Project Partners: 計劃夥伴： Funded by: 捐助機構： Gap of Health Care for Midlife Women: Controlling Risk Factors of Stroke as Example Chau Pui Hing CADENZA Project,

Project Partners:計劃夥伴：

Funded by:捐助機構：

Gap of Health Care for Midlife Women:Controlling Risk Factors of Stroke

as Example

Chau Pui HingCADENZA Project, Faculty of Social Sciences,

The University of Hong Kong



22

Our Team Members

Prof Jean Woo

Prof Susanne C Ho

Prof William B Goggins



3

Background

There is a tendency to assume that men have a worse cardiovascular risk factor profile than women

More effort may have been directed towards men

Women generally have a healthier lifestyle than men

Further lead to possible gaps in health promotion efforts among women



4

An Illustration

Here, we use cerebrovascular disease (stroke) as an example to illustrate possible gaps in health care, especially among midlife women



5

The Impact of Stroke

Lead to disability and functional limitation, resulting in long term residential care (Woo et al. 1992a; Woo et al. 1998a)

The leading cause of hospital admissions particularly among the older Hong Kong population, accounting for the largest number of bed days (Department of Health 2004)

Economic burden of elderly stroke patients was about US$250 million in 2001 (Woo et al. 1997)

The 4th leading cause of deaths in Hong Kong and accounted for about 8% of all deaths (Department of Health, 2010)

Among the avoidable causes of mortality, stroke ranked first in Hong Kong compared with Paris, Manhattan, New York and Inner London (Chau et al. 2010)



6

Risk Factors for Stroke

Hypertension, hypercholesterolemia, smoking, diabetes mellitus, overweight, etc.

Different stroke subtypes have different risk factors

Hypertension is a common risk factor for both ischemic and hemorrhagic strokes

Smoking increases the risk of stroke for both subtypes, but is more associated with ischemic stroke



7

Stroke Prevention

Risk factor reduction, such as anti-smoking, blood pressure and diabetes detection and control, is promoted as preventive measure



8

Stroke is emphasized



9

Stroke is not

emphasized



10

Our Study

Examine trends in some of the risk factors in relation to the stroke trends in Hong Kong based on evidences drawn from different studies

Aim to identify some possible gaps in public health strategy for controlling risk factors in achieving reductions in stroke incidence among women



11

Incidence of Hemorrhagic Stroke in HK (2005-07)

0

100

200

300

400

500

600

700

800

35-44 45-54 55-64 65-74 75-84 85+Age Group

Rat

e pe

r 10

0,00

0 po

pula

tion

Male

Female

Remarks: Incidence rates were calculated based on hospital admission statistics Hemorrhagic stroke was identified by ICD9: 431-432

Women had lower incidence rates than men for all age groups



12

Incidence of Ischemic Stroke in HK (2005-07)

0

500

1000

1500

2000

2500

35-44 45-54 55-64 65-74 75-84 85+Age Group

Rat

e pe

r 10

0,00

0 po

pula

tion

Male

Female

Remarks: Incidence rates were calculated based on hospital admission statistics Ischemic stroke was identified by ICD9: 433, 434, 436 and 437

Women had lower incidence rates than men for all age groups



13

Prevalence of Daily Cigarette Smokers (2010)

0

5

10

15

20

25

30

20-29 30-39 40-49 50-59 60+Age Group

Pre

vale

nce

rate

(%

)

Male

Female

Source: Tobacco Control Office, Department of Health

Women had lower prevalence rates than men for all age groups



14

Prevalence of Hypertension (2003-04)

0

10

20

30

40

50

60

70

80

25-34 35-44 45-54 55-64 65-74 75+Age Group

Pre

vale

nce

rate

(%

)

Male

Female

Remarks: Hypertension was defined as a systolic blood pressure ≥140mmHg or a diastolic blood pressure ≥90mmHg

Source: Population Health Survey 2003/04

Women had lower or similar prevalence rates as their male counterparts



15

Prevalence of Overweight (2004-05)

0

5

10

15

20

25

30

35

40

45

50

25-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84Age Group

Pre

vale

nce

rate

(%

)

Male

Female

Remarks: Overweight was defined as a BMI ≥ 25kg/m2 Source: Heart Health Survey 2004/05

Women had lower prevalence rates than men for most age groups



16

Prevalence of Diabetes Mellitus (2004-05)

0

5

10

15

20

25

30

35

40

25-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79Age Group

Pre

vale

nce

rate

(%

)

Male

Female

Remarks: DM was defined by self-report history or diagnosed by OGTT (fasting glucose ≥7.0mmol/L or 2-hour glucose ≥11.1mmol/L) Source: Heart Health Survey 2004/05

Women had higher prevalence rates than men for the middle aged and elderly



17

Prevalence of High Blood Cholesterol (2004-05)

0

10

20

30

40

50

60

70

80

90

25-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84Age Group

Pre

vale

nce

rate

(%

)

Male

Female

Remarks: High blood cholesterol was defined as a plasma cholesterol ≥5.2mmol/L Source: Heart Health Survey 2004/05

Women had higher prevalence rates than men among the middle aged and elderly



18

Good enough? How about

the trends?



19

Trends in Stroke Incidence (Aged 35-44)

0

5

10

15

20

25

30

Hemorrhagicstroke (Male)

Hemorrhagicstroke

(Female)

Ischemicstroke (Male)

Ischemicstroke

(Female)

Rat

e pe

r 10

0,00

0 po

pula

tion

1999-2001

2002-2004

2005-2007

Remarks: Incidence rates were calculated based on hospital admission statistics Hemorrhagic stroke was identified by ICD9: 431-432 Ischemic stroke was identified by ICD9: 433, 434, 436 and 437Source: Chau et al. (2011)



20

Trends in Stroke Incidence

An overall decreasing trend was shown for ischemic stroke, but this pattern did not apply to the middle aged population (aged 35-44)

Hemorrhagic stroke incidence increased among the middle aged

Remarks:

Trends (2005-7 vs 2002-4 and 2002-4 vs 1999-2001) were tested with Poisson regression analysis (=5%)



21

Trends in Male Daily Cigarette Smokers Prevalence

0

10

20

30

40

50

60

1980 1985 1990 1995 2000 2005 2010

Year

Pre

vale

nce

rate

(%

)

15-19

20-29

30-39

40-49

50-59

60+




22

Trends in Female Daily Cigarette Smokers Prevalence

0

2

4

6

8

10

12

14

16

1980 1985 1990 1995 2000 2005 2010

Year

Pre

vale

nce

rate

(%

)

15-19

20-29

30-39

40-49

50-59

60+




23

Trends in Daily Cigarette Smokers Prevalence

From 1982 to 2010, prevalence rate of daily cigarette smokers was decreasing among men of all ages, but that among young and middle aged women (aged <40) has been increasing until recently



24

Trends in Hypertension Prevalence

0

10

20

30

40

50

60

70

80

25-34 35-44 45-54 55-64 65-74

Age Group

Prev

alen

ce rat

e (%

) Male 1995/6

Male 2003/4

Female 1995/6

Female 2003/4

Remarks: Hypertension was defined as a systolic blood pressure ≥140mmHg or a diastolic blood pressure ≥90mmHg

Sources: Cardiovascular Risk Factor Study 1995-1996; Population Health Survey 2003/04



25

Trends in Hypertension Prevalence

Prevalence of hypertension in 2003-2004 increased as compared to 1995-1996

The increase in hypertension prevalence rate was steeper for the young and midlife population

Although the increase in prevalence rates among women was slower than their male counterparts, the prevalence rates of hypertension among women aged 35-44 nearly tripled



26

Trends in Overweight Prevalence

0

10

20

30

40

50

60

25-44 45-49 50-54 55-59 60-64 65-69 70-74

Age Group

Pre

vale

nce

rate

(%

)

Male1995/6

Male2004/5

Female1995/6

Female2004/5

Remarks: Overweight was defined as a BMI ≥ 25kg/m2 Sources: Cardiovascular Risk Factor Prevalence Study 1995-1996; Heart Health Survey 2004/05



27

Trends in Diabetes Mellitus Prevalence

0

5

10

15

20

25

30

35

40

25-44 45-49 50-54 55-59 60-64 65-69 70-74

Age Group

Pre

vale

nce

rate

(%

) Male1995/6Male2004/5Female1995/6Female2004/5

Remarks: DM was defined by self-report history or diagnosed by OGTT (fasting glucose ≥7.0mmol/L or 2-hour glucose ≥11.1mmol/L) 10-year age groups (instead of 5-years) were used in Cardiovasular Risk Factor Prevalence Study 1995/6Sources: Cardiovascular Risk Factor Prevalence Study 1995-1996; Heart Health Survey 2004/05



28

Trends in Hypercholesterolemia Prevalence

0

10

20

30

40

50

60

70

80

25-44 45-49 50-54 55-59 60-64 65-69 70-74

Age Group

Pre

va

len

ce

ra

te (

%) Male

1995/6

Male2004/5

Female1995/6

Female2004/5

Remarks: High blood cholesterol was defined as a plasma cholesterol ≥5.2mmol/L Source: Cardiovascular Risk Factor Study 1995-1996; Heart Health Survey 2004/05



29

Trends in Overweight, Diabetes Mellitus and Hypercholesterolemia

Fortunately, the trends in these risk factors were decreasing among women

For the young and midlife women, the reduced stroke risk related to the decline in these factors perhaps was offset by the increase in the prevalence of other risk factors

Nevertheless, the prevalence of hypercholesterolemia in women was still higher than men in the middle and elderly age groups



30

Discussions

Stroke is one of the illnesses that women have lower incidence rates than men

Women also have lower prevalence rates of some of the risk factors like smoking, hypertension and overweight

These possibly are related to less emphasis on stroke prevention and risk factors reduction among women



31

Alarming Trends

Increasing hemorrhagic stroke incidence rate and non-decreasing ischemic stroke incidence rate are observed not only in midlife men, but also midlife women

Probably related to Increasing prevalence rates of hypertension, particularly the faster increase among the young and middle aged population

Increasing prevalence rates of smoking among young and middle aged women



32

Implications

Despite the lower risk of stroke among women, there is room for improvement in health promotion efforts in controlling the risk factors, particularly hypertension and smoking

These strategies should be implemented at population level, in addition to the individual level control measures

Improvement in control may prevent the mid age rise in incidence of hemorrhagic stroke and may lead to a decline in the incidence of ischemic stroke



3333

Way Forward

It is acknowledged that secondary data analyses are subject to certain limitations, further research based on primary data is necessary to explore how to strengthen public health strategy



3434

Acknowledgments

Data provisionThe Strategy and Planning Division of the Hospital Authority

Prof Sarah M McGhee



3535

Acknowledgments

This study was supported by “CADENZA: A Jockey Club Initiative for Seniors” funded by The Hong Kong Jockey Club Charities Trust, and the Health and Health Services Research Fund (HHSRF: 06070451), Food and Health Bureau, Hong Kong SAR Government



36

Documents

Project Partners: 計劃夥伴： Funded by: 捐助機構： Gap of Health Care for Midlife Women: Controlling Risk Factors of Stroke as Example Chau Pui Hing CADENZA Project,