Original Paper

Neuroepidemiology 2017;48:72–78 Received: December 14, 2016

Accepted: April 10, 2017
DOI: 10.1159/000475667
Published online: May 13, 2017

Comparisons of Risk Factors for

Intracerebral Hemorrhage versus
Ischemic Stroke in Chinese Patients
Chung-Fen Tsai a Jiann-Shing Jeng b Niall Anderson c Cathie L.M. Sudlow d, e
a
Department of Neurology, Cardinal Tien Hospital, Fu Jen Catholic University, and b Stroke Center and Department
of Neurology, National Taiwan University Hospital, Taipei, Taiwan; c Centre for Population Health Sciences,
d
Centre for Clinical Brain Sciences, and e Institute of Genetics and Molecular Medicine, University of Edinburgh,
Edinburgh, UK

Keywords (OR 1.44, 95% CI 1.16–1.77) had significantly stronger asso-

Risk factor · Intracerebral hemorrhage · Ischemic stroke ·
Chinese
Abstract
Background: Chinese populations have a higher stroke inci-
dence, a higher proportion of intracerebral hemorrhage
(ICH), and a lower proportion of ischemic stroke (IS) as com-
pared with white populations. The reasons are not fully un-
derstood. Methods: To evaluate the differences of major risk
factors between ICH and IS in Chinese stroke patients, we
analysed acute ICH and IS patients consecutively recruited in
National Taiwan University Hospital Stroke Registry from
2006 to 2011. We used multiple logistic regression models to
examine the associations of risk factors with ICH vs. IS. Also,
we conducted subgroup analyses when a strongly signifi-
cant interaction was detected. Results: We included a total
of 1,373 ICH and 4,953 IS patients. ICH patients were young-
er than IS patients (mean age 61 vs. 68 years, p < 0.001), but
there was no significant difference in gender (males 62 vs.
59%, p = 0.064). A logistic regression model adjusted for age,
gender, and other major risk factors showed that both hy-
pertension (OR 2.23, 95% CI 1.74–2.87) and alcohol intake
ciations with ICH than IS, whereas diabetes, atrial fibrillation,
ischemic heart disease, hyperlipidemia, smoking, and tran-
sient ischemic attack were less associated with ICH than IS.
In subgroup analyses, the association of hypertension with
ICH vs. IS was more marked in younger patients. Conclusion:
Hypertension and alcohol intake are more strongly associ-
ated with ICH than IS in Chinese stroke patients, especially in
younger patients. © 2017 S. Karger AG, Basel
Introduction
Stroke remains one of the leading causes of death world-
wide, and intracerebral hemorrhage (ICH) is the most dev-
astating pathological type of stroke accounting for 10–20%
of total strokes among western populations [1]. The inci-
dence of ICH is much higher among Asians, including
Chinese [2]. Although knowledge of stroke, availability of
brain imaging, medical care, and mortality have improved
in recent years, the incidence of ICH has not decreased and
the functional outcome in survivors remains poor, leading
to an alarming situation worldwide [3, 4].
132.239.1.231 - 6/12/2017 4:10:19 AM
Univ. of California San Diego

© 2017 S. Karger AG, Basel Prof. Cathie Sudlow

Centre for Clinical Brain Sciences
University of Edinburgh, 49 Little France Crescent
Downloaded by:

E-Mail karger@karger.com
Edinburgh, EH16 4SB (UK)
www.karger.com/ned
E-Mail cathie.sudlow @ ed.ac.uk
 In a systematic review, we have reported that Chinese
populations had a higher stroke incidence and a 2-fold
proportion of ICH among all strokes, as compared with
white populations [5]. The reasons for the prevalence of
this trend are not clear but could include differences in
genetic and environmental exposures, and differences in
risk factor associations between ICH and ischemic stroke
(IS) [6–8]. Our recent meta-analysis of major risk factors
found that hypertension and alcohol intake were signifi-
cantly more frequent in ICH than IS in Chinese stroke
patients, but not in white stroke patients [9]. However,
these findings could be confounded by age, gender, and
other risk factors.
To explore this further, we performed individual
Chinese patient data analyses using data from the
National Taiwan University Hospital (NTUH) Stroke
Registry, comparing major risk factors between ICH
and IS, and adjusting for potential confounders. We
aimed to test the hypothesis that risk factor prevalence
and associations vary between ICH and IS in Chinese
stroke patients. As Chinese populations are aging rap-
idly and make up around one-fifth of the world’s popu-
lation, a better understanding of the reasons for a high-
er incidence and proportion of ICH in Chinese could
lead to more efficient stroke-prevention strategies,
thereby reducing the burden of the impending stroke [5,
10].
Methods
Subjects
The NTUH Stroke Registry is a large hospital-based registry
initiated in 1995, prospectively recruiting consecutive acute
stroke patients [11–13]. Patients who had acute stroke within 10
days were included. A neurologist assessed each patient upon ar-
rival, recorded demographic information and clinical features,
reviewed medical records, arranged timely brain imaging, and
discussed the imaging findings with a neuroradiologist. The In-
stitutional Review Board of NTUH approved the stroke registry,
and informed consent was given by the patients. In this study, we
conducted analyses for first-ever or recurrent spontaneous ICH
and IS adult patients recruited between January 2006 and
December 2011.
Diagnosis of Stroke and Its Types
The diagnosis of stroke was based on clinical features: acute
neurologic dysfunction of vascular origin lasting for more than
24 h [14], along with brain CT or MRI findings. Strokes were clas-
sified as IS, ICH, or subarachnoid hemorrhage (SAH) according to
standard definitions [15]. Patients with traumatic ICH, postin-
farct hemorrhagic transformation, subdural/epidural/SAH, tumor
bleeding, no brain imaging, or non-cerebrovascular causes were
excluded.
Comparisons of Risk Factors for Stroke in
Chinese Patients
Major Risk Factor Definitions
Vascular risk factor information was obtained from the pa-
tients, family, and medical records. Hypertension was defined
as history along with antihypertensive treatment or blood pres-
sure ≥140/90 mm Hg 7 days after stroke; diabetes was defined
as history along with anti-diabetic treatment or fasting plasma
glucose >126 mg/dL. Atrial fibrillation (AF) and ischemic heart
disease (IHD) were defined as history or electrocardiographic
evidence. Hyperlipidemia was recorded if patients had history
along with anti-hyperlipidemic treatment, hypercholesterol-
emia, or hypertriglyceridemia (≥200 mg/dL). Smoking included
current or previous smoking history. Alcohol intake was de-
fined as habitual drinking more than once per week. We also
recorded previous stroke and history of transient ischemic at-
tack (TIA).
Statistical Analyses
For ICH vs. IS, we used Student t test to compare the mean age,
and Pearson’s chi-square test to compare the proportions of male
gender, risk factors and 1-month case fatality between groups.
Since it was not assumed to contribute a linear change in odds of
ICH vs. IS, we divided age into 5 equal-sized categories. First, we
calculated crude ORs with 95% CIs for each risk factor. Then we
fitted a logistic regression model for the relevant risk factor, adjust-
ing for age and gender, obtaining adjusted ORs (OR I). We devel-
oped a second logistic regression model to adjust simultaneously
for all other major risk factors along with age and gender. In the
second model, we used stepwise selection and analysis of variance
to incorporate the strongly significant 2-way interactions among
variables (p < 0.001), and to choose the best fitting model. From
the parameters of this model, we obtained further adjusted ORs
(OR II).
In addition, we conducted subgroup analyses to examine risk
factor associations with ICH vs. IS in different subgroups where
there was a strongly significant interaction. All statistical hypoth-
esis tests were 2-sided, and p values <0.05 were considered signifi-
cant. Statistical analyses were performed with R statistical software
(http://www.R-project.org/) [16].
Results
Characteristics of ICH and IS Patients
From January 1, 2006 to December 31, 2011, we in-
cluded 1,373 spontaneous ICH patients and 4,953 adult
IS patients for analyses. For patients with more than one
stroke during the study period, analyses were based only
on the first stroke episode. All patients had brain CT im-
aging and 50% had additional brain MR and MR angiog-
raphy.
ICH patients were younger than IS patients (mean age
61.4 vs. 68.1 years, p < 0.001), while there was no signifi-
cant difference in gender between groups (males 61.9% in
ICH and 59.1% in IS, p = 0.064). Patients with ICH had a
much higher 1-month case fatality than those with IS
(19.3 vs. 5.5%, p < 0.001).
132.239.1.231 - 6/12/2017 4:10:19 AM
Univ. of California San Diego
Neuroepidemiology 2017;48:72–78 73
DOI: 10.1159/000475667
Downloaded by:
Table 1. Characteristics and risk factor distributions in ICH and IS among Chinese patients

ICH (n = 1,373) IS (n = 4,953) ICH vs. IS,

p value
n % 95% CI n % 95% CI

Age, years, mean ± SD 61.4±15.7 68.1±13.8 <0.0001**

Gender, male 850 61.9 59.2–64.5 2,929 59.1 57.8–60.5 0.064*
Hypertension 1,058 77.1 74.7–79.2 3,809 76.9 75.7–78.7 0.904*
Diabetes 310 22.6 20.4–24.9 1,838 37.1 35.8–38.4 <0.001*
AF 125 9.1 7.6–10.8 1,180 23.8 22.6–25.0 <0.001*
Ischemic heart 102 7.4 6.1–8.9 759 15.3 14.3–16.4 <0.001*
Hyperlipidemia 238 17.3 15.3–19.4 1,744 35.2 33.9–36.6 <0.001*
Smoking 327 23.8 21.6–26.1 1,455 29.4 28.1–30.7 <0.001*
Alcohol 221 16.1 14.2–18.1 689 13.9 13.0–14.9 0.041*
Previous stroke 282 20.5 18.4–22.8 1,175 23.7 22.5–24.9 0.013*
TIA 11 0.8 0.4–1.4 193 3.9 3.4–4.5 <0.001*
1-month case fatality 265 19.3 17.2–21.5 272 5.5 4.9–6.2 <0.001*

ICH, intracerebral hemorrhage; IS, ischemic stroke; NTUH, National Taiwan University Hospital; AF, atrial fibrillation; TIA,
transient ischemic attack. ** Based on Student t test; * based on Pearson’s chi-square test.

Risk Factor Comparisons for ICH vs. IS
The clinical characteristics and risk factor distribu-
tions for ICH and IS are shown in Table 1. In unadjusted
comparisons, ICH patients had a significantly lower prev-
alence of diabetes, AF, IHD, hyperlipidemia, smoking,
previous stroke and TIA than IS patients. Alcohol intake
was slightly more common in ICH vs. IS (crude OR 1.19,
95% CI 1.00–1.40), while hypertension did not differ sig-
nificantly between these 2 types (Fig. 1).
After adjusting for age and gender, the association of
hypertension with ICH vs. IS became significantly
stronger (OR I 1.25, 95% CI 1.07–1.45), while the re-
sults for other risk factors remained similar except that
associations with alcohol and previous stroke became
nonsignificant. After further adjusting for all risk fac-
tors but before including significant interactions, hy-
pertension and alcohol intake were significantly more
associated with ICH than IS (hypertension OR II with-
out interactions 1.60, 95% CI 1.42–1.95; alcohol OR II
without interactions 1.45, 95% CI 1.16–1.79). For hy-
pertension, the association became yet stronger when
strongly significant interactions were included (hyper-
tension OR II with interactions 2.23, 95% CI 1.74–2.87;
Fig.  1). Fully adjusted analyses yielded similar but
somewhat stronger negative associations than in unad-
justed analyses for AF, hyperlipidemia, and smoking,
while results were changed only in a very negligible
manner following adjustment for diabetes, TIA, and
previous stroke.
Subgroup Analysis of Hypertension in Different
Age Groups
We found a strongly significant interaction between
age and hypertension (p < 0.001), implying a significant
difference in the association across different age groups
for hypertension, but not other risk factors. We, therefore,
examined the association of hypertension with ICH vs. IS
among 5 equal-sized age groups (18–55, 56–64, 65–72, 73–
80, 81–106 years). Compared with older stroke patients,
hypertension had a stronger association with ICH vs. IS in
younger stroke patients (Fig. 2). The fully adjusted results
showed that hypertension was significantly associated
with ICH vs. IS in patients aged <73 years (18–55 years OR
II 2.33, 95% CI 1.79–3.05; 56–64 years OR II 2.33, 95% CI
1.58–3.48; 65–72 years OR II 1.84, 95% CI 1.22–2.87) but
not in those aged ≥73 years (73–80 years OR II 0.81, 95%
CI 0.56–1.18; 81–106 years OR II 0.96, 95% CI 0.63–1.50).
Discussion
In our study, we showed that ICH patients had a much
higher case fatality and a younger age of onset than IS pa-
tients, but no significant difference in gender. In terms of
risk factor comparisons between ICH and IS, unadjusted
and adjusted analyses were qualitatively similar, though
they varied to a certain extent in terms of the size of esti-
mates and significance. Both hypertension and alcohol
intake had stronger associations with ICH than IS after
132.239.1.231 - 6/12/2017 4:10:19 AM
Univ. of California San Diego

74 Neuroepidemiology 2017;48:72–78 Tsai/Jeng/Anderson/Sudlow

DOI: 10.1159/000475667
Downloaded by:
 Risk factor OR 95% CI
Hypertension CR 1.01 (0.87, 1.17)
OR I 1.25 (1.07, 1.45)
OR II 2.23 (1.74, 2.87)

Diabetes CR 0.49 (0.43, 0.57)

OR I 0.53 (0.46, 0.61)
OR II 0.48 (0.41, 0.56)

Atrial fibrillation CR 0.32 (0.26, 0.39)

OR I 0.40 (0.33, 0.49)
OR II 0.23 (0.17, 0.30)

Ischemic heart CR 0.44 (0.35, 0.55)

OR I 0.53 (0.42, 0.65)
OR II 0.67 (0.52, 0.82)

Hyperlipidemia CR 0.39 (0.33, 0.45)

OR I 0.35 (0.30, 0.41)
OR II 0.30 (0.26, 0.36)

Smoking CR 0.75 (0.65, 0.86)

OR I 0.56 (0.48, 0.66)
OR II 0.49 (0.41, 0.59)

Alcohol CR 1.19 (1.00, 1.41)

OR I 0.98 (0.82, 1.17)
OR II 1.44 (1.16, 1.77)

Previous stroke CR 0.83 (0.72, 0.96)

OR I 0.97 (0.83, 1.13)
OR II 1.04 (0.89, 1.22)

TIA CR 0.20 (0.10, 0.37)

Fig. 1. Risk factor analyses for ICH vs. IS in OR I 0.19 (0.10, 0.34)
Chinese patients. ICH, intracerebral hem-
OR II 0.21 (0.10, 0.37)
orrhage; IS, ischemic stroke; TIA, transient
ischemic attack; CR, crude odds ratio; OR 0.1 0.2 0.5 1.0 2.0 5.0
I, adjusted odds ratio I; OR II, adjusted Risk factor more frequent Risk factor more frequent
odds ratio II. Horizontal lines represent in IS in ICH
95% CIs. Diamonds represent pooled ORs.

adjusting for confounders, whereas diabetes, AF, IHD,
hyperlipidemia, smoking, and TIA were less frequent in
ICH vs. IS. Furthermore, the association of hypertension
with ICH vs. IS differed across different age groups, being
more marked in younger stroke patients. Although
Chinese are reported to have a much higher ICH inci-
dence than white populations, the reasons are still not
clear [17, 18]. Risk factor analyses for ICH vs. IS using
robust methods based on a large number of Chinese pa-
tients are limited. Our results are in line with our meta-
analyses after adjusting for confounding factors – hyper-
tension and alcohol intake had stronger associations with
ICH than IS in Chinese [9]. They may be responsible – at
least in part – for a higher incidence and proportion of
ICH in Chinese populations.
Few large-scale studies or systematic reviews have di-
rectly compared risk factors between ICH and IS. An ear-
lier systematic review in mainly white populations re-
132.239.1.231 - 6/12/2017 4:10:19 AM
Univ. of California San Diego

Comparisons of Risk Factors for Stroke in Neuroepidemiology 2017;48:72–78 75

Chinese Patients DOI: 10.1159/000475667
Downloaded by:
 Hypertension
OR II 18–55 years
OR II 56–64 years
OR II 65–72 years
OR II 73–80 years
OR II 84–106 years
Fig. 2. Subgroup analyses of hypertension
for ICH vs. IS in different age groups. ICH,
intracerebral hemorrhage; IS, ischemic
stroke; OR II, adjusted odds ratio II. Hori-
zontal lines represent 95% CIs. Diamonds
represent pooled ORs.
ported that increased age, male gender, hypertension, and
alcohol intake were risk factors for ICH, whereas hyper-
cholesterolemia was associated with a lower risk of ICH
[19]. Recently, INTERSTROKE study conducted risk fac-
tor analyses for all strokes, IS, and ICH among 3,000
stroke cases and controls from 22 countries (around one
third from Southeast Asia) [8]. Hypertension, smoking,
waist-to-hip ratio, diet, and alcohol intake were signifi-
cant risk factors for ICH. Hypertension was more strong-
ly associated with ICH than IS, whereas the association
with smoking appeared stronger with IS than ICH. How-
ever, risk factor associations for ICH and IS were not pro-
vided solely in Chinese populations.
Hypertension is one of the most important risk factors
for ICH, and its association with ICH probably differs
among ethnic groups [20, 21]. Research from Asia Pacific
Cohort study suggested a stronger association of increased
blood pressure with hemorrhagic stroke among eastern
Asians than White populations [20, 21]. However, these
studies were conducted for all hemorrhagic strokes, in-
cluding ICH and SAH together, while their causes were
somewhat different. No separate analysis for ICH was re-
ported. Our recent systematic review and meta-analyses
showed a higher incidence of stroke along with a higher
proportion of ICH in Chinese, and hypertension had a
stronger association with ICH vs. IS as compared with
white populations [5, 9]. Current analyses from individu-
al patient data after controlling for confounders further
76 Neuroepidemiology 2017;48:72–78
DOI: 10.1159/000475667
OR 95% CI
2.33 (1.79, 3.05)
2.33 (1.58, 3.48)
1.84 (1.22, 2.87)
0.81 (0.56, 1.18)
0.96 (0.63, 1.50)
0.5 1.0 2.0 5.0
Hypertension more Hypertension more frequent
frequent in IS in ICH
consolidate this finding that hypertension is a stronger
risk factor for ICH vs. IS in Chinese patients [9, 22].
The reasons for a higher incidence of total strokes and
ICH, and the greater association with hypertension for ICH
vs. IS in Chinese populations are not fully understood. The
preference of high salt intake, inadequate treatment of hy-
pertension, and a higher proportion of deep ICH in Chinese
(predominantly associated with hypertension) may all con-
tribute to these findings [23–25]. In the INTERMAP study
among British, American, Japanese and Chinese popula-
tions, the Chinese were found to have the highest daily so-
dium intake, which was known to lead to high blood pres-
sure and increased risk of stroke [23]. Also, the proportion
of awareness, treatment, and control rates are relatively low-
er among the Chinese people. In mainland China, only 45%
were aware of high blood pressure, 28% took antihyperten-
sive medication, and 8% achieved control target (<140/90
mm Hg) [24]. In Taiwan, despite improvements in medical
care after the implementation of the National Health Insur-
ance scheme, the proportions of people with hypertension
receiving treatment or achieving good control are still low,
particularly in stroke patients less than 65 years old [26].
This may be one of the important reasons accounting for the
stronger association with ICH vs. IS in younger stroke pa-
tients, and highlight the need to enhance education and
treatment in this group.
With regard to lipids, increased total cholesterol is as-
sociated with the risk of IS but not hemorrhagic stroke
132.239.1.231 - 6/12/2017 4:10:19 AM
Univ. of California San Diego
Tsai/Jeng/Anderson/Sudlow
Downloaded by:
[27]. Recent research has also shown that low serum tri-
glyceride is associated with increased risk of ICH, but the
exact mechanism is not clear [28]. In our study, there
seemed to be a positive association of increased lipid with
IS but a negative association with ICH.
Although the effects of alcohol may be mediated
through elevated blood pressure or other causes [29, 30],
in our study, alcohol intake was still a significant indepen-
dent risk factor for ICH vs. IS after adjusting for con-
founders including hypertension. Previous meta-analy-
ses and large case–control studies have shown that alco-
hol has a dose-dependent relationship with hemorrhagic
stroke and with ICH, whereas it has a curvilinear relation-
ship with IS – a protective effect for low to moderate in-
take and increased risk for high consumption [8, 31].
Our results provide important information on risk fac-
tor comparisons for ICH vs. IS in Chinese populations, in
whom there is a higher incidence of total strokes and ICH.
Our study has several strengths. First, we recruited a con-
siderable number of patients from the well-established
NTUH Stroke Registry, with comprehensive records of
essential information including risk factors. Second, the
inclusion of acute stroke patients was based on a standard
definition of stroke, having stroke within 10 days, early
specialist assessment, and reliable classification of its
pathological types (100% brain CT or MRI rate). Third,
we used multiple logistic regression modeling to adjust
for confounding factors, and incorporated interactions
among variables. Furthermore, we carried out subgroup
analyses to examine the association of hypertension with
ICH vs. IS in different age groups.
However, there are some limitations. The NTUH
stroke registry is a large hospital-based registry in Taiwan,
which may not be fully representative of all types of
strokes in Chinese populations. Also, information of
some risk factors was collected from medical records, pa-
tients, and families. We could not totally exclude the pos-
sibility of recall bias from a few patients.
Although there is a decreasing trend of ICH incidence
in some populations, the incidence or proportion of ICH
in all strokes is still much higher among the Chinese and
other Asians [3, 5, 8, 32]. ICH is a multifactorial disease
caused by several risk factors and interactions. In our
analyses, hypertension and alcohol intake are important,
modifiable risk factors for ICH vs. IS among the Chinese,
especially in younger stroke patients. A better under-
standing of the underlying reasons could help shed light
on different stroke mechanisms, guide further well-de-
signed research in this area, and provide potential targets
to make effective strategies of stroke prevention.
Acknowledgments and Funding
The authors wish to thank all the staff and participants in
NTUH for their help in data collection. The study was sup-
ported  partly by the Cardinal Tien Hospital Research Grant
(CTH106A-2A13).
Disclosure Statement
The authors had no conflicts of interest to disclose.
Author Contributors
Study concept and design: All. Acquisition of data: C.-F.T. and
J.-S.J. Statistical analysis: C.-F.T. and N.A. Interpretation of data:
All. Manuscript drafting: C.-F.T. Critical revision: All.

References
1 Feigin VL, Lawes CM, Bennett DA, Barker-
Collo SL, Parag V: Worldwide stroke
incidence and early case fatality reported
in  56  population-based studies: a syste-
matic  review. Lancet Neurol 2009; 8: 355–
369.
2 van Asch CJ, Luitse MJ, Rinkel GJ, van der
Tweel I, Algra A, Klijn CJ: Incidence, case fa-
tality, and functional outcome of intracere-
bral haemorrhage over time, according to age,
sex, and ethnic origin: a systematic review and
meta-analysis. Lancet Neurol 2010; 9: 167–
176.
3 Qureshi AI, Mendelow AD, Hanley DF: In-
tracerebral haemorrhage. Lancet 2009; 373:
1632–1644.
4 Feigin VL, Krishnamurthi RV, Parmar P, Nor-
rving B, Mensah GA, Bennett DA, et al; GBD
2013 Stroke Panel Experts Group: Update on
the global burden of ischemic and hemorrhag-
ic stroke in 1990–2013: the GBD 2013 study.
Neuroepidemiology 2015;45:161–176.
5 Tsai CF, Thomas B, Sudlow CL: Epidemiolo-
gy of stroke and its subtypes in Chinese vs
white populations: a systematic review. Neu-
rology 2013;81:264–272.
6 Donnan GA, Hankey GJ, Davis SM: Intracere-
bral haemorrhage: a need for more data and
new research directions. Lancet Neurol 2010;9:
133–134.
7 Samarasekera N, Smith C, Al-Shahi Salman
R: The association between cerebral amyloid
angiopathy and intracerebral haemor-
rhage: systematic review and meta-analysis.
J Neurol Neurosurg Psychiatry 2012; 83:
275–281.
8 O’Donnell MJ, Xavier D, Liu L, Zhang H,
Chin SL, Rao-Melacini P, et al: Risk factors for
ischaemic and intracerebral haemorrhagic
stroke in 22 countries (the INTERSTROKE
study): a case-control study. Lancet 2010;376:
112–123.
9 Tsai CF, Anderson N, Thomas B, Sudlow CL:
Comparing risk factor profiles between intra-
cerebral hemorrhage and ischemic stroke in
Chinese and white Populations: systematic
review and meta-analysis. PLoS One 2016;
11:e0151743.
132.239.1.231 - 6/12/2017 4:10:19 AM
Univ. of California San Diego

Comparisons of Risk Factors for Stroke in Neuroepidemiology 2017;48:72–78 77

Chinese Patients DOI: 10.1159/000475667
Downloaded by:
10 Liu M, Wu B, Wang WZ, Lee LM, Zhang SH,
Kong LZ: Stroke in China: epidemiology, pre-
vention, and management strategies. Lancet
Neurol 2007;6:456–464.
11 Jeng JS, Lee TK, Chang YC, Huang ZS, Ng SK,
Chen RC, et al: Subtypes and case-fatality
rates of stroke: a hospital-based stroke regis-
try in Taiwan (SCAN-IV). J Neurol Sci 1998;
156:220–226.
12 Hsieh FI, Lien LM, Chen ST, Bai CH, Sun MC,
Tseng HP, et al: Get with the guidelines-
stroke performance indicators: surveillance
of stroke care in the Taiwan Stroke Registry:
Get With the Guidelines-Stroke in Taiwan.
Circulation 2010;122:1116–1123.
13 Yeh SJ, Tang SC, Tsai LK, Jeng JS: Pathoge-
netical subtypes of recurrent intracerebral
hemorrhage: designations by SMASH-U clas-
sification system. Stroke 2014;45:2636–2642.
14 Hatano S: Experience from a multicentre
stroke register: a preliminary report. Bull
World Health Organ 1976;54:541–553.
15 Sudlow CL, Warlow CP: Comparable studies
of the incidence of stroke and its pathological
types: results from an international collabora-
tion. International Stroke Incidence Collabo-
ration. Stroke 1997;28:491–499.
16 R Core Team: R: A Language and Environ-
ment for Statistical Computing. R Foun-
dation for Statistical Computing, Vienna,
Austria, 2013. http://www.R-project.org/(ac-
cessed September 9, 2016).
17 Jiang B, Wang WZ, Chen H, Hong Z, Yang
QD, Wu SP, et al: Incidence and trends of
stroke and its subtypes in China: results from
three large cities. Stroke 2006;37:63–68.
78 Neuroepidemiology 2017;48:72–78
DOI: 10.1159/000475667
18 Hu HH, Sheng WY, Chu FL, Lan CF, Chiang
BN: Incidence of stroke in Taiwan. Stroke
1992;23:1237–1241.
19 Ariesen MJ, Claus SP, Rinkel GJ, Algra A: Risk
factors for intracerebral hemorrhage in the
general population: a systematic review.
Stroke 2003;34:2060–2065.
20 Blood pressure, cholesterol, and stroke in
eastern Asia. Eastern Stroke and Coronary
Heart Disease Collaborative Research Group.
Lancet 1998;352:1801–1807.
21 Woodward M, Huxley H, Lam TH, Barzi F,
Lawes CM, Ueshima H; Asia Pacific Cohort
Studies Collaboration: A comparison of the
associations between risk factors and cardio-
vascular disease in Asia and Australasia. Eur J
Cardiovasc Prev Rehabil 2005;12:484–491.
22 Yong H, Foody J, Linong J, Dong Z, Wang Y,
Ma L, et al: A systematic literature review of
risk factors for stroke in China. Cardiol Rev
2013;21:77–93.
23 Zhou BF, Stamler J, Dennis B, Moag-Stahlberg
A, Okuda N, Robertson C, et al; INTERMAP
Research Group: Nutrient intakes of middle-
aged men and women in China, Japan, United
Kingdom, and United States in the late 1990s:
the INTERMAP study. J Hum Hypertens 2003;
17:623–630.
24 Gu D, Reynolds K, Wu X, Chen J, Duan X,
Muntner P, et al; InterASIA Collaborative
Group. The International Collaborative
Study of Cardiovascular Disease in ASIA:
prevalence, awareness, treatment, and control
of hypertension in China. Hypertension 2002;
40:920–927.
25 Wang WJ, Lu JJ, Wang YJ, Wang CX, Wang
YL, Hoff K, et al; China National Stroke Reg-
istry (CNSR): Clinical characteristics, man-
agement, and functional outcomes in Chinese
patients within the first year after intracere-
bral hemorrhage: analysis from China Na-
tional Stroke Registry. CNS Neurosci Ther
2012;18:773–780.
26 Su TC, Bai CH, Chang HY, You SL, Chien KL,
Chen MF, et al: Evidence for improved con-
trol of hypertension in Taiwan: 1993–2002. J
Hypertens 2008;26:600–606.
27 Zhang X, Patel A, Horibe H, Wu Z, Barzi
F,  Rodgers A, et al; Asia Pacific Cohort
Studies Collaboration: Cholesterol, coro-
nary heart disease, and stroke in the Asia
Pacific region. Int J Epidemiol 2003; 32: 563–
572.
28 Wieberdink RG, Poels MM, Vernooij MW,
Koudstaal PJ, Hofman A, van der Lugt A, et
al: Serum lipid levels and the risk of intracere-
bral hemorrhage: the Rotterdam Study. Arte-
rioscler Thromb Vasc Biol 2011; 31: 2982–
2989.
29 Yoshita K, Miura K, Morikawa Y, Ishizaki M,
Kido T, Naruse Y, et al: Relationship of alco-
hol consumption to 7-year blood pressure
change in Japanese men. J Hypertens 2005;23:
1485–1490.
30 Peng GS, Yin SJ, Cheng CA, Chiu SW, Lee JT,
Lin WW, et al: Increased risk of cerebral hem-
orrhage in Chinese male heavy drinkers with
mild liver disorder. Cerebrovasc Dis 2007;23:
309–314.
31 Patra J, Taylor B, Irving H, Roerecke M, Bali-
unas D, Mohapatra S, et al: Alcohol consump-
tion and the risk of morbidity and mortality
for different stroke types – a systematic review
and meta-analysis. BMC Public Health 2010;
10:258.
32 Burke TA, Venketasubramanian RN: The ep-
idemiology of stroke in the East Asian region:
a literature-based review. Int J Stroke 2006;1:
208–215.
132.239.1.231 - 6/12/2017 4:10:19 AM
Univ. of California San Diego
Tsai/Jeng/Anderson/Sudlow
Downloaded by: