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

Wen Yea Hwong; Swee Hung Ang; Michiel L Bots; Sheamini Sivasampu; Sharmini Selvarajah; Wan Chung Law; Lydia Abdul Latif; Ilonca Vaartjes

doi:10.5334/gh.791

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

Glob Heart. 2021 May 26;16(1):39. doi: 10.5334/gh.791.

Authors

Wen Yea Hwong^{1

2}, Swee Hung Ang¹, Michiel L Bots², Sheamini Sivasampu¹, Sharmini Selvarajah^{2

3}, Wan Chung Law⁴, Lydia Abdul Latif⁵, Ilonca Vaartjes²

Affiliations

¹ Institute for Clinical Research, National Institutes of Health, Ministry of Health, Selangor, MY.
² Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, NL.
³ Sharmini Selvarajah Consulting, Selangor, MY.
⁴ Neurology Unit, Department of Medicine, Sarawak General Hospital, Ministry of Health, Kuching, MY.
⁵ Regen Rehab Hospital, Petaling Jaya, MY.

PMID: 34211825
PMCID: PMC8162294
DOI: 10.5334/gh.791

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 low- and 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.

Keywords: Malaysia; developing countries; incidence; mortality; stroke.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Cost of Illness
Female
Humans
Incidence
Information Storage and Retrieval
Malaysia / epidemiology
Male
Stroke* / epidemiology

Grants and funding

This study is funded by the Ministry of Health Malaysia research grant under the project ‘Monitoring Stroke Burden in Malaysia: the use of linked national data sources’ (NMRR 18-100-39847). WYH is supported by the Honours Track of MSc Epidemiology, University Medical Center Utrecht with a grant from the Netherlands Organization for Scientific Research (Grant number: 022.005.021). IV is funded by the Dutch Heart Foundation for project Facts and Figures. Ministry of Health Malaysia, UMC Utrecht and the Dutch Heart Foundation had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.