Background: The population in Hong Kong is mainly Chinese, but their lifestyle is increasingly westernized. It is uncertain whether the trends of stroke in Hong Kong would follow a Chinese or Western pattern. This is the first study to examine the trends of ischemic and hemorrhagic stroke in Hong Kong between 1999 and 2007 with a view to providing data for planning preventive programs and resources for treatment. Methods: Data from the Clinical Management System database of the Hong Kong Hospital Authority for 1999–2007 were used to examine incidence rates of stroke by subtypes among the Hong Kong population aged 35 and above. Poisson regression models were used to examine the trends in the ischemic and hemorrhagic stroke incidence in different subgroups. Results: During 1999–2007, while the age-adjusted incidence of ischemic stroke has decreased, that of hemorrhagic stroke has remained fairly stable. In the younger age group (35–44 years), the incidence of ischemic stroke remained stable, whereas that of hemorrhagic stroke has increased. Furthermore, the incidence of all stroke among Hong Kong Chinese is much higher than in many other developed countries. Conclusions: There were different trends of hemorrhagic and ischemic stroke incidence in Hong Kong. The findings highlight the public health importance of further research into the underlying causes of the increasing trend in hemorrhagic stroke in the younger age group, and the higher overall age-adjusted stroke incidence in Hong Kong compared with other developed countries.

1.
Kay R, Woo J, Kreel L, Wong HY, Teoh R, Nicholls MG: Stroke subtypes among Chinese living in Hong Kong: the Shatin Stroke Registry. Neurology 1992;42:985–987.
2.
Jeng JS, Lee TK, Chang YC, Huang ZS, Ng SK, Chen RC, Yip PK: Subtypes and case-fatality rates of stroke: a hospital-based stroke registry in Taiwan (SCAN-IV). J Neurol Sci 1998;156:220–226.
3.
Kim JS, Yoon SS: Stroke subtypes and risk factors in patients living in southern Seoul, Korea: the impact of hypertension control on stroke subtypes. J Stroke Cerebrovasc Dis 1998;7:205–210.
4.
Wong KS: Risk factors for early death in acute ischemic stroke and intracerebral hemorrhage: a prospective hospital-based study in Asia. Stroke 1999;30:2326–2330.
5.
Schulz UGR, Rothwell PM: Differences in vascular risk factors between etiological subtypes of ischemic stroke: importance of population-based studies. Stroke 2003;34:2050–2059.
6.
Hardie K, Hankey GJ, Jamrozik K, Broadhurst RJ, Anderson C: Ten-year risk of first recurrent stroke and disability after first-ever stroke in the Perth Community Stroke Study. Stroke 2004;35:731–735.
7.
Kay R, Wong KS: Epidemiology of stroke among the Chinese. Neurol J Southeast Asia 1998;3:1–4.
8.
Rosamond WD, Folsom AR, Chambless LE, Wang CH, McGovern PG, Howard G, Copper LS, Shahar E: Stroke incidence and survival among middle-aged adults: 9-year follow-up of the Atherosclerosis Risk in Communities (ARIC) cohort. Stroke 1999;30:736–743.
9.
Morikawa Y, Nakagawa H, Naruse Y, Nishijo M, Miura K, Tabata M, Hirokawa W, Kagamimori S, Honda M, Yoshita K, Hayashi K: Trends in stroke incidence and acute case fatality in a Japanese rural area: the Oyabe study. Stroke 2000;31:1583–1587.
10.
Zhang LF, Yang J, Hong Z, Yuan GG, Zhou BF, Zhao LC, Huang YN, Chen J, Wu YF, Collaborative Group of China Multicenter Study of Cardiovascular Epidemiology: Proportion of different subtypes of stroke in China. Stroke 2003;34:2091–2096.
11.
Rothwell PM, Coull AJ, Giles MF, Howard SC, Silver LE, Bull LM, Gutnikov SA, Edwards P, Mant D, Sackley CM, Farmer A, Sandercock PAG, Dennis MS, Warlow CP, Bamford JM, Anslow P, Oxford Vascular Study: Change in stroke incidence, mortality, case-fatality, severity, and risk factors in Oxfordshire, UK from 1981 to 2004 (Oxford Vascular Study). Lancet 2004;363:1925–1933.
12.
Cabral NL, Gonçalves ARR, Longo AL, Moro CHC, Costa G, Amaral CH, Fonseca LAM, Eluf-Neto J: Incidence of stroke subtypes, prognosis and prevalence of risk factors in Joinville, Brazil: a 2-year community based study. J Neurol Neurosurg Psychiatry 2009;80:755–761.
13.
Yang QD, Niu Q, Zhou YH, Liu YH, Xu HW, Gu WP, Tian FF, Xie YQ, Zhang L, Xia J: Incidence of cerebral hemorrhage in the Changsha Community: a prospective study from 1986 to 2000. Cerebrovasc Dis 2004;17:303–313.
14.
Appelros P, Jonsson F, Asplund K, Eriksson M, Glader EL, Asberg KH, Norrving B, Stegmayr B, Terént A, Riks-Stroke Collaboration: Trends in baseline patient characteristics during the years 1995–2008: observations from Riks-stroke, the Swedish Stroke Register. Cerebrovasc Dis 2010;30:114–119.
15.
Wei JW, Arima H, Huang Y, Wang JG, Yang Q, Liu Z, Liu M, Lu C, Heeley EL, Anderson CS, ChinaQUEST Investigators: Variation in the frequency of intracerebral haemorrhage and ischaemic stroke in China: a national, multicentre, hospital register study. Cerebrovasc Dis 2010;29:321–327.
16.
Islam MS, Anderson CS, Hankey GJ, Hardie K, Carter K, Broadhurst R, Jamrozik K: Trends in incidence and outcome of stroke in Perth, Western Australia during 1989 to 2001: the Perth Community Stroke Study. Stroke 2008;39:776–782.
17.
Béjot Y, Aouba A, de Peretti C, Grimaud O, Aboa-Eboulé C, Chin F, Woimant F, Jougla E, Giroud M: Time trends in hospital-referred stroke and transient ischemic attack: result of a 7-year nationwide survey in France. Cerebrovasc Dis 2010;30:346–354.
18.
Corso G, Bottacchi E, Giardini G, De la Pierre F, Meloni T, Pesenti Campagnoni M, Ponzetti C, Veronese Morosini M: Community-based study of stroke incidence in the Valley of Aosta, Italy. Neuroepidemiology 2009;32:186–195.
19.
Jiang B, Wang WZ, Chen H, Hong Z, Yang QD, Wu SP, Du XL, Bao QJ: Incidence and trends of stroke and its subtypes in China: results from three large cities. Stroke 2006;37:63–68.
20.
Census and Statistics Department of Hong Kong: 2006 Population By-Census – Main Report, vol I. Hong Kong, Census and Statistics Department, 2007.
21.
Leung SSF, Lee WTK, Lui SSH, Ng MY, Peng XH, Luo HY, Lam CWK, Davies DDP: Fat intake in Hong Kong Chinese children. Am J Clin Nutr 2000;72(suppl):1373S–1378S.
22.
Huang CY, Chan FL, Yu YL, Woo E, Chin D: Cerebrovascular disease in Hong Kong Chinese. Stroke 1990;21:230–235.
23.
Hospital Authority of Hong Kong: Hospital Authority Statistical Report 1998/99 to 2008/09. http://www.ha.org.hk/gallery/ha_publications.asp?Library_ID=15 (accessed Sept 6, 2010).
24.
Ahmad OB, Boschi-Pinto C, Lopez AD, Murray CJL, Lozano R, Inoue M: Age standardization of rates: a new WHO world standard. GPE Discussion Paper Series, No 31. Geneva, EIP/GPE/EBD, WHO, 2001.
25.
Feigin VL, Lawes CMM, Bennett DA, Anderson CS: Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol 2003;2:43–53.
26.
Kita Y, Okayama A, Ueshima H, Wada M, Nozaki A, Choudhury SR, Bonita R, Inamoto Y, Kasamatsu T: Stroke incidence and case fatality in Shiga, Japan 1989–1993. Int J Epidemiol 1999;28:1059–1065.
27.
Thrift AG, Dewey HM, Sturm JW, Srikanth VK, Gilligan AK, Gall SL, Macdonell RAL, McNeil JJ, Donnan GA: Incidence of stroke subtypes in the North East Melbourne Stroke Incidence Study (NEMESIS): differences between men and women. Neuroepidemiology 2009;32:11–18.
28.
Azarpazhooh MR, Etemadi MM, Donnan GA, Mokhber N, Majdi MR, Ghayour-Mobarhan M, Ghandehary K, Farzadfard MT, Kiani R, Panahandeh M, Thrift AG: Excessive incidence of stroke in Iran: evidence from the Mashhad Stroke Incidence Study (MSIS), a population-based study of stroke in the Middle East. Stroke 2010;41:e3–e10.
29.
Feldmann E, Daneault N, Kwan E, Ho KJ, Pessin MS, Langenberg P, Caplan LR: Chinese-white differences in the distribution of occlusive cerebrovascular disease. Neurology 1990;40:1541–1545.
30.
Shi F, Hart RG, Sherman DG, Tegeler CH: Stroke in the People’s Republic of China. Stroke 1989;20:1581–1585.
31.
Census and Statistics Department of Hong Kong: Women and Men in Hong Kong – key statistics, 2010 ed. Hong Kong, Census and Statistics Department, 2010.
32.
Levi F, Lucchini F, Negri E, La Vecchia C: Trends in mortality from cardiovascular and cerebrovascular diseases in Europe and other areas of the world. Heart 2002;88:119–124.
33.
Kleindorfer D, Broderick J, Khoury J, Flaherty M, Woo D, Alwell K, Moomaw CJ, Schneider A, Miller R, Shukla R, Kissela B: The unchanging incidence and case-fatality of stroke in the 1990s: a population-based study. Stroke 2006;37:2473–2478.
34.
Benatru I, Rouaud O, Durier J, Contegal F, Couvreur G, Bejot Y, Osseby GV, Salem DB, Ricolfi F, Moreau T, Giroud M: Stable stroke incidence rates but improved case-fatality in Dijon, France, from 1985 to 2004. Stroke 2006;37:1674–1679.
35.
Iso H, Shimamoto T, Naito Y, Sato S, Kitamura A, Iida M, Konishi M, Jacobs DR, Komachi Y: Effects of long-term hypertension control program on stroke incidence and prevalence in a rural community in Northeastern Japan. Stroke 1998;29:1510–1518.
36.
Gorelick PB, Sacco RL, Smith DB, Alberts M, Mustone-Alexander L, Rader D, Ross JL, Raps E, Ozer MN, Brass LM, Malone ME, Goldberg S, Booss J, Hanley DF, Toole JF, Greengold NL, Rhew DC: Prevention of a first stroke: a review of guidelines and a multidisciplinary consensus statement from the National Stroke Association. JAMA 1999;281:1112–1120.
37.
Wang WZ, Jian B, Wu SP, Hong Z, Yang QD, Sander JW, Du XL, Bao QJ: Change in stroke incidence from a population-based intervention trial in three urban communities in China. Neuroepidemiology 2007;28:155–161.
38.
Feldmann E, Broderick JP, Kernan WN, Viscoli CM, Brass LM, Brott T, Morgenstern LB, Wilterdink JL, Horwitz RI: Major risk factors for intracerebral hemorrhage in the young are modifiable. Stroke 2005;36:1881–1885.
39.
Lee TH, Hsu WC, Chen CJ, Chen ST: Etiologic Study of young ischemic stroke in Taiwan. Stroke 2002;33:1950–1955.
40.
Janus ED (ed): The Hong Kong cardiovascular risk factor prevalence study, 1995–1996. Hong Kong, Department of Clinical Biochemistry, Queen Mary Hospital of Hong Kong, 1997.
41.
Department of Health of Hong Kong, Department of Community Medicine of The University of Hong Kong: Population Health Survey 2003/2004. http://www.chp.gov.hk/en/epidemiology/134/362/363.html (accessed Sept 6, 2010).
42.
Tobacco Control Office of the Department of Health of Hong Kong: Info-Station – Statistics – Prevalence of female daily cigarette smokers by age. http://www.tco.gov.hk/english/infostation/infostation_sta_01.html (accessed Sept 6, 2010).
43.
The Chinese University of Hong Kong: Press releases 2005 – May – Day 11: Increasing salt intake predisposes Hong Kong people to hypertension and its complications. http://www.cuhk.edu.hk/v6/en/media/pressreleases/press_release2005.html (accessed Sept 6, 2010).
44.
Truelsen T, Nielsen N, Boysen G, Grønbæk M: Self-reported stress and risk of stroke: the Copenhagen City Heart Study. Stroke 2003;34:856–862.
45.
Qureshi AI, Suri MFK, Nasar A, Kirmani JF, Ezzeddine MA, Divani AA, Giles WH: Changes in cost and outcome among US patients with stroke hospitalized in 1990 to 1991 and those hospitalized in 2000 to 2001. Stroke 2007;38:2180–2184.
46.
Feigin VL, Lawes CMM, Bennett DA, Barker-Collo SL, Parag V: Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurol 2009;8:355–369.
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