The 21-Year Trend of Stroke Incidence in a General Japanese Population: Results from the Takashima Stroke Registry, 1990-2010.

INTRODUCTION: Since the 1960s, the stroke morality rate in Japan has declined significantly. Although several risk factors for stroke have become more evident due to increasingly Westernized lifestyle, there have been no population-based registry data on recent time trends in stroke incidence in Japan. The purpose of this study is to determine these trends in stroke incidence using a population-based registry. METHODS: Data were obtained from the Takashima Stroke Registry, which covers approximately 50,000 residents in Takashima City, Japan. The age- and sex-standardized stroke incidence rate was estimated using the direct method. Average annual relative changes of stroke incidence were estimated using Poisson regression models. RESULTS: We identified a total of 2,371 patients with first-ever stroke during the period 1990-2010. Crude incidence rates of total stroke (per 100,000 person-years) were 225 in the early period (1990-2001) and 187 in the late period (2002-2010), and the mean age at onset of stroke increased from 71.9 years in the early period to 74.8 years in the late period. Age- and sex-standardized incidence rates of stroke (per 100,000 person-years) decreased from 327 in the early part of this study period and 206 in the later period. During the 21-year period, age- and sex-standardized average annual relative reduction in stroke incidence was statistically significant (-3.7% per year). When stratified into early and late periods, the adjusted annual relative reduction in stroke incidence was observed during the early period (-2.1% per year), and there were no significant changes during the late period. CONCLUSIONS: In this population-based registry, there was a significant reduction in incidence of stroke from 1990 to 2010. Although the speed of reduction in stroke incidence appears to have slowed down after 2000, continuous public health measures are required to provide further protection against stroke.

Hollow-Fiber RO Membranes Fabricated via Adsorption of Low-Charge Poly(vinyl alcohol) Copolymers.

We report a new type of alkaline-stable hollow-fiber reverse osmosis (RO) membrane with an outside-in configuration that was established via adsorption of positively charged poly(vinyl alcohol) copolymers containing a small amount of quaternary ammonium moieties. Anionic sulfonated poly(arylene ether sulfone nitrile) hollow-fiber membranes were utilized as a substrate upon which the cationic copolymer layer was self-organized via electrostatic interaction. While the adsorption of the low-charge copolymer on the membrane support proceeded in a Layer-by-Layer (LbL) fashion, it was found that the adsorbed amount by one immersion step was enough to form a defect-free separation layer with a thickness of around 20 nm after cross-linking of vinyl alcohol units with glutaraldehyde. The resultant hollow-fiber membrane showed excellent desalination performances (NaCl rejection of 98.3% at 5 bar and 1500 mg/L), which is comparable with commercial low-pressure polyamide RO membranes, as well as good alkaline resistance. The separation performance could be restored by repeating the LbL treatment after alkaline degradation. Such features of LbL membranes may contribute to extending RO membrane lifetimes.

(Dibenzoylmethanato)boron difluoride derivatives containing triphenylamine moieties: a new type of electron-donor/π-acceptor system for dye-sensitized solar cells.

(Dibenzoylmethanato)boron difluoride derivatives containing triphenylamine moieties were synthesized as a new type of electron-donor/π-acceptor system. These new compounds exhibited long-wavelength absorptions in the UV/Vis spectra, and reversible oxidation and reduction waves in cyclic voltammetry experiments. Their amphoteric redox properties are based on their resonance hybrid forms, in which a positive charge is delocalized on the triphenylamine moieties and a negative charge is localized on the boron atoms. Molecular orbital (MO) calculations indicate that their HOMO and LUMO energies vary with the number of phenylene rings connected to the difluoroboron-chelating ring. This is useful for optimizing the HOMO and LUMO levels to an iodine redox (I(-)/I3(-)) potential and a titanium dioxide conduction band, respectively. Dye-sensitized solar cells fabricated by using these compounds as dye sensitizers exhibited solar-to-electric power conversion efficiencies of 2.7-4.4 % under AM 1.5 solar light.

Acute case-fatality rates of stroke and acute myocardial infarction in a Japanese population: Takashima stroke and AMI registry, 1989-2005.

BACKGROUND: Few comprehensive stroke and acute myocardial infarction registries of long duration exist in Japan to illustrate trends in acute case-fatality of stroke and acute myocardial infarction with greater precision. We examined 17-year case-fatality rates of stroke and acute myocardial infarction using an entire community-monitoring registration system to investigate trends in these rates over time in a Japanese population. METHODS: Data were obtained from the Takashima Stroke and AMI Registry covering a stable population of approximately 55 000 residents of Takashima County in central Japan. We divided the total observation period of 17 years into four periods, 1989-1992, 1993-1996, 1997-2000, and 2001-2005. We calculated gender, age-specific and age-adjusted acute case-fatality rates (%) of stroke and acute myocardial infarction across these four periods. RESULTS: During the study period of 1989-2005, there were 341 fatal cases within 28 days of onset among 2239 first-ever stroke events and 163 fatal cases among 433 first-ever acute myocardial infarction events. The age-adjusted acute case-fatality rate of stroke was 14·9% in men and 15·7% in women. The age-adjusted acute case-fatality rate of acute myocardial infarction was 34·3% in men and 43·3% in women. The age-adjusted acute case-fatality rates of stroke and acute myocardial infarction showed insignificant differences across the four time periods. The average annual change in the acute case-fatality rate of stroke (-0·2%; 95% CI: -2·4-2·1) and acute myocardial infarction (2·7%; 95% CI: -0·7-6·1) did not change significantly across the study years. CONCLUSIONS: The acute case-fatality rates of stroke and acute myocardial infarction have remained stable from 1989 to 2005 in a rural and semi-urban Japanese population.

Wake-up stroke: incidence, risk factors and outcome of acute stroke during sleep in a Japanese population. Takashima Stroke Registry 1988-2003.

Characterization of the time of stroke onset has been plagued by the problem of determining the time of the onset of events that are detected when the patient awakens. Our aim was to evaluate the characteristics, risk factors and acute fatality associated with wake-up stroke. Data was obtained from Takashima Stroke Registry covering approximately 55,000 residents in central Japan. During the period 1988-2003, information about the situation at stroke onset was available for 897 cerebral infarction (CI) and 335 intracerebral hemorrhage (ICH) events. Differences in characteristics and outcome between stroke during sleep and stroke while awake were explored. Among CI and ICH cases, 9.7 and 11.9% suffered from stroke during sleep, respectively. Hypertension and experiencing a severe event were associated with stroke during sleep among CI. Smoking and experiencing a severe event were associated with stroke during sleep and a drinking history reduced the chance of stroke during sleep among ICH. Acute fatality risks did not differ between stroke during sleep and stroke while awake among both CI and ICH cases. About 1 in 10 stroke patients had an onset of stroke during sleep. Hypertensive, smoker and clinically more severely affected patients had a higher prevalence of stroke during sleep. There were no differences between the 2 groups with respect to acute-case fatality.

Ambient air pollutants and acute case-fatality of cerebro-cardiovascular events: Takashima Stroke and AMI Registry, Japan (1988-2004).

BACKGROUND: Apart from the conventional risk factors, cerebro-cardiovascular disease (CVD) are also reported to be associated with air pollution, thus lowering the level of exposure might contribute in prevention activities to reduce the associated adverse outcomes. Though few studies conducted in Japan have reported on the CVD mortality but none have explored the effect of air pollutant exposure on the acute case-fatality of CVD. We investigated the effects of air pollution exposure on acute case-fatality of stroke and acute myocardial infarction (AMI) in a setting where pollutant levels are rather low. METHODS: We leveraged the data from the Takashima Stroke and AMI Registry, which covers a population of approximately 55,000 in Takashima County located in central Japan. The study period of 6,210 days (16 years, leap years also taken into account) were divided into quartiles of daily average pollutant concentration; suspended particulate matter (SPM), sulfur dioxide (SO(2)), nitrogen dioxide (NO(2)), and photochemical oxidants (Ox). The stroke and AMI events were categorized to corresponding quartiles based on the pollution levels of the onset day. To study the effects of air pollutants, we estimated the fatality rate ratio across quartiles of the pollutants where the lowest quartile served as the reference. RESULTS: There were 307 (men: 153 and women: 154) fatal stroke cases within 28 days of onset among the 2,038 first ever stroke during 1988-2004. In the same period, there were 142 (men: 94 and women: 54) fatal AMI cases within 28 days of onset among the 429 first ever AMI events. The mean of the measured pollutant levels were as follows: SPM 26.9 µg/m(3), SO(2) 3.9 ppb, NO(2) 16.0 ppb, and Ox 28.4 ppb. Among the pollutants, higher levels of NO(2) showed increased fatality risk. In multi-pollutant model, the highest quartile of NO(2) was associated with 60% higher stroke case-fatality risk in comparison to lowest quartile of NO(2). In the fully adjusted model the fatality-rate ratio was 1.65 (95% CI 1.06-2.57). This association was more prominent among stroke subtype of cerebral infarction. Other pollutant levels did not show any association with stroke or AMI case-fatality. CONCLUSION: We observed association between NO(2) levels, an index of traffic related air pollution, with the acute case-fatality of stroke, especially cerebral infarction in our study population. Further studies are needed in different regions to determine the association between ambient air pollutants and acute cardiovascular fatalities.

Short-term exposure to air pollution and incidence of stroke and acute myocardial infarction in a Japanese population.

BACKGROUND: Exposure to high levels of air pollution can increase the risk of cardiovascular events. However, there is no clear information in Japan on the effect of pollution on the incidence of stroke and acute myocardial infarction (AMI). Therefore, we investigated the effects of air pollution on the incidence of stroke and AMI in a setting where pollutant levels are rather low. METHODS: Data were obtained from the Takashima Stroke and AMI Registry, which covers a population of approximately 55,000 in Takashima County in central Japan. We applied a time-stratified, bidirectional, case-crossover design to estimate the effects of air pollutants, which included suspended particulate matter (SPM), sulfur dioxide (SO(2)), nitrogen dioxide (NO(2)) and photochemical oxidants (Ox). We used the distributed lag model to estimate the effect of pollutant exposure 0-3 days before the day of event onset and controlled for meteorological covariates in all of the models. RESULTS: There were 2,038 first-ever strokes (1,083 men, 955 women) and 429 first-ever AMI cases (281 men, 148 women) during 1988-2004. The mean pollutant levels were as follows: SPM 26.9 µg/m(3); SO(2) 3.9 ppb; NO(2) 16.0 ppb, and Ox 28.4 ppb. In single-pollutant and two-pollutant models, SO(2) was associated with the risk of cerebral hemorrhage. Other stroke subtypes and AMI were not associated with air pollutant levels. CONCLUSIONS: We observed an association between SO(2) and hemorrhagic stroke; however, we found inconclusive evidence for a short-term effect of air pollution on the incidence of other stroke types and AMI.

Time lag to hospitalisation and the associated determinants in patients with acute myocardial infarction: the Takashima AMI Registry, Japan.

BACKGROUND: Prompt initiation of treatment is the cornerstone in the management of patients with acute myocardial infarction (AMI). The time lags for AMI hospitalisations were examined to identify the factors influencing the interval. METHODS: Time lag information was available for 273 men and 148 women from the Takashima AMI Registry during 1988-2006. Multivariate regression analyses were performed to evaluate the factors influencing early and late admission. RESULTS: The median time to hospitalisation was 2 h (mean 6.1, SD 18.7). Within 2 h of onset, 59.8% patients arrived and 20.6% arrived during the 2-6 h interval. A substantial number of patients (19.6%) arrived after 6 h and onwards. A time lag of >2 h in hospital admission was significantly influenced by history of hypertension, angina, presence of syncope as an initial symptom and time of AMI onset. A time lag of >6 h shared similar characteristics except for presence of history of angina. CONCLUSIONS: About one-fifth of patients with AMI have prolonged time lag in the study population. Future research intervention and health promotion activities should focus on achieving a reduction in presentation delays.

Ischemic stroke subtypes in a Japanese population: Takashima Stroke Registry, 1988-2004.

BACKGROUND AND PURPOSE: Population-based information on the epidemiology of ischemic stroke (IS) subtypes is scant. In this study, we characterized IS subtypes in terms of incidence, time trend, and risk factor profiles in a community-based population. METHODS: We obtained data from the Takashima Stroke Registry on approximately 55 000 residents of Takashima County in central Japan and calculated age-adjusted stroke incidence rates for different IS subtypes. We determined the incidence time trend by calculating the average annual change across years and also compared risk factors between subtypes. RESULTS: There were 1389 first-ever ischemic strokes registered during 1988 to 2004. Lacunar infarction was the most frequent etiology (54.1%) followed by cardioembolic infarction (22.9%). Age-adjusted incidence rates for different IS subtypes were lacunar, 77.1; cardioembolic, 31.5; and nonlacunar, 29.7/10(5) person-years. The average annual change was not significant for the IS subtypes except for nonlacunar infarction, which showed a decreasing trend. Risk factor analysis showed that patients with lacunar infarctions were younger and less likely to have a history of transient ischemic attack or a drinking habit than patients with nonlacunar infarctions. CONCLUSIONS: Lacunar infarct was the most common IS subtype in our population. We found no significant change in the incidence of subtypes during the study, except a decrease in nonlacunar infarction.

Brachial-ankle pulse wave velocity predicts all-cause mortality in the general population: findings from the Takashima study, Japan.

Brachial-ankle pulse wave velocity (baPWV) is a relatively new non-invasive measure of arterial stiffness obtained using an automated system. We assessed the relationship between baPWV and 6.5-year overall mortality from the Takashima cohort study. The baPWV was measured in 2642 participants at baseline. When participants were divided into tertiles, all-cause mortality increased significantly as baPWV increased (P<0.001). Participants in the highest baPWV tertile showed an increased risk of all-cause mortality evidenced by a multivariable adjusted hazard ratio of 6.8 (95% confidence interval: 1.4-32.8) as compared with the lowest tertile. The present study demonstrated that increased baPWV is an independent predictor of all-cause mortality in the Japanese population.

Circaseptan variation in case-fatality rate for patients with acute subarachnoid hemorrhage (Takashima Stroke Registry 1988-2003).

We explored the circaseptan variation in 28-day case-fatalities for patients with subarachnoid hemorrhage (SAH) across days of the week. Data were obtained from the Takashima Stroke Registry, which covers approximately 50000 residents of central Japan. There were 169 first-ever SAH cases registered during the period 1988-2003 (68 in males, 101 in females). We divided the SAH cases into two groups according to the day on which the SAH occurred: "weekend" and "weekday". The 28-day case-fatality rate and 95% confidence interval (CI) were calculated. Multiple logistic regression analysis was used to calculate the adjusted odds ratio (95% CI) for weekday fatalities by entering all relevant patient-level variables into the model. The 28-day case-fatality rate for SAH was higher on weekdays (51.7%) than on weekends (32.6%; odds ratio 2.19; 95% CI: 1.10-4.49). The differences in fatality rate persisted after adjustment for age, sex, severity, family history of stroke and patient history of hypertension, diabetes mellitus, dyslipidemia, drinking and smoking. We observed a circaseptan variation in fatalities from SAH, with higher fatality rates during weekdays in our study population.

Diurnal variation in onset of hemorrhagic stroke is independent of risk factor status: Takashima Stroke Registry.

BACKGROUND: We examined the circadian periodicity of hemorrhagic stroke onset to identify any existing specific pattern and its relationship with conventional stroke risk factors using 14-year stroke registration data. METHODS: Data were obtained from the Takashima Stroke Registry, which covers a stable population of approx. 55,000 in Takashima County in central Japan. Out of 499 registered first-ever hemorrhagic stroke events during 1990-2003, there were 429 (186 men, 243 women) events with classifiable onset time. Hemorrhagic stroke incidence was categorized as occurring at night (midnight to 6 a.m.), morning (6 a.m. to noon), afternoon (noon to 6 p.m.) or evening (6 p.m. to midnight). The OR (with 95% CI) of having a stroke in the morning, afternoon or evening were calculated, with night serving as reference. RESULTS: There was significant diurnal variation in hemorrhagic stroke incidence (p < 0.001). The proportion of hemorrhagic strokes was highest in the morning (36.1%, 95% CI: 31.7-40.8) and lowest in the night (11.9%, 95% CI: 9.1-15.3). An excess stroke incidence in the morning was observed in both genders, in subjects < 65 years and > or =65 years, and in both intracerebral hemorrhage and subarachnoid hemorrhage. A second surge was also observed during the later part of the day. The higher daytime risk persisted after adjusting for age, gender, and risk factors. CONCLUSION: In the examination of circadian variation of hemorrhagic stroke onset, a 2-peak temporal distribution was observed, which was independent of conventional risk factors.

The time interval window between stroke onset and hospitalization and its related factors.

OBJECTIVE: Successful acute stroke intervention depends on early hospitalization. The time interval between stroke onset to hospitalization was examined to identify the factors influencing the interval and also to determine whether treatment time window expansion will translate into more treatment. METHODS: Data was obtained from Takashima Stroke Registry covering approximately 55,000 residents in Japan. During 1988-2002, the interval between stroke onset and hospitalization was available for 1,446 registered patients (men 761, women 685). Multivariate regression analyses were performed to evaluate the factors influencing early and late admission. RESULTS: The proportions of the patients who arrived within 3 h of onset were 61.4%. Only 8.7% of the patients arrived during a 3- to 6-hour interval. A substantial proportion (29.9%) of patients arrived after 6 h. Early stroke hospitalization was significantly associated with the severity of the stroke event and time of stroke onset. CONCLUSION: Clinically more severe stroke patients were hospitalized earlier and nocturnal strokes had delayed admission. Even expanding the therapeutic time window from

Stroke case fatality shows seasonal variation regardless of risk factor status in a Japanese population: 15-year results from the Takashima Stroke Registry.

BACKGROUND: Seasonal variation in fatality caused by stroke was examined using 15 years of data from a stroke registry of a Japanese population. METHODS: Data were obtained from the Takashima Stroke Registry, which covers approximately 55,000 residents in central Japan. There were 1,650 registered cases of first-ever stroke between 1988 and 2002. 7- and 28-day fatality rates and 95% confidence intervals were calculated for winter, spring, summer and autumn. After adjusting for gender, age at onset and risk factors, the hazard ratios for fatal strokes in winter, spring and autumn were calculated, with summer serving as the reference. RESULTS: For cerebral infarction, the highest 7- and 28-day fatality rates occurred during spring and winter, where they were more than double the rate during summer. The severest strokes were also more likely to occur during winter and spring. A high spring and winter hazard ratio for 28-day mortality was present in both lacunar and nonlacunar subtypes, in both genders and in subjects < 65 and > or = 65 years of age. No apparent seasonal pattern was observed for cerebral hemorrhage or subarachnoid hemorrhage. The spring and winter excess fatality persisted even after adjusting for age, gender and risk factors. CONCLUSION: Patients who suffer an ischemic stroke during winter or spring have a poorer prognosis. Further investigation is needed to determine the factors that explain this excess risk.

Incidence, admission and case-fatality of acute myocardial infarction: weekend versus weekday in a Japanese population: 16-year results from Takashima AMI Registry (1988-2003).

For acute myocardial infarction (AMI), "weekend" has been associated with higher incidence, admission, and fatality. But, very few studies in this regard are available in Japan. Day of the week variation in AMI was examined using an entire community covering 16-year AMI registration data from Japan. Data were obtained from the Takashima AMI Registry, which covers a stable population of approximately 55,000 in central Japan. There were 379 registered first ever AMI cases with 121 fatal events within 28 days of onset during 1988-2003. We divided the days into two groups: 'Weekend' (Saturday and Sunday) and 'Weekdays' (Monday to Friday). The incidence rate (per 100,000 person-year), admission rate (per 1,000 days) and 28-day case-fatality rates (per 100 events) as well as corresponding rate ratios were calculated with 95% confidence intervals. The distribution of the day of the week for onset, admission and fatality for all subjects was fairly random in our study population; incidence (chi (2) test, P = 0.8), admission (chi (2) test, P = 0.9) and case-fatality (chi (2) test, P = 0.8). The incidence, admission, and case-fatality rates were similar for the 2 day-groups. The incidence rate ratio 1.06 (95% CI: 0.9-1.3), admission ratio 1.03 (95% CI: 0.8-1.3), and case-fatality ratio 1.18 (95% CI: 0.7-1.9) showed no significant risk difference between weekend and weekday. After various adjustments, hazard ratio for weekend AMI in reference to weekday AMI was 1.07 (95% CI: 0.5-2.1). There were no obvious differences in occurrence, hospital admission and acute outcome for AMI patients in the weekday or weekend.

pH-Dependent catalytic activity and chemoselectivity in transfer hydrogenation catalyzed by iridium complex with 4,4'-dihydroxy-2,2'-bipyridine.

Transfer hydrogenation catalyzed by an iridium catalyst with 4,4'-dihydroxy-2,2'-bipyridine (DHBP) in an aqueous formate solution exhibits highly pH-dependent catalytic activity and chemoselectivity. The substantial change in the activity is due to the electronic effect based on the acid-base equilibrium of the phenolic hydroxyl group of DHBP. Under basic conditions, high turnover frequency values of the DHBP complex, which can be more than 1000 times the value of the unsubstituted analogue, are obtained (up to 81 000 h(-1) at 80 degrees C). In addition, the DHBP catalyst exhibits pH-dependent chemoselectivity for alpha,beta-unsaturated carbonyl compounds. Selective reduction of the C=C bond of enone with high activity are observed under basic conditions. The ketone moieties can be reduced with satisfactory activity under acidic conditions. In particular, pH-selective chemoselectivity of the C=O versus C=C bond reduction was observed in the transfer hydrogenation of cinnamaldehyde.

Seasonal pattern of incidence and case fatality of acute myocardial infarction in a Japanese population (from the Takashima AMI Registry, 1988 to 2003).

We examined the seasonal variations in the incidence and case fatality of acute myocardial infarction (AMI) in a geographically defined population using 16-year AMI registration data. It remains unclear whether the incident events of AMI display any seasonal variation. Documentation of such a pattern may foster investigation for understanding the potential mechanisms responsible for these effects and may provide novel avenues for prevention of AMI. Data were obtained from the Takashima AMI Registry, which covers an entire community of approximately 55,000 in central Japan. There were 335 definite cases of AMI during 1988 to 2003 (217 men, 118 women). Of these, there were 96 fatal cases (53 men, 43 women) within 28 days of onset. Incidence rates (per 100,000 person-years) and case fatality rates with 95% confidence intervals (CI) were calculated across seasons. Poisson regression analysis was used to calculate the incidence rate, and case fatality ratios adjusted for age and gender. The AMI incidence rate was higher in winter (44.9, 95% CI 35.9 to 53.9) and spring (44.1, 95% CI 35.3 to 52.9) than the other seasons. After adjustment for age and gender, AMI risk was 1.4 (95% CI 1.03 to 1.9) times higher in winter and was 1.4 (95% CI 1.01 to 1.9) times higher in spring than summer. The 28-day AMI case fatality rate was also higher in winter (34.4%, 95% CI 24.9 to 43.9) and spring (32.3%, 95% CI 22.9 to 41.7). Age- and gender-adjusted fatality risk was 2.4 (95% CI 1.2 to 4.9) times higher in winter and 2.3 (95% CI 1.1 to 4.6) times higher in spring than summer. In conclusion, higher AMI incidence and case fatality rates were observed in winter and spring in a Japanese population.

Complete oxidation of acetaldehyde and toluene over a Pd/WO(3) photocatalyst under fluorescent- or visible-light irradiation.

Acetaldehyde was completely oxidized to CO(2) over a Pd/WO(3) photocatalyst under fluorescent-light irradiation in a flow-type reactor, and Pd/WO(3) was also used to completely oxidize toluene to CO(2) in a batch reactor under visible-light irradiation.

Case fatality of stroke and day of the week: is the weekend effect an artifact? Takashima stroke registry, Japan (1988-2003).

BACKGROUND AND PURPOSE: For stroke admissions, the 'weekend effect' has been associated with higher stroke fatality. However, it is unclear if stroke case fatality shows this pattern if the onset day is taken into account. Day of the week variation in stroke case fatality was examined using 16-year stroke registration data. DESIGN AND METHODS: Data were obtained from Takashima Stroke Registry in central Japan. There were 1,578 registered first-ever cerebral infarction and cerebral hemorrhage stroke cases during 1988-2003. We divided the days into 2 groups: 'weekend' and 'weekdays'. The 7-day and 28-day case fatality rates and 95% confidence intervals (95% CI) were calculated by gender, age and stroke subtype. RESULTS: For all strokes, the 7-day case fatality rate based on the hospital admission day was 9.5% (95% CI: 6.8-13.1) for weekend admissions and 7.3% (95% CI: 6.0-8.9) for weekday admissions. However, case fatality rates based on the onset day were 7.2% (95% CI: 5.1-10.0) for weekend onset and 8.0% (95% CI: 6.6-9.8) for weekday onset. The 28-day case fatality rate for the weekend admission group was 14.7% (95% CI: 11.3-18.8) and for the weekday admission group it was 10.1% (95% CI: 8.5-11.9). In contrast, the 28-day case fatality rate for the weekend onset group was 11.3% (95% CI: 8.6-14.7) and for the weekday onset group it was 11.0% (95% CI: 9.3-13.0). This phenomenon was observed mainly for cerebral infarction and to some extent for cerebral hemorrhage. CONCLUSION: Stroke fatality rates based on the day of admission were higher during the weekend than weekdays, although the difference did not reach statistical significance. However, this trend disappeared when the fatality rate was based on the day of onset.