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

• Published in: PloS one Vol. 17; no. 11; p. e0277296
• Main Authors: Tsai, Chung-Fen, Wang, Ya-Hui, Teng, Nai-Chi, Yip, Ping-Keung, Chen, Li-Kwang
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 16.11.2022; Public Library of Science (PLoS)
• Subjects: Brain Ischemia - epidemiology; Cerebral Hemorrhage - epidemiology; Epidemiology; Fatalities; Female; Gender differences; Hemorrhage; Humans; Incidence; Ischemia; Ischemic Stroke; Male; Medicine and Health Sciences; Men; People and Places; Sex Characteristics; Sex differences; Social Sciences; Stroke; Stroke - epidemiology; Subarachnoid hemorrhage; Taiwan - epidemiology; Trend analysis; Trends; Women; Taiwan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0277296

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. 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. 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). 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.