Population-Based Incidence Rates of First-Ever Stroke in Central Vietnam

IntroductionStroke incidence data with methodologically acceptable design in Southeast Asia countries is limited. This study aimed to determine incidence of age-, sex- and subtype-specific first-ever stroke (FES) in Vietnam.MethodsWe conducted a hospital-based retrospective study, targeting all stroke cases hospitalized at a solo-provider hospital in our study site of Nha Trang from January 2009 to December 2011 with International Classification of Diseases, 10th revision (ICD-10) codes I60-69. We calculated positive predictive values (PPVs) of each ICD-10-coded stroke by conducting a detailed case review of 190 randomly selected admissions with ICD-10 codes of I60-I69. These PPVs were then used to estimate annual incident stroke cases from the computerized database. National census data in 2009 was used as a denominator.Results2,693 eligible admissions were recorded during the study period. The crude annual incidence rate of total FES was 90.2 per 100,000 population (95% CI 81.1–100.2). The age-adjusted incidence of FES was 115.7 (95% CI 95.9–139.1) when adjusted to the WHO world populations. Importantly, age-adjusted intracerebral hemorrhage was as much as one third of total FES: 36.9 (95% CI 26.1–51.0).ConclusionsWe found a considerable proportion of FES in Vietnam to be attributable to intracerebral hemorrhage, which is as high or exceeding levels seen in high-income countries. A high prevalence of improperly treated hypertension in Vietnam may underlie the high prevalence of intracerebral hemorrhagic stroke in this population.**引言**：东南亚地区采用方法学严谨设计的卒中发病率数据较为匮乏。本研究旨在明确越南地区按年龄、性别及卒中亚型划分的首发性卒中（First-Ever Stroke, FES）发病率。 **方法**：本研究开展了一项基于医院的回顾性研究，纳入2009年1月至2011年12月期间，在研究地点芽庄的单机构医院住院的所有符合国际疾病分类第10版（ICD-10）编码I60-I69的卒中病例。我们通过对190例随机抽取的、ICD-10编码为I60-I69的住院病例进行详细病例复核，计算了各ICD-10编码对应卒中的阳性预测值（Positive Predictive Value, PPV）。随后利用上述PPV值从计算机化数据库中估算年度新发卒中病例数，并以2009年全国人口普查数据作为分母进行标化。 **结果**：研究期间共收录2693例符合入组标准的住院病例。总首发性卒中的粗年度发病率为90.2/10万（95%置信区间：81.1~100.2）。以世界卫生组织（WHO）世界人口为标准进行年龄标化后，首发性卒中的标化发病率为115.7（95%置信区间：95.9~139.1）。值得注意的是，年龄标化后的脑出血病例占总首发性卒中的三分之一：为36.9（95%置信区间：26.1~51.0）。 **结论**：本研究发现越南地区有相当比例的首发性卒中为脑出血所致，该比例与高收入国家相当甚至更高。越南境内高血压控制不佳的高患病率，可能是该人群出血性卒中高发的潜在原因。