Trends in stroke incidence in Hong Kong differ by stroke subtype.

BACKGROUND: The population in Hong Kong is mainly Chinese, but their lifestyle is increasingly westernized. It is uncertain whether the trends of stroke in Hong Kong would follow a Chinese or Western pattern. This is the first study to examine the trends of ischemic and hemorrhagic stroke in Hong Kong between 1999 and 2007 with a view to providing data for planning preventive programs and resources for treatment. METHODS: Data from the Clinical Management System database of the Hong Kong Hospital Authority for 1999-2007 were used to examine incidence rates of stroke by subtypes among the Hong Kong population aged 35 and above. Poisson regression models were used to examine the trends in the ischemic and hemorrhagic stroke incidence in different subgroups. RESULTS: During 1999-2007, while the age-adjusted incidence of ischemic stroke has decreased, that of hemorrhagic stroke has remained fairly stable. In the younger age group (35-44 years), the incidence of ischemic stroke remained stable, whereas that of hemorrhagic stroke has increased. Furthermore, the incidence of all stroke among Hong Kong Chinese is much higher than in many other developed countries. CONCLUSIONS: There were different trends of hemorrhagic and ischemic stroke incidence in Hong Kong. The findings highlight the public health importance of further research into the underlying causes of the increasing trend in hemorrhagic stroke in the younger age group, and the higher overall age-adjusted stroke incidence in Hong Kong compared with other developed countries.

Avoidable mortality pattern in a Chinese population--Hong Kong, China.

BACKGROUND: We examined the avoidable mortality pattern in Hong Kong, and the influence of age and gender. Comparison with Paris, Inner London and Manhattan was performed, and we discussed the findings in terms of prevention programmes, ethnicity and lifestyles. METHODS: Mortality and population data by age and gender were obtained from vital statistics sources. Two periods, 1999-2003 and 2004-06, were selected for analysis. Negative binomial regression and logistic regression were used to model, respectively, the number and proportion of avoidable mortality, in relation to age and gender. RESULTS: The standardized total mortality rates (per 1000 population) were 2.51 in the period 1999-2003 and 2.25 in the period 2004-06, whereas the standardized avoidable mortality rates (per 1000 population) were 0.85 and 0.77 for the two periods, respectively. Cerebrovascular disease (stroke) was the leading cause of avoidable mortality. Women in the age range of 65-74 years had the highest avoidable mortality proportion. In 1999-2003, Hong Kong had the second lowest standardized avoidable mortality rate among the four cities compared, whereas the avoidable mortality proportion was the highest. CONCLUSION: There might be room for improvement in the primary care system in Hong Kong, particularly in the development of effective prevention programmes targeting the leading causes of avoidable mortality.

Disagreement in preference for residential care between family caregivers and elders is greater among cognitively impaired elders group than cognitively intact elders group.

OBJECTIVES: This study examined the predictive factors of preference for residential care in cognitively intact and impaired elders and their family caregivers. It was hypothesized that disagreement in preference for residential care between the elders and their caregivers was greater in the cognitively impaired. METHODS: A cross-sectional survey was conducted during June 2007 to March 2008 in Hong Kong, and 707 community-dwelling elders aged 65 and above and 705 family caregivers were interviewed. Cognitively impaired elders were over-sampled to give reliable estimates for that sub-group. A structural questionnaire was used to collect data on preference for residential care and potential factors. Logistic regression was used to identify the predictors. RESULTS: More cognitively impaired elder-caregiver dyads (37.4%) had disagreement in preference for residential care than cognitively intact elder-caregiver dyads (20.5%) (p < .001). From the elders' perspective, less preference for residential care was associated with cognitive impairment, whereas greater preference was associated with depression (for cognitively intact elders), more usage of community service and functional impairment. From the caregivers' perspective, greater preference for residential care was associated with greater caregiver burden, or care-recipients having cognitive or functional impairment, or more usage of community services. CONCLUSIONS: Cognitively intact elders were more likely to indicate preference for residential care than cognitively impaired elders. Elders, both cognitively intact and impaired, were less likely than their caregivers to indicate preference for residential care. Disagreement in preference for residential care between the elders and their caregivers was larger for the cognitively impaired group than the cognitively intact group.

Access to primary care in Hong Kong, Greater London and New York City.

We investigate avoidable hospital conditions (AHC) in three world cities as a way to assess access to primary care. Residents of Hong Kong are healthier than their counterparts in Greater London or New York City. In contrast to their counterparts in New York City, residents of both Greater London and Hong Kong face no financial barriers to an extensive public hospital system. We compare residence-based hospital discharge rates for AHC, by age cohorts, in these cities and find that New York City has higher rates than Hong Kong and Greater London. Hong Kong has the lowest hospital discharge rates for AHC among the population 15-64, but its rates are nearly as high as those in New York City among the population 65 and over. Our findings suggest that in contrast to Greater London, older residents in Hong Kong and New York face significant barriers in accessing primary care. In all three cities, people living in lower socioeconomic status neighborhoods are more likely to be hospitalized for an AHC, but neighborhood inequalities are greater in Hong Kong and New York than in Greater London.

Usage of community services and domestic helpers predicted institutionalization of elders having functional or cognitive impairments: a 12-month longitudinal study in Hong Kong.

OBJECTIVES: To estimate the 12-month institutionalization rate and to identify the associated predictors among functionally impaired elders with or without cognitive impairment. METHODS: A cohort of Hong Kong community-dwelling elders aged 65 or older with functional and/or cognitive impairments was recruited and interviewed from 2007 to 2008. Twelve months after the baseline interview, the family caregivers or elders were interviewed to update the residence status of the elders. Logistic regressions were used to examine the association between institutionalization and the baseline variables. RESULTS: Eighty elders (of 749 respondents) had been institutionalized within 12 months from baseline. The institutionalization rates were 6.2% (95% confidence interval (CI): 4.0%-8.5%) for elders with functional impairment only and 17.3% (95% CI: 13.0%-21.6%) for elders with both functional and cognitive impairments. Stepwise multiple logistic regressions found that more usage of community services was the single predictor to institutionalization in 1 year for the elders with functional impairment only. The risk was doubled (odd ratio = 2.166, 95% CI: 1.286-3.647) for usage in 1 more community service. For elders with both functional and cognitive impairments, the institutionalization risk was reduced by about 70% with employment of a domestic helper (odd ratio = 0.268, 95% CI: 0.120-0.598), despite increased risk being associated with advancing age of caregiver, caregiver being male, and deteriorating functional status of the elder. CONCLUSION: Among the functionally impaired elders, more usage of community services predicted increased institutionalization, whereas among the functionally and cognitively impaired elders, employment of a domestic helper predicted reduced institutionalization. Innovative services and care models are needed to prevent unnecessary institutionalization and to postpone premature institutionalization. Further research needs to be conducted to investigate the long term care needs of the elders from the perspective of both the elders and their caregivers.

Trends in prevalence and mortality of dementia in elderly Hong Kong population: projections, disease burden, and implications for long-term care.

Background. We describe the trends in prevalence and mortality of dementia among older people in Hong Kong over time. Projections of the number of older people with dementia through 2039 and estimation of the disease burden are also included. Methods. Prevalence data were extracted from previous studies in Hong Kong. Mortality data were obtained from the Department of Health of Hong Kong. Projections of the number of people with dementia were calculated by applying the prevalence rates of dementia obtained from previous studies to Hong Kong population projections. The burden of dementia was measured by Disability-Adjusted Life Years (DALYs). Results. The number of people aged 60 and above with dementia is projected to increase by 222%, from 103,433 in 2009 to 332,688 in 2039, with a large proportion of those living in institutions. The number of deaths due to dementia among people aged 60 and above has more than doubled between 2001 and 2009. Mortality rates for dementia have also risen. In 2006, about 286,313 DALYS were lost due to dementia. Conclusions. The information presented may be used to formulate a long-term care strategy for dementia of the ageing population in Hong Kong.

Analysis of spatio-temporal variations in stroke incidence and case-fatality in Hong Kong.

Geographical variations in stroke incidence and case-fatality have been documented worldwide. This study examines whether there are spatio-temporal variations in stroke incidence and case-fatality in Hong Kong and attempts to determine to what extent socioeconomic status (SES) and healthcare provision account for these variations. Residence-based hospital discharge data from the Hospital Authority (HA) in Hong Kong were geo-referenced and used to examine incidence rates and case-fatality rates by stroke subtype among the population aged 35 years and above in 1999-2007. Multilevel models were used to examine the spatio-temporal variations. Ischemic stroke incidence was found to decrease among those aged above 55 years, while hemorrhagic stroke incidence increased. Ischemic stroke case-fatality was found to decrease but hemorrhagic stroke case-fatality remained stable. For both subtypes, there were significant variations in stroke incidence and case-fatality across the districts of residence, but insignificant variations across HA service clusters. Only variations in ischemic stroke incidence and hemorrhagic stroke case-fatality at the district level could be partly explained by district-level SES. Identification of districts with higher risk for stroke incidence and case-fatality would help to formulate enhanced preventive measures. Future studies are needed to identify factors that contribute to the geographical variations.