Trends of Stroke Incidence and 28-Day All-Cause Mortality after a Stroke in Malaysia: A Linkage of National Data Sources

Abstract

Background: Data on nationwide trends for stroke metrics are crucial to understand the extent of the disease burden to a country's health system. Yet, this information remains scarce in lowand middle-income countries. Objectives: This study investigated trends of stroke incidence and 28-day all-cause mortality after a stroke from 2008 to 2016 in Malaysia, through linkage across national data sources. Methods: Hospital admissions with a principal diagnosis of stroke or transient ischemic attack were included. Cases with first stroke were identified through linkage of hospital admission registers where age and sex-standardized trends of stroke incidence and its subtypes were calculated. By linking hospital registers to the National Death Register, the 28-day all-cause mortality rates after a stroke were estimated. Mann-Kendall's test was used for trend evaluation. Results: From 243,765 records, the trend of stroke incidence showed an increase of 4.9% in men and a drop of 3.8% among women. Incidences were higher in men, at 99.1 per 100,000 population in 2008 and 103.9 per 100,000 in 2016 than women (80.3 per 100,000 in 2008 and 77.2 per 100,000 in 2016). There was a substantial increase in stroke incidence among those below 65 years old, with the largest increase of 53.3% in men aged between 35-39 years and 50.4% in women of similar age group. The trend for 28-day all-cause mortality showed a decline for men at -13.1% and women, -10.6%. Women had higher mortality from stroke (22.0% in 2008 and 19.7% in 2016) than men (19.4% in 2008 to 17.2% in 2016). Conclusion:This first empirical study on stroke trends in Malaysia revealed a worrying increase in stroke incidence among the younger population. Despite a declining trend, mortality rates remained moderately high especially in women. Comprehensive strategies to strengthen the prevention and management of stroke care are warranted.

What Are the Predictors of Intracranial Aneurysm Rupture in Indonesian Population Based on Angiographic Findings? Insight from Intracranial Aneurysm Registry on Three Comprehensive Stroke Centres in Indonesia

“…SAH is widely known as the most devastating type of stroke with high mortality and morbidity. Previous studies suggested higher mortality rates of SAH in Indonesia [2][3][4] compared with studies in other Southeast Asian countries [5,6] and worldwide [10]. Several factors that may contrib-ute to this figure include (1) sociodemographic factors, namely, low awareness of health issues and hesitancy to conduct routine medical check-up if no symptoms are present [11][12][13]; (2) diagnostic and treatment delay due to the cultural belief to self-medicate and disparities in healthcare facility and personnel across this archipelago nation [14,15]; and (3) study design and location, as our hospital is the tertiary health care and referral centres for eastern Indonesia region and most of the SAH patients usually admitted with severe disease progression and other complications that could not be handled in primary or secondary health centres.…”

“…If left untreated, IA could evolve into subarachnoid haemorrhage (SAH) which poses significant mortality and morbidity [1]. According to several studies in Indonesia, ruptured aneurysmal SAH has a mortality rate of 20.8-53.1% [2][3][4], which is significantly higher compared to other Southeast Asian countries [5,6]. Recently, the fast development of technological advances could significantly reduce the mortality and morbidity level of ruptured IA through early and aggressive treatment.…”

Effect of Core Exercises on Motor Function Recovery in Stroke Survivors with Very Severe Motor Impairment

“…Current AHA (2017) [ 10 ] statistics states that nearly 10 percent of all strokes occur in individuals 18 to 50 years of age. In Malaysia, there was a substantial increase in stroke incidence in those under 65 years of age [ 11 , 12 ]. Therefore, a pool of 260 stroke patients aged between 20 and 60 years old (particularly those from Kota Kinabalu and the surrounding districts, including Penampang, Tuaran, Putatan, and Papar) who had received outpatient treatment at the Department of Rehabilitation Medicine at Queen Elizabeth I Hospital or Tuaran Hospital (Sabah, Malaysia) were recruited.…”

Stroke Burden in Malaysia

“…Malaysia has a lower age and sex-standardized stroke mortality and DALYs compared to many other countries in South East Asia [ 7 ]. At the national level, there was a 4.9% increase in stroke incidence between 2008 and 2016 among men but a 3.8% fall among women; 28-day all-cause mortality fell in both sexes, by 13.1% and 10.6%, respectively [ 8 ]. From the data, there are more patients living with stroke-related disabilities [ 9 ].…”

“…The National Health and Morbidity Survey Malaysia from 2006 to date conducted by the Ministry of Health, Malaysia, is a successive national health survey which has shown a continuous rise in the prevalence of vascular risk factors in the community, especially diabetes mellitus, hyperlipidaemia, and obesity with a gradual reduction in the prevalence of hypertension [ 12 ]. Database on hospital admissions (2008–2016) from Ministry of Health hospitals detected that there was a substantial increase in stroke incidence in those under 65 years of age, the largest increase of 53.3% and 50.4% in men and women, respectively, in the age strata of 35–39 years [ 8 ]. A smaller hospital-based study has shown that a large proportion of ischaemic strokes in young adults (under the age of 50) have larger proportions of conventional risk factors in comparison to a similar cohort from Australia [ 13 ].…”