Korea); hypercholesterolemia in Japan, Table 1. Mortality, incidence, prevalence, and DALYs lost because of stroke Country Age-sex standardized mortality /100,000 person-years (2010)2 Incidence /100,000 person-years Prevalence /1,000 Age-sex standardized DALYs lost /100,000 people (2010)2 South Asia Bangladesh 54.8 - 9.4 (>30 years)16 888.1); inactivity in Malaysia (low in Nepal and Lao PDR); obesity in Brunei, Papua New Guinea, and Mongolia (low in Timor Leste, Cambodia, and Bangladesh); tobacco smoking in Indonesia (low in India). In general, hypertension, diabetes mellitus and tobacco smoking tend to be more prevalent among men, whereas hypercholesterolemia, inactivity and obesity tend to be more prevalent among women. Data on the vascular risk factors among stroke patients are available for a number of countries (Table 3). These are derived from hospital-based stroke registries.6,12,25-36 They are not strictly comparable as varying definitions were used, and studies were performed at differing time points, but there is still some consistency in the findings. Hypertension is the most common risk factor, with diabetes mellitus and smoking following closely. A significant proportion of stroke patients have had previous cerebrovascular events and coronary artery disease. Possessing knowledge on the risk factors in each population can inform policy makers and healthcare planners on which factors should be targeted and what appropriate preventive measures should be taken. Stroke subtypes Information on stroke subtypes is also available in most counTable 2. Vascular risk factors in the community Country Hypertension (SBP>140 mmHg and DBP>90 mmHg) (2015) 18+ years (%) Diabetes mellitus (FBS>7.0 mmol/L or on medication) (2014) 18+ years (%) Hypercholesterolemia (TC>hospital-based stroke registries (In general, ischemic stroke occurs more commonly than hemorrhagic stroke, except in India and Vietnam, where the converse is observed. Subarachnoid hemorrhage is uncommon. Cerebral venous sinus thrombosis may also cause stroke, especially among young women.4,6 Geographical variations within countries Variations in stroke epidemiology have been found within many countries. Studies in China have shown that the stroke incidence is higher in the northern regions compared to the south,9 with double the incidence along the stroke belt.41 In India, on the contrary, the incidence is higher in rural areas.7 In Thailand, the stroke prevalence is highest in the cities, and then, in a decreasing fashion, in the central, south, north, and northeast regions of the country.23 Similarly, stroke prevalence was found to be higher in cities and urban areas than in rural regions, in Indonesia.20 These differences have been attributed to the differences in the risk factors between various regions in the same country. However, there is no difference in the age-standardized stroke mortality between the metropolitan cities of Korea and the other regions in the country.12 Comparative epidemiology Heart disease and stroke are competing causes of mortality. Generally, stroke-associated mortality, as a percent of total mortality, is lower than ischemic heart disease-related mortality, in most parts of the world.42 This has been attributed to the higher prevalence of diabetes mellitus and higher mean serum cholesterol levels among those with. https://doi.org/10.5853/jos.2017.00234 http://j-stroke.org 291 Vol. 19 / No. 3 / September 2017 than stroke patients. However, in some countries, the converse is true, wherein the stroke-related mortality exceeds the mortality caused by ischemic heart disease (in China by 11.9%, Korea by 9.9%, Mongolia by 8.0%, Thailand by 6.6%, etc.). Yet, the stroke mortality in Asia is higher than in North America or Europe.43 Likewise, globally, the disease burden—as measured by the DALYs lost—associated with stroke is lower than that associated with ischemic heart disease.42 However, in terms of mortality, the stroke burden exceeds the ischemic heart disease burden in the same countries in which an excess stroke mortality is observed—China, Mongolia, and Thailand. As in much of the world, ischemic stroke occurs more frequently than hemorrhagic stroke (Table 4). However, the 15– 40% incidence of stroke due to hemorrhage, in Asia, is much higher than the 15% observed in most developed countries in North America and Western Europe. The incidence of hemorrhagic stroke is highest in East Asia, notably in China, compared to North America and Western Europe.44 Trends Globally, between 1990 and 2013, there was a rise in the number of deaths, survivors, and events associated with stroke. However, the significant increase in the associated deaths and DALYs lost were not significantly different between developing and developed countries.1 Stroke-related mortality has been decreasing in East-Asian countries such as Japan, Korea, Taiwan, and the urbanized areas of China.43 This may be due to the better risk factor control and stroke care in; TIA, transient ischemic attack; CVT, cerebral venous thrombosis; UNC, unclassified. 292 http://j-stroke.org https://doi.org/10.5853/jos.2017.00234 Venketasubramanian, et al. Stroke in South, East, and South-East Asia ized stroke incidence, in general, has remained relatively constant. The GDB study showed a reduction in age-standardized