raffles Hospital, Singapore (N.V.). ephkohch@nus.edu.sg.
authors.forename: Gerald Choon-Huat
authors.initials: GC
authors.lastname: Koh
authors.affiliation: From the Saw Swee Hock School of Public Health, National University Health System, Singapore (C.S.T., F.M.-R., S.H.X.N., G.C.-H.K.); Yong Loo Lin School of Medicine, National University of Singapore, Singapore (F.M.-R., P.Z.T., G.C.-H.K.); Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Centre, Berlin, Germany (F.M.-R.); Division of Neurology, National University Hospital, National University Health System, Singapore (B.P.L.C.); Tang Neurology & Medical Clinic, Mount Elizabeth Medical Centre, Singapore (K.-F.T.); Medicine Department, Jurong Health, Singapore (A.A.); Department of Rehabilitation Medicine, Tan Tock Seng Hospital, Singapore (K.H.K.); National Neuroscience Institute, Singapore General Hospital Campus, Singapore (H.M.C.); National Registry of Disease Office, Health Promotion Board, Singapore (K.Y.C.); and Raffles Neuroscience Centre, Raffles Hospital, Singapore (N.V.).
authors.forename: Narayanaswamy
authors.initials: N
authors.lastname: Venketasubramanian
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012042:Registries; D017678:Sex Distribution; D012846:Singapore / Q000453:epidemiology; D020521:Stroke / Q000453:epidemiology*
keywords: Asian; case fatality; epidemiology; incidence; stroke