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Background Previous findings of the association between socioeconomic deprivation and mortality after ischemic stroke are inconsistent. There is a lack of data on the association with combined low education, occupational class, and income. We assessed the associations of three indicators with mortality. Methods We examined data from the China National Stroke Registry, recording all stroke patients occurred between September 2007 and August 2008. Baseline socioeconomic deprivation was measured using low levels of education at Results In a 12-month follow-up 1640 patients died. After adjustment for age, sex, cardiovascular risk factors, severity of stroke, and prehospital medications, odds ratio for mortality in patients with low education was 1.25 (95%CI 1.05–1.48), manual laboring 1.37 (1.09–1.72), and low income 1.19 (1.03–1.37). Further adjustment for acute care and medications in and after hospital made no substantial changes in these odds ratios, except a marginal significant odds ratio for low income (1.15, 0.99–1.33). The odds ratio for low income was 1.27 (1.01–1.60) within patients with high education. Compared with no socioeconomic deprivation, the odds ratio in patients with socioeconomic deprivation determined by any one indicator was 1.33 (1.11–1.59), by any two indicators 1.36 (1.10–1.69), and by all three indicators 1.56 (1.23–1.97). Conclusions There are significant inequalities in survival after ischemic stroke in China in terms of social and material forms of deprivation. General socioeconomic improvement, targeting groups at high risk of mortality is likely to reduce inequality in survival after stroke.

Background Although ethnic or cultural differences affect prevalence of cardiovascular risk factors, limited information is available about the age- and gender-stratified prevalence of the risk factors in Asian stroke population. Aims and hypothesis We assessed gender- and age-stratified prevalences of major risk factors in Korean stroke patients, and assumed that the gender differences are attenuated by adjustment with lifestyle factors. Methods Using the nationwide hospital-based stroke registry, we identified 9417 ischemic stroke patients admitted between April 2008 and January 2011. Prevalence of hypertension, diabetes, hyperlipidemia, atrial fibrillation, prior stroke, and coronary heart disease was assessed in both genders by age groups. We analyzed gender differences of the prevalence among the age groups by calculating prevalence ratio, and further explored the influence of lifestyle factors on the gender difference in multivariable analyses. Results Hypertension and hyperlipidemia were more common in men until middle age, but after that more common in women, whereas diabetes was more common in women after 65 years of age. Atrial fibrillation increased steadily with age in both genders but was more common in women through all age groups. Prior stroke and coronary heart disease showed inconsistent gender differences. Gender differences in hypertension and diabetes among the age groups were attenuated by adjustment with accompanying risk factors including lifestyle factors. Conclusion Korean women with stroke had more hypertension and hyperlipidemia after middle age, more diabetes after 65 years, and more atrial fibrillation throughout all ages. Strategies to control risk factors in women at risk for stroke are eagerly needed.

Background In Japan, stroke mortality and incidence started to decline during the 1960s. The recent unfavourably diverging trends in risk factors make it uncertain whether the decline will continue. Few comprehensive stroke registries of long research duration exist in Japan to illustrate the trends in stroke incidence. Objective We examined 12-year stroke registration data to evaluate the current trend in a Japanese population. Methods Data were obtained from the Takashima Stroke Registry, covering approximately 55000 residents of Takashima County in central Japan. We calculated the age-adjusted stroke incidence rates (/100 000 person-years) and 95% confidence intervals for 1990–1992, 1993–1995, 1996–1998, and 1999–2001. We applied the direct method to adjust for the age distribution among the four periods. The incidence time trend was determined by calculating the average annual change across the study years using negative binomial regression analysis. Results There were 1453 (men: 771 and women: 682) registered first-ever stroke cases during 1990–2001. The diagnosis was established by neuro-imaging in 93·6% of the cases. The average age was 69·4 years in men and 74·2 years in women. The age-adjusted incidence rates of stroke across the four observation periods were 143·1 (confidence interval: 127·4-158·8) in 1990–1992, 147·4 (confidence interval: 131·9–162·8) in 1993–1995, 120·4 (confidence interval: 106·7–134·0) in 1996–1998, and 122·9 (confidence interval: 109·6–136·2) in 1999–2001. The stroke incidence across the study years showed an insignificant time trend, with an average annual change of −0·33% (confidence interval: −2·44 to 1·78) per year. Similar trends were observed for both men and women and stroke subtypes. Conclusions The previously reported declining trend in stroke incidence may have levelled off or slowed down considerably in the Japanese population.

The Takashima Stroke Registry is a disease registration system for stroke established in Japan in 1988. This stroke registry is a population-based, prospective, observational study whose objective is to monitor trends in the incidence and case-fatality of stroke in Japan. Takashima County is located in the rural area of the Shiga prefecture in central Japan, having a stable population of approximately 54,000. It is a farming community with similar cultural values and standards of living throughout the region. The population has remained fairly stable during the 16-year study period. 1750 stroke cases (men 937 and women 813) were registered during 1988–2002. The average ages of the men and women patients were 69.4 and 74.4 years respectively. Stroke diagnostic criteria are established for the Monitoring System for Cardiovascular Disease commissioned by the Ministry of Health and Welfare, Japan. These criteria were based on WHO-MONICA project. Takashima registry system was planned to capture all the cases in the study area by covering all the hospitals of the county. To ensure that eligible patients hospitalized outside the county were not omitted, registration procedures were also conducted at three high-level medical facilities within the Shiga region but outside the county. Due to the high rate of computed tomography use in Japan the identification of stroke cases within the study area is almost complete and stroke diagnosis and classification are accurately recorded.