{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T14:13:42Z","timestamp":1788185622976,"version":"build-2803163510"},"reference-count":15,"publisher":"BMJ","issue":"Suppl 5","license":[{"start":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T00:00:00Z","timestamp":1788134400000},"content-version":"unspecified","delay-in-days":30,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Fam Med Com Health"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To analyse the temporal trend of stroke incidence from 2019 to 2024 in Macao and evaluate its relationship with hypertension (HTN) and type 2 diabetes mellitus (T2DM) management within a universal health coverage (UHC) system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective observational study using routinely collected electronic health records.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Macao Health Bureau\u2019s primary care system, which provides free, publicly funded community health services to all residents.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Macao residents aged \u226515 years with a confirmed diagnosis of ischaemic or haemorrhagic stroke recorded in the Macao Health Bureau medical system between 1 January 2019 and 31 December 2024 (n=8265).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Age-standardised stroke incidence declined from 250.03 per 100\u2009000 in 2019 to 219.95 per 100\u2009000 in 2022, followed by a rebound in 2023\u20132024\u2009which may partly reflect pandemic-related data entry delays. Over 88% of patients with pre-existing HTN or T2DM had documented healthcare follow-up in the year preceding their stroke. Stroke incidence among these high-risk patients declined and the interval from diagnosis to stroke onset lengthened significantly, yet a substantial stroke burden persisted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>High healthcare engagement was associated with improved risk monitoring and delayed stroke onset. However, the persistent stroke burden suggests that achieving high coverage alone is not sufficient\u2014ongoing quality improvement in chronic disease management is essential to translate engagement into better outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/fmch-2026-004068","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T13:15:13Z","timestamp":1788182113000},"page":"e004068","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Stroke incidence trends and the role of chronic disease management in a universal health coverage system: a retrospective observational study in Macao, 2019\u20132024"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8245-7079","authenticated-orcid":false,"given":"Kwong Ho","family":"Tam","sequence":"first","affiliation":[{"name":"Seac Pai Van Health Centre, Health Bureau of the Macao SAR Government, Macao SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5194-083X","authenticated-orcid":false,"given":"Hao Wan","family":"Chou","sequence":"additional","affiliation":[{"name":"Tap Seac Health Centre, Health Bureau of the Macao SAR Government, Macao SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-0211-8549","authenticated-orcid":false,"given":"Wing Yi","family":"Kwong","sequence":"additional","affiliation":[{"name":"Fai Chi Kei Health Center, Health Bureau of the Macao SAR Government, Macao SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1866-0093","authenticated-orcid":false,"given":"Sao Kuan","family":"Lei","sequence":"additional","affiliation":[{"name":"Seac Pai Van Health Centre, Health Bureau of the Macao SAR Government, Macao SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1218-7901","authenticated-orcid":false,"given":"Wen","family":"zeng","sequence":"additional","affiliation":[{"name":"Health Bureau of the Macao SAR Government, Macao SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6139-9068","authenticated-orcid":false,"given":"In","family":"Wong","sequence":"additional","affiliation":[{"name":"Community Health Care Department, Health Bureau of the Macao SAR Government, Macao SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"2026083106150510000_14.Suppl_5.e004068.1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(21)00252-0"},{"key":"2026083106150510000_14.Suppl_5.e004068.2","unstructured":"World Health Organization . International Statistical Classification of Diseases and Related Health Problems. 11th edn. Geneva: World Health Organization, 2019."},{"key":"2026083106150510000_14.Suppl_5.e004068.3","first-page":"973","article-title":"Global, regional, and national burden of stroke and its risk factors, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021","volume":"23","year":"2021","journal-title":"Lancet Neurol"},{"key":"2026083106150510000_14.Suppl_5.e004068.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)30506-2"},{"key":"2026083106150510000_14.Suppl_5.e004068.5","unstructured":"Macao Health Bureau . Annual health statistics report 2023. Macao Health Bureau of Macao SAR; 2024."},{"key":"2026083106150510000_14.Suppl_5.e004068.6","unstructured":"World Health Organization . Universal Health Coverage (UHC). Geneva World Health Organization; 2021. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/universal-health-coverage-(uhc)"},{"key":"2026083106150510000_14.Suppl_5.e004068.7","unstructured":"Royal College of Physicians . Sentinel Stroke National Audit Programme (SSNAP). London Royal College of Physicians; 2026. Available: https:\/\/www.strokeaudit.org"},{"key":"2026083106150510000_14.Suppl_5.e004068.8","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.032380"},{"key":"2026083106150510000_14.Suppl_5.e004068.9","unstructured":"Royal College of Physicians . Primary health care. Geneva World Health Organization; 2021. 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