Incidence, subtypes, sex differences and trends of stroke in Taiwan

Abstract

Background: Chinese populations have been reported higher incidence of all strokes and intracerebral hemorrhage. However, few large-scale studies have evaluated changes of stroke epidemiology in the 21st century.

Methods: We explored the rates of incidence of all first-ever strokes, subtypes, and 1-month case fatality by using data from the Taiwan National Health Insurance Research Database since 2004. Also, we investigated sex differences in stroke. Time-trend analysis was performed for incidence and case fatality rates of all strokes and subtypes in both sexes.

Results: The age-adjusted incidence of all strokes per 100,000 person-years decreased by 16%, from 251 (95% confidence interval [CI] 249-253) in 2004 to 210 (95% CI 209-212) in 2011 (p<0.001); it was always higher in Chinese men than in women. Among pathological subtypes, the incidence of intracerebral hemorrhage markedly decreased by 26% over the years (p<0.001), while that of ischemic stroke slightly decreased by 8%. However, when stratified by sex, the incidence of ischemic stroke decreased significantly in only women, not in men (men: p = 0.399, women: p = 0.004). Regarding the incidence of subarachnoid hemorrhage, it remained unchanged. Furthermore, the rate of 1-month case fatality decreased significantly for all strokes in both sexes (p<0.001).

Conclusions: In Taiwan, the incidence rate of first-ever stroke decreased in both Chinese men and women in the early 21st century. Men had a higher incidence rate than women. Furthermore, a marked decrease was noted in the incidence of intracerebral hemorrhage, while a slight decrease was noted in that of ischemic stroke; however, the decreased incidence of ischemic stroke was significant in only women.

Fig 1. Trends of age-adjusted incidence of all first-ever strokes.

P_All = p for trend in all strokes; P_M = p for trend in men; P_W = p for trend in women.

Fig 2

A. Trends of incidence of intracerebral hemorrhage. B. Trends of incidence of subarachnoid hemorrhage. C. Trends of incidence of ischemic stroke. P_All = p for trend in all strokes; P_M = p for trend in men; P_W = p for trend in women.

Fig 3. Changes in the male-to-female incidence ratio for all strokes and subtypes.

M = male; F = female; ICH = intracerebral hemorrhage; IS = ischemic stroke; SAH = subarachnoid hemorrhage; P_All = p for trend in all strokes; P_ICH = p for trend in ICH; P_IS = p for trend in ischemic stroke; P_SAH = p for trend in subarachnoid hemorrhage.

Fig 4. Trends of 1-month case fatality of all strokes.

P_All = p for trend in all strokes; P_M = p for trend in men; P_W = p for trend in women.