Family medicine and community health · 2026
Stroke incidence trends and the role of chronic disease management in a universal health coverage system: a retrospective observational study in Macao, 2019-2024.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Tam Kwong Ho, Chou Hao Wan, Kwong Wing Yi, Lei Sao Kuan, Zeng Wen, Wong In
Аннотация
OBJECTIVE: 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.
DESIGN: Retrospective observational study using routinely collected electronic health records.
SETTING: Macao Health Bureau's primary care system, which provides free, publicly funded community health services to all residents.
PARTICIPANTS: Macao residents aged ≥15 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).
RESULTS: Age-standardised stroke incidence declined from 250.03 per 100 000 in 2019 to 219.95 per 100 000 in 2022, followed by a rebound in 2023-2024 which 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.
CONCLUSION: 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-ongoing quality improvement in chronic disease management is essential to translate engagement into better outcomes.
DESIGN: Retrospective observational study using routinely collected electronic health records.
SETTING: Macao Health Bureau's primary care system, which provides free, publicly funded community health services to all residents.
PARTICIPANTS: Macao residents aged ≥15 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).
RESULTS: Age-standardised stroke incidence declined from 250.03 per 100 000 in 2019 to 219.95 per 100 000 in 2022, followed by a rebound in 2023-2024 which 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.
CONCLUSION: 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-ongoing quality improvement in chronic disease management is essential to translate engagement into better outcomes.