Stroke incidence and case fatality in Shiga, Japan 1989-1993

Background This paper describes incidence rates and case-fatality for sub-t ypes of stroke using data collected in Takashima, Shiga, Japan, from 1989 t o 1993 and compares these with similar registers in other parts of Japan. Methods Registered patients included all residents of the county who experi enced a first-ever stroke. Stroke was defined as sudden onset of neurologic al symptoms which continued for a minimum of 24 hours or led to death. Almo st all such patients are hospitalized in this country. Early case fatality was defined as patients who died within 28 days of stroke onset. Diagnosis of stroke type was based on clinical symptoms as well as computed tomograph y (CT) scans. Results Age-adjusted incidence rates for stroke per 100 000 population aged 35 years and older were 268.7 for men and 167.5 for women. The age-specifi c incidence rate of both cerebral infarction and cerebral haemorrhage incre ased with advancing age. The occurrence of cerebral infarction in men was t wice as high as in women. The 28-day case fatality for all sub-types of str oke was 16.1% in men and 15.8% in women. Case fatality for cerebral infarct ion, cerebral haemorrhage, and subarachnoid haemorrhage was 10.7%, 22.4% an d 28.6% respectively. Conclusions Takashima County has a moderately high stroke incidence rate an d case fatality compared with other similar studies in Japan. The incidence rate of cerebral infarction in men is twice that in women, while other sub -types of stroke showed smaller differences. In order to decrease the incid ence of stroke in Japan, greater efforts at primary prevention will be nece ssary, in particular, it is important to prevent cerebral infarction in men .