Changes in mortality from cerebrovascular disease and clinical pattern of stroke in Taiwan

The total population in Taiwan increased at a rate of about 20% per five-year interval during the period from 1957 to 1972 and has continued to increase at about 15% in the subsequent five-year periods. The number of cerebrovascular disease (CVD) deaths increased rapidly during the period from 1962 to 1982 and has tended to level off since 1982. From 1962 to 1977, the rate of increase in CVD deaths among the elderly almost paralleled the growth in the elderly population, but it has slowed in recent years. The age-adjusted CVD death rates are consistently higher in men than in women. In both sexes, the highest CVD death rates were reached in 1972, and a decreasing trend has been conspicuous since 1977. The age-specific death rates have shown a similar tendency in all age groups for both sexes, except for men aged 45 to 54 years. The cumulative mortality rates are higher for men than for women in all age groups over 55 years. Although cerebral hemorrhage (CH) constitutes 35.5% (Taiwan series) and 35.2% (Taipei series) of acute strokes, it comprises 60.1% (Taiwan series) and 57.7% (Taipei series) of all fatal strokes. The case-fatality rate for CH is three to four times that for cerebral infarct (CI). Hypertension is the most significant risk factor for almost all major types of stroke, being most frequently seen among patients with CH. Diabetes mellitus, cardiac disease and hyperlipidemia are more frequent in CI than in CH and subarachnoid hemorrhage (SAH). The low CI to CH ratio clearly indicates the high incidence of CH in Taiwan. The more rapidly declining death rate from CVD since 1982 is largely due to a reduction in the case-fatality rate for CH. The ratio of CI to CH has gradually been increasing since 1983, indicating a relative increase in the incidence of CI. The effective anti-hypertension campaign started in 1986 has contributed to the reduction in the incidence and fatality of stroke.