Stroke incidence in the South West District of the Penang Island, Malaysia: PEARLs: Penang Acute Stroke Research Longitudinal Study

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Abstract

Objectives

This community based incidence study aims to report the stroke incidence in the south-west region of the Penang Island.

Methods

All strokes occurring in the population of residents in the southwest region of the Penang Island, Malaysia during a period of 12 months, from April 2010 to March 2011 were screened and assessed. Standard definitions for stroke were used. All stroke cases were ascertained using multiple overlapping sources. Incidence rate was based on first ever in a lifetime stroke cases. All recurrent strokes were excluded from the incidence count.

Results

The overall stroke incidence rate in the study region during the study period was 67 per 100,000 after age adjustment to 2010 Malaysian population.

Conclusion

This study provides the first stroke incidence data in Malaysia and is vital for effective health system planning.

Highlights

► Stroke incidence in the South-West District of the Penang Island, Malaysia ► We conducted the study from April 2010 to March 2012. ► Stroke incidence rate was 67/100,000 (age adjusted to 2010 Malaysian population).

Introduction

Globally stroke is the second common cause of mortality, after heart disease and accounts for 5.7 million deaths annually (Mathers et al., 2008). According to the WHO 2001 estimates, 90% of the global stroke mortality came from developing countries (Mathers et al., 2006). Age-adjusted incidence rate in India is reported to be between 145 and 262 per 100,000 (Das et al., 2007).

Population-based data on stroke is still lacking in a large number of the Asian countries (Feigin et al., 2009) and limited to prevalence and mortality. The PEARL study is the first stroke incidence study in the country, conducted by adopting the “ideal” criteria for stroke incidence studies proposed by Sudlow and Warlow (1997), to attain the most precise assessment.

Malaysia is facing a major stroke epidemic, like many other countries in the world. Cerebrovascular disease was ranked as the 5th principal cause of death in the public hospitals and contributes approximately 8% of the total death in the country for the year of 2009 (Ministry of Health Malaysia, 2009). Understanding the incidence of stroke is particularly important to the government and policy makers to ensure adequate resources are allocated to manage the disease on a national level. Yet stroke incidence in Malaysia has not been established. The main aim of our study is to establish the stroke incidence in south-west region of the Penang Island, Malaysia.

Section snippets

Methods

This study was conducted between April 1, 2010 and March 30, 2011 in the defined South-Western District of the Penang Island, Malaysia. The World Health Organization's definition of stroke was used in this study (Hatano, 1976). The definition includes events due to cerebral infarction or intracerebral and subarachnoid hemorrhage but excludes transient ischemic attacks that are neurological deficits lasting less than 24 h.

The national census, conducted in 2010, reported the total population of

Results

A total of 926 potential stroke cases were screened in this study. After clinical assessment and/or medical record review, 698 cases were excluded from this study. These cases were excluded due to patients not living in the geographically defined study region (26.7%), the stroke event occurred outside the study period (9.6%), clinical assessment details of the cases could not be confirmed (18.5%) and the event was not considered to be stroke (45.2%).

A total of 228 stroke cases were included in

Discussion

As this is the first incidence study conducted in Malaysia, a comparison to evaluate the trend of the disease in the country could not be done. Nevertheless, we found that males have a higher age-adjusted stroke incidence rate compared to females in the study population.

The incidence rate we report is very similar to the rate reported in South Vietnam (Kurtzke, 1985). However, other low–middle income regions, such as Sub-Saharan Africa reports a higher incidence rate (Walker et al., 2010). This

Conclusion

This PEARL stroke incidence study provides a crucial baseline from which the trend of incidence in the region can be determined in the future. Similar population based incidence studies are vital for health system planning, especially when the stroke incidence in the low–middle income countries, Malaysia inclusive, is on the rising trend (Mathers et al., 2006).

Conflict of interest

The authors declare that there are no conflicts of interest.

References (10)

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