Background: Chinese populations have a higher stroke incidence, a higher proportion of intracerebral hemorrhage (ICH), and a lower proportion of ischemic stroke (IS) as compared with white populations. The reasons are not fully understood. Methods: To evaluate the differences of major risk factors between ICH and IS in Chinese stroke patients, we analysed acute ICH and IS patients consecutively recruited in National Taiwan University Hospital Stroke Registry from 2006 to 2011. We used multiple logistic regression models to examine the associations of risk factors with ICH vs. IS. Also, we conducted subgroup analyses when a strongly significant interaction was detected. Results: We included a total of 1,373 ICH and 4,953 IS patients. ICH patients were younger than IS patients (mean age 61 vs. 68 years, p < 0.001), but there was no significant difference in gender (males 62 vs. 59%, p = 0.064). A logistic regression model adjusted for age, gender, and other major risk factors showed that both hypertension (OR 2.23, 95% CI 1.74-2.87) and alcohol intake (OR 1.44, 95% CI 1.16-1.77) had significantly stronger associations with ICH than IS, whereas diabetes, atrial fibrillation, ischemic heart disease, hyperlipidemia, smoking, and transient ischemic attack were less associated with ICH than IS. In subgroup analyses, the association of hypertension with ICH vs. IS was more marked in younger patients. Conclusion: Hypertension and alcohol intake are more strongly associated with ICH than IS in Chinese stroke patients, especially in younger patients.

Feigin VL, Lawes CM, 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.
van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ: Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol 2010;9:167-176.
Qureshi AI, Mendelow AD, Hanley DF: Intracerebral haemorrhage. Lancet 2009;373:1632-1644.
Feigin VL, Krishnamurthi RV, Parmar P, Norrving B, Mensah GA, Bennett DA, et al; GBD 2013 Stroke Panel Experts Group: Update on the global burden of ischemic and hemorrhagic stroke in 1990-2013: the GBD 2013 study. Neuroepidemiology 2015;45:161-176.
Tsai CF, Thomas B, Sudlow CL: Epidemiology of stroke and its subtypes in Chinese vs white populations: a systematic review. Neurology 2013;81:264-272.
Donnan GA, Hankey GJ, Davis SM: Intracerebral haemorrhage: a need for more data and new research directions. Lancet Neurol 2010;9:133-134.
Samarasekera N, Smith C, Al-Shahi Salman R: The association between cerebral amyloid angiopathy and intracerebral haemorrhage: systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2012;83:275-281.
O'Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, et al: Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet 2010;376:112-123.
Tsai CF, Anderson N, Thomas B, Sudlow CL: Comparing risk factor profiles between intracerebral hemorrhage and ischemic stroke in Chinese and white Populations: systematic review and meta-analysis. PLoS One 2016;11:e0151743.
Liu M, Wu B, Wang WZ, Lee LM, Zhang SH, Kong LZ: Stroke in China: epidemiology, prevention, and management strategies. Lancet Neurol 2007;6:456-464.
Jeng JS, Lee TK, Chang YC, Huang ZS, Ng SK, Chen RC, et al: Subtypes and case-fatality rates of stroke: a hospital-based stroke registry in Taiwan (SCAN-IV). J Neurol Sci 1998;156:220-226.
Hsieh FI, Lien LM, Chen ST, Bai CH, Sun MC, Tseng HP, et al: Get with the guidelines-stroke performance indicators: surveillance of stroke care in the Taiwan Stroke Registry: Get With the Guidelines-Stroke in Taiwan. Circulation 2010;122:1116-1123.
Yeh SJ, Tang SC, Tsai LK, Jeng JS: Pathogenetical subtypes of recurrent intracerebral hemorrhage: designations by SMASH-U classification system. Stroke 2014;45:2636-2642.
Hatano S: Experience from a multicentre stroke register: a preliminary report. Bull World Health Organ 1976;54:541-553.
Sudlow CL, Warlow CP: Comparable studies of the incidence of stroke and its pathological types: results from an international collaboration. International Stroke Incidence Collaboration. Stroke 1997;28:491-499.
R Core Team: R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing, Vienna, Austria, 2013., 2016).
Jiang B, Wang WZ, Chen H, Hong Z, Yang QD, Wu SP, et al: Incidence and trends of stroke and its subtypes in China: results from three large cities. Stroke 2006;37:63-68.
Hu HH, Sheng WY, Chu FL, Lan CF, Chiang BN: Incidence of stroke in Taiwan. Stroke 1992;23:1237-1241.
Ariesen MJ, Claus SP, Rinkel GJ, Algra A: Risk factors for intracerebral hemorrhage in the general population: a systematic review. Stroke 2003;34:2060-2065.
Blood pressure, cholesterol, and stroke in eastern Asia. Eastern Stroke and Coronary Heart Disease Collaborative Research Group. Lancet 1998;352:1801-1807.
Woodward M, Huxley H, Lam TH, Barzi F, Lawes CM, Ueshima H; Asia Pacific Cohort Studies Collaboration: A comparison of the associations between risk factors and cardiovascular disease in Asia and Australasia. Eur J Cardiovasc Prev Rehabil 2005;12:484-491.
Yong H, Foody J, Linong J, Dong Z, Wang Y, Ma L, et al: A systematic literature review of risk factors for stroke in China. Cardiol Rev 2013;21:77-93.
Zhou BF, Stamler J, Dennis B, Moag-Stahlberg A, Okuda N, Robertson C, et al; INTERMAP Research Group: Nutrient intakes of middle-aged men and women in China, Japan, United Kingdom, and United States in the late 1990s: the INTERMAP study. J Hum Hypertens 2003;17:623-630.
Gu D, Reynolds K, Wu X, Chen J, Duan X, Muntner P, et al; InterASIA Collaborative Group. The International Collaborative Study of Cardiovascular Disease in ASIA: prevalence, awareness, treatment, and control of hypertension in China. Hypertension 2002;40:920-927.
Wang WJ, Lu JJ, Wang YJ, Wang CX, Wang YL, Hoff K, et al; China National Stroke Registry (CNSR): Clinical characteristics, management, and functional outcomes in Chinese patients within the first year after intracerebral hemorrhage: analysis from China National Stroke Registry. CNS Neurosci Ther 2012;18:773-780.
Su TC, Bai CH, Chang HY, You SL, Chien KL, Chen MF, et al: Evidence for improved control of hypertension in Taiwan: 1993-2002. J Hypertens 2008;26:600-606.
Zhang X, Patel A, Horibe H, Wu Z, Barzi F, Rodgers A, et al; Asia Pacific Cohort Studies Collaboration: Cholesterol, coronary heart disease, and stroke in the Asia Pacific region. Int J Epidemiol 2003;32:563-572.
Wieberdink RG, Poels MM, Vernooij MW, Koudstaal PJ, Hofman A, van der Lugt A, et al: Serum lipid levels and the risk of intracerebral hemorrhage: the Rotterdam Study. Arterioscler Thromb Vasc Biol 2011;31:2982-2989.
Yoshita K, Miura K, Morikawa Y, Ishizaki M, Kido T, Naruse Y, et al: Relationship of alcohol consumption to 7-year blood pressure change in Japanese men. J Hypertens 2005;23:1485-1490.
Peng GS, Yin SJ, Cheng CA, Chiu SW, Lee JT, Lin WW, et al: Increased risk of cerebral hemorrhage in Chinese male heavy drinkers with mild liver disorder. Cerebrovasc Dis 2007;23:309-314.
Patra J, Taylor B, Irving H, Roerecke M, Baliunas D, Mohapatra S, et al: Alcohol consumption and the risk of morbidity and mortality for different stroke types - a systematic review and meta-analysis. BMC Public Health 2010;10:258.
Burke TA, Venketasubramanian RN: The epidemiology of stroke in the East Asian region: a literature-based review. Int J Stroke 2006;1:208-215.
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