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TitleTitle Trends of Disease Burden Consequent to Stroke in Older Persons in Hong Kong
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Page 66

Chapter 664

In recent years, several population-based stroke rate studies have been published. The

following sections draw on a variety of sources to present the case-fatality rates of stroke of

some published population-based studies of selected countries.

6.2.1 United States

Population-based data on trends in case-fatality of stroke are scarce, with only one

population-based study thus far reporting time-trend data for case-fatality rate of stroke in the

United States. Based on data from the Framingham Study of 9,152 persons aged 55 years or

older, the 30-day case-fatality rates decreased significantly in males (from 23% to 14%; P=0.01)

but insignificantly in females (from 21% to 20%; P=0.32) during the periods 1950 to 1977 and

1990 to 2004 (over 174,917 person-years of follow-up) (Table 6.3) (Carandang et al., 2006).

Table 6.2 30-day case-fatality rates of stroke

in five Western registries and in one local registry in Hong Kong

Study Country
Population

size
Age

Case-
fatality

Source

The US National Institute of
Neurological Disorders and Stroke
(NINDS) Stroke Data Bank

United
States

1,562 All ages 14.2% Foulkes et al.
(1988)

The Lehigh Valley Stroke Register United
States

2,621 NA 20.2% Friday et al.
(1989)

The Lausanne Stroke Registry Switzerland 1,000 20-89 8.2% Bogousslavsky
et al. (1988)

The Dijon Stroke Registry France 800 NA 24.7% Giroud et al.
(1989)

The Oxfordshire Community
Stroke Project

United
Kingdom

642 All ages 23.9% Bamford et al.
(1990)

The Shatin Stroke Registry Hong Kong 777 All ages 25.4% Kay et al. (1992)

NA: Not available.

Page 67

Trends in Stroke Case-fatality in Hong Kong 65

The case-fatality rates for stroke were also evaluated in other studies. In the Atherosclerosis

Risk in Communities Cohort study for persons aged 45-64, the age-, sex- and race-adjusted

30-day case-fatality rate was 10.3% for all strokes, 7.3% for ischemic strokes and 33.1% for

hemorrhagic strokes. Higher case-fatality rates were found in men (11.0%) than in women

(9.8%) (Rosamond et al., 1999). Similar rates were reported in the Cardiovascular Health Study

of persons aged 65 years or older, with the one-month case-fatality of stroke being 12.6% for

all strokes, 8.1% for ischemic strokes and 44.6% for hemorrhagic strokes (El-Saed et al., 2006).

6.2.2 United Kingdom

Based on data from the South London Stroke Register in the United Kingdom, the overall

case-fatality rates of stroke were 16.6% at 7 days, 25.7% at 28 days, 32.9% at 90 days and 36.7%

at 180 days but with no significant differences between ethnic groups (Wolfe et al., 2002).

Trend data for case-fatality rate of stroke in the United Kingdom is also available. According

to a population-based cohort study, there was a declining trend in one-year case-fatality rate

of stroke between 1997 and 2005. In males, the one-year case-fatality declined from 29.2%

in 1997 to 22.2% in 2005. In females, the decline was from 41.2% in 1997 to 29.2% in 2005.

Reducing one-year case-fatality after acute stroke may be partly explained by increased

prescribing of antihypertensive, statin and antiplatelet drugs to patients with recent strokes

(Figure 6.2) (Gulliford et al. 2009).

Table 6.3 30-day case-fatality of stroke in the United States, by sex, 1950-2004

Sex 1950-1977 1978-1989 1990-2004

Male 23% 20% 14%

Female 21% 21% 20%

Data source: Carandang et al. (2006)

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