{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T04:30:43Z","timestamp":1784867443803,"version":"3.55.0"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T00:00:00Z","timestamp":1709251200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"},{"start":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T00:00:00Z","timestamp":1709251200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>High-quality epidemiological data on hemorrhagic stroke (HS) and its subtypes, intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH), remains limited in Asian ethnicities. We investigated the trends in HS incidence and 30-day mortality from 2005 to 2019 in a multi-ethnic Asian population from a national registry.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods:<\/jats:title>\n                    <jats:p>Data on all stroke cases from the Singapore Stroke Registry from 2005 to 2019 were collected. Cases were defined using centrally adjudicated review of diagnosis codes. Death outcomes were obtained by linkage with the national death registry. Incidence (per 100,000 people) and 30-day mortality (per 100 people) were measured as crude and age-standardized rates. Trends were analyzed using linear regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>We analyzed 19,017 cases of HS (83.9% ICH; 16.1% SAH). From 2005 to 2019, age-standardized incidence rates (ASIR) for HS remained stable from 34.4 to 34.5. However, age-standardized mortality rates (ASMR) decreased significantly from 29.5 to 21.4 (p\u2009&amp;lt;\u20090.001). For ICH, ASIR remained stable while ASMR decreased from 30.4 to 21.3 (p\u2009&amp;lt;\u20090.001); for SAH, ASIR increased from 2.7 to 6.0 (p\u2009=\u20090.006) while ASMR remained stable. In subgroup analyses, HS incidence increased significantly in persons &amp;lt;65\u2009years (from 18.1 to 19.6) and Malays (from 39.5 to 49.7).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion:<\/jats:title>\n                    <jats:p>From 2005 to 2019, ASIR of HS remained stable while ASMR decreased. Decreasing ASMR reflects improvements in the overall management of HS, consistent with global trends.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Population health efforts to address modifiable risk factors for HS in specific demographic subgroups may be warranted to reduce incidence and mortality of HS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23969873231202392","type":"journal-article","created":{"date-parts":[[2023,9,30]],"date-time":"2023-09-30T02:55:53Z","timestamp":1696042553000},"page":"189-199","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["Trends in hemorrhagic stroke incidence and mortality in a National Stroke Registry of a multi-ethnic Asian population"],"prefix":"10.1093","volume":"9","author":[{"given":"Mervyn Jun Rui","family":"Lim","sequence":"first","affiliation":[{"name":"Division of Neurosurgery, National University Hospital, Singapore 1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huili","family":"Zheng","sequence":"additional","affiliation":[{"name":"Clinical Research Unit, Khoo Teck Puat Hospital, Singapore 2"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-0797-8439","authenticated-orcid":false,"given":"Zheting","family":"Zhang","sequence":"additional","affiliation":[{"name":"Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 3"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ching Hui","family":"Sia","sequence":"additional","affiliation":[{"name":"Department of Cardiology, National University Heart Centre, Singapore 4"},{"name":"Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 5"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin Yong-Qiang","family":"Tan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 5"},{"name":"Division of Neurology, National University Hospital, Singapore 6"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcus Eng","family":"Hock Ong","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Singapore General Hospital, Singapore 7"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent Diong Weng","family":"Nga","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, National University Hospital, Singapore 1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tseng Tsai","family":"Yeo","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, National University Hospital, Singapore 1"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew Fu Wah","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Singapore General Hospital, Singapore 7"},{"name":"Pre-hospital & Emergency Research Centre, Duke-National University of Singapore Medical School, Singapore 8"},{"name":"Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore 9"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,3,1]]},"reference":[{"key":"2026012113110122400_bibr1-23969873231202392","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1016\/S1474-4422(21)00252-0","article-title":"Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019","volume":"20","author":"Feigin","year":"2021","journal-title":"Lancet Neurol"},{"key":"2026012113110122400_bibr2-23969873231202392","doi-asserted-by":"crossref","DOI":"10.1017\/CBO9781316095805","volume-title":"Caplan's stroke: a clinical approach","author":"Caplan","year":"2016"},{"key":"2026012113110122400_bibr3-23969873231202392","doi-asserted-by":"crossref","first-page":"286","DOI":"10.5853\/jos.2017.00234","article-title":"Stroke epidemiology in South, East, and South-East Asia: a review","volume":"19","author":"Venketasubramanian","year":"2017","journal-title":"J Stroke"},{"key":"2026012113110122400_bibr4-23969873231202392","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/S1474-4422(09)70340-0","article-title":"Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis","volume":"9","author":"van Asch","year":"2010","journal-title":"Lancet Neurol"},{"key":"2026012113110122400_bibr5-23969873231202392","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.jacc.2007.01.098","article-title":"Racial\/ethnic differences in the risk of intracranial hemorrhage among patients with atrial fibrillation","volume":"50","author":"Shen","year":"2007","journal-title":"J Am Coll Cardiol"},{"key":"2026012113110122400_bibr6-23969873231202392","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0175556","article-title":"Temporal trends in stroke incidence in South Asian, Chinese and white patients: a population based analysis","volume":"12","author":"Khan","year":"2017","journal-title":"PLoS One"},{"key":"2026012113110122400_bibr7-23969873231202392","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2021.38786","article-title":"Demographic characteristics and clinical outcomes of Asian American and Pacific Islander patients with primary intracerebral hemorrhage","volume":"4","author":"Bako","year":"2021","journal-title":"JAMA Netw Open"},{"key":"2026012113110122400_bibr8-23969873231202392","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1177\/17474930221135531","article-title":"Trends in the incidence of stroke and its subtypes from 1963 to 2018 in Japanese urban and rural communities: the Circulatory Risk in Communities Study (CIRCS)","volume":"18","author":"Li","year":"2023","journal-title":"Int J Stroke"},{"key":"2026012113110122400_bibr9-23969873231202392","doi-asserted-by":"crossref","first-page":"759221","DOI":"10.3389\/fneur.2021.759221","article-title":"Trends in incidence and mortality of stroke in China from 1990 to 2019","volume":"12","author":"Sun","year":"2021","journal-title":"Front Neurol"},{"key":"2026012113110122400_bibr10-23969873231202392","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0277296","article-title":"Incidence, subtypes, sex differences and trends of stroke in Taiwan","volume":"17","author":"Tsai","year":"2022","journal-title":"PLoS One"},{"key":"2026012113110122400_bibr11-23969873231202392","doi-asserted-by":"crossref","first-page":"42","DOI":"10.5853\/jos.2018.03125","article-title":"Executive Summary of Stroke Statistics in Korea 2018: a report from the Epidemiology Research Council of the Korean Stroke Society","volume":"21","author":"Kim","year":"2019","journal-title":"J Stroke"},{"key":"2026012113110122400_bibr12-23969873231202392","doi-asserted-by":"crossref","first-page":"39","DOI":"10.5334\/gh.791","article-title":"Trends of stroke incidence and 28-day all-cause mortality after a stroke in Malaysia: a linkage of national data sources","volume":"16","author":"Hwong","year":"2021","journal-title":"Glob Heart"},{"key":"2026012113110122400_bibr13-23969873231202392","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.1161\/CIRCULATIONAHA.113.002424","article-title":"Secular trends in cardiovascular disease and its risk factors in Japanese: half-century data from the Hisayama Study (1961-2009)","volume":"128","author":"Hata","year":"2013","journal-title":"Circulation"},{"key":"2026012113110122400_bibr14-23969873231202392","doi-asserted-by":"crossref","first-page":"87","DOI":"10.5469\/neuroint.2022.00220","article-title":"Trends in mortality from hemorrhagic stroke in Korea from 2012 to 2020","volume":"17","author":"Cho","year":"2022","journal-title":"Neurointervention"},{"key":"2026012113110122400_bibr15-23969873231202392","doi-asserted-by":"crossref","first-page":"e0139461","DOI":"10.1371\/journal.pone.0139461","article-title":"Trends in incidence of stroke and transition of stroke subtypes in rural Tianjin China: a population-based study from 1992 to 2012","volume":"10","author":"Li","year":"2015","journal-title":"PLoS One"},{"key":"2026012113110122400_bibr16-23969873231202392","doi-asserted-by":"crossref","first-page":"2728","DOI":"10.1161\/STROKEAHA.115.009797","article-title":"Trends in stroke incidence and 28-day case Fatality in a nationwide stroke registry of a multiethnic Asian population","volume":"46","author":"Tan","year":"2015","journal-title":"Stroke"},{"key":"2026012113110122400_bibr17-23969873231202392","article-title":"Population and population structure","author":"Singapore Department of Statistics","year":"2023"},{"key":"2026012113110122400_bibr18-23969873231202392","doi-asserted-by":"crossref","first-page":"780","DOI":"10.3389\/fneur.2020.00780","article-title":"Stroke care services in Singapore during COVID-19 pandemic - a national perspective","volume":"11","author":"Venketasubramanian","year":"2020","journal-title":"Front Neurol"},{"key":"2026012113110122400_bibr19-23969873231202392","doi-asserted-by":"crossref","first-page":"767","DOI":"10.1111\/ijs.12472","article-title":"Countrywide stroke incidence, subtypes, management and outcome in a multiethnic Asian population: the Singapore Stroke Registry\u2014methodology","volume":"10","author":"Venketasubramanian","year":"2015","journal-title":"Int J Stroke"},{"key":"2026012113110122400_bibr20-23969873231202392","volume-title":"Registration of births and deaths act","author":"Parliament of Singapore","year":"2021"},{"key":"2026012113110122400_bibr21-23969873231202392","unstructured":"World Health Organization. Cause of death, https:\/\/www.who.int\/standards\/classifications\/classification-of-diseases\/cause-of-death (2023, accessed August 19, 2023)."},{"key":"2026012113110122400_bibr22-23969873231202392","article-title":"World (WHO 2000-2025) standard","author":"World Health Organization","year":"2013"},{"key":"2026012113110122400_bibr23-23969873231202392","volume-title":"Population in Brief 2019","author":"Singapore Department of Statistics","year":"2019"},{"key":"2026012113110122400_bibr24-23969873231202392","doi-asserted-by":"crossref","DOI":"10.1161\/STR.0000000000000407","article-title":"2022 guideline for the management of patients with spontaneous intracerebral hemorrhage: a guideline from the American Heart Association\/American Stroke Association","volume":"53","author":"Greenberg","year":"2022","journal-title":"Stroke"},{"key":"2026012113110122400_bibr25-23969873231202392","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1055\/s-0038-1649503","article-title":"Global burden of stroke","volume":"38","author":"Katan","year":"2018","journal-title":"Semin Neurol"},{"key":"2026012113110122400_bibr26-23969873231202392","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1111\/j.1747-4949.2011.00602.x","article-title":"Singapore ministry of health clinical practice guidelines on stroke and transient ischemic attacks","volume":"6","author":"Venketasubramanian","year":"2011","journal-title":"Int J Stroke"},{"key":"2026012113110122400_bibr27-23969873231202392","doi-asserted-by":"crossref","DOI":"10.1212\/WNL.0000000000201340","article-title":"Trends in the incidence of spontaneous subarachnoid hemorrhages in the United States, 2007-2017","volume":"100","author":"Xia","year":"2023","journal-title":"Neurology"},{"key":"2026012113110122400_bibr28-23969873231202392","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1186\/s13054-015-1036-0","article-title":"Subarachnoid hemorrhage: who dies, and why?","volume":"19","author":"Lantigua","year":"2015","journal-title":"Crit Care"},{"key":"2026012113110122400_bibr29-23969873231202392","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1227\/01.NEU.0000338946.42939.C7","article-title":"Resuscitation and critical care of poor-grade subarachnoid hemorrhage","volume":"64","author":"Komotar","year":"2009","journal-title":"Neurosurg"},{"key":"2026012113110122400_bibr30-23969873231202392","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1007\/s12028-013-9929-8","article-title":"Withdrawal of technological life support following subarachnoid hemorrhage","volume":"19","author":"Kowalski","year":"2013","journal-title":"Neurocrit Care"},{"key":"2026012113110122400_bibr31-23969873231202392","doi-asserted-by":"crossref","DOI":"10.1161\/STROKEAHA.121.037332","article-title":"Contemporary trends in the nationwide incidence of primary intracerebral hemorrhage","volume":"53","author":"Bako","year":"2022","journal-title":"Stroke"},{"key":"2026012113110122400_bibr32-23969873231202392","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1001\/jama.2022.12759","article-title":"Association of younger vs older ages with changes in incidence of stroke and other vascular events, 2002-2018","volume":"328","author":"Li","year":"2022","journal-title":"JAMA"},{"key":"2026012113110122400_bibr33-23969873231202392","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1097\/HJH.0b013e328317c8c3","article-title":"Risk factors associated with hypertension awareness, treatment, and control in a multi-ethnic Asian population","volume":"27","author":"Wu","year":"2009","journal-title":"J Hypertens"},{"key":"2026012113110122400_bibr34-23969873231202392","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2018-025869","article-title":"Sociodemographic factors in relation to hypertension prevalence, awareness, treatment and control in a multi-ethnic Asian population: a cross-sectional study","volume":"9","author":"Liew","year":"2019","journal-title":"BMJ Open"},{"key":"2026012113110122400_bibr35-23969873231202392","volume-title":"National Population Health Survey 2021","author":"Epidemiology & Disease Control Division and Policy, Research & Surveillance Group Ministry of Health and Health Promotion Board","year":"2021"},{"key":"2026012113110122400_bibr36-23969873231202392","doi-asserted-by":"publisher","DOI":"10.1136\/bmjdrc-2020-002064","article-title":"Socioeconomic status and ethnic variation associated with type 2 diabetes mellitus in patients with uncontrolled hypertension in Singapore","volume":"9","author":"Porhcisaliyan","year":"2021","journal-title":"BMJ Open Diabetes Res Care"},{"key":"2026012113110122400_bibr37-23969873231202392","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1093\/ije\/dyy014","article-title":"Cohort profile: the Singapore multi-ethnic cohort (MEC) study","volume":"47","author":"Tan","year":"2018","journal-title":"Int J Epidemiol"}],"container-title":["European Stroke Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23969873231202392","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/23969873231202392","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/esj\/article-pdf\/9\/1\/189\/64653157\/23969873231202392.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/esj\/article-pdf\/9\/1\/189\/64653157\/23969873231202392.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T18:12:36Z","timestamp":1769019156000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/esj\/article\/9\/1\/189\/8269109"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,1]]},"references-count":37,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024,3,1]]}},"URL":"https:\/\/doi.org\/10.1177\/23969873231202392","relation":{},"ISSN":["2396-9873","2396-9881"],"issn-type":[{"value":"2396-9873","type":"print"},{"value":"2396-9881","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,3,1]]},"published":{"date-parts":[[2024,3,1]]}}}