Pui Hing Chau

Trends in stroke incidence in Hong Kong differ by stroke subtype.

Background: The population in Hong Kong is mainly Chinese, but their lifestyle is increasingly westernized. It is uncertain whether the trends of stroke in Hong Kong would follow a Chinese or Western pattern. This is the first study to examine the trends of ischemic and hemorrhagic stroke in Hong Kong between 1999 and 2007 with a view to providing data for planning preventive programs and resources for treatment. Methods: Data from the Clinical Management System database of the Hong Kong Hospital Authority for 1999–2007 were used to examine incidence rates of stroke by subtypes among the Hong Kong population aged 35 and above. Poisson regression models were used to examine the trends in the ischemic and hemorrhagic stroke incidence in different subgroups. Results: During 1999–2007, while the age-adjusted incidence of ischemic stroke has decreased, that of hemorrhagic stroke has remained fairly stable. In the younger age group (35–44 years), the incidence of ischemic stroke remained stable, whereas that of hemorrhagic stroke has increased. Furthermore, the incidence of all stroke among Hong Kong Chinese is much higher than in many other developed countries. Conclusions: There were different trends of hemorrhagic and ischemic stroke incidence in Hong Kong. The findings highlight the public health importance of further research into the underlying causes of the increasing trend in hemorrhagic stroke in the younger age group, and the higher overall age-adjusted stroke incidence in Hong Kong compared with other developed countries.

Trends in hip fracture incidence and mortality in Chinese population from Hong Kong 2001–09

BACKGROUND there is a suggestion that while the age-adjusted incidence of hip fracture in the West may be declining, the incidence may be rising in Asia. OBJECTIVE this study examines the incidence and post-fracture mortality from 2001 to 2009 among the population aged 65 years and over. METHODS hip fracture incidence rates and case-fatality rates among Hong Kong population aged 65 and over for the period 2001-09 were obtained from the Hong Kong Hospital Authority (HA) database. Rates were adjusted for age. Poisson and logistic regressions were used to examine trends in incidence and post-fracture mortality, respectively. RESULTS the age-adjusted incidence rate of hip fracture among the population aged 65 and over in Hong Kong (per 100,000 population) decreased from 381.6 for men and 853.3 for women in 2001 to 341.7 and 703.1, respectively, in 2009. There were no significant changes in post-fracture mortality trends. CONCLUSIONS there is a downward trend in age-specific hip fracture incidence rates since 2001 among Hong Kong Chinese, but no change in post-fracture mortality trends.

Monitoring the severe acute respiratory syndrome epidemic and assessing effectiveness of interventions in Hong Kong Special Administrative Region

Objective: To estimate the infection curve of severe acute respiratory syndrome (SARS) using the back projection method and to assess the effectiveness of interventions. Design: Statistical method. Data: The daily reported number of SARS and interventions taken by Hong Kong Special Administrative Region (HKSAR) up to 24 June 2003 are used. Method: To use a back projection technique to construct the infection curve of SARS in Hong Kong. The estimated epidemic curve is studied to identify the major events and to assess the effectiveness of interventions over the course of the epidemic. Results: The SARS infection curve in Hong Kong is constructed for the period 1 March 2003 to 24 June 2003. Some interventions seem to be effective while others apparently have little or no effect. The infections among the medical and health workers are high. Conclusions: Quarantine of the close contacts of confirmed and suspected SARS cases seems to be the most effective intervention against spread of SARS in the community. Thorough disinfection of the infected area against environmental hazards is helpful. Infections within hospitals can be reduced by better isolation measures and protective equipments.

Trends in Prevalence and Mortality of Dementia in Elderly Hong Kong Population: Projections, Disease Burden, and Implications for Long-Term Care

Background. We describe the trends in prevalence and mortality of dementia among older people in Hong Kong over time. Projections of the number of older people with dementia through 2039 and estimation of the disease burden are also included. Methods. Prevalence data were extracted from previous studies in Hong Kong. Mortality data were obtained from the Department of Health of Hong Kong. Projections of the number of people with dementia were calculated by applying the prevalence rates of dementia obtained from previous studies to Hong Kong population projections. The burden of dementia was measured by Disability-Adjusted Life Years (DALYs). Results. The number of people aged 60 and above with dementia is projected to increase by 222%, from 103,433 in 2009 to 332,688 in 2039, with a large proportion of those living in institutions. The number of deaths due to dementia among people aged 60 and above has more than doubled between 2001 and 2009. Mortality rates for dementia have also risen. In 2006, about 286,313 DALYS were lost due to dementia. Conclusions. The information presented may be used to formulate a long-term care strategy for dementia of the ageing population in Hong Kong.

Usage of Community Services and Domestic Helpers Predicted Institutionalization of Elders Having Functional or Cognitive Impairments: A 12-Month Longitudinal Study in Hong Kong

OBJECTIVES To estimate the 12-month institutionalization rate and to identify the associated predictors among functionally impaired elders with or without cognitive impairment. METHODS A cohort of Hong Kong community-dwelling elders aged 65 or older with functional and/or cognitive impairments was recruited and interviewed from 2007 to 2008. Twelve months after the baseline interview, the family caregivers or elders were interviewed to update the residence status of the elders. Logistic regressions were used to examine the association between institutionalization and the baseline variables. RESULTS Eighty elders (of 749 respondents) had been institutionalized within 12 months from baseline. The institutionalization rates were 6.2% (95% confidence interval (CI): 4.0%-8.5%) for elders with functional impairment only and 17.3% (95% CI: 13.0%-21.6%) for elders with both functional and cognitive impairments. Stepwise multiple logistic regressions found that more usage of community services was the single predictor to institutionalization in 1 year for the elders with functional impairment only. The risk was doubled (odd ratio = 2.166, 95% CI: 1.286-3.647) for usage in 1 more community service. For elders with both functional and cognitive impairments, the institutionalization risk was reduced by about 70% with employment of a domestic helper (odd ratio = 0.268, 95% CI: 0.120-0.598), despite increased risk being associated with advancing age of caregiver, caregiver being male, and deteriorating functional status of the elder. CONCLUSION Among the functionally impaired elders, more usage of community services predicted increased institutionalization, whereas among the functionally and cognitively impaired elders, employment of a domestic helper predicted reduced institutionalization. Innovative services and care models are needed to prevent unnecessary institutionalization and to postpone premature institutionalization. Further research needs to be conducted to investigate the long term care needs of the elders from the perspective of both the elders and their caregivers.

Reconstructing the incidence of human immunodeficiency virus (HIV) in Hong Kong by using data from HIV positive tests and diagnoses of acquired immune deficiency syndrome

The human immunodeficiency virus-acquired immune deficiency syndrome (HIV-AIDS) epidemic in Hong Kong has been under surveillance in the form of voluntary reporting since 1984. However, there has been little discussion or research on the reconstruction of the HIV incidence curve. This paper is the first to use a modified back-projection method to estimate the incidence of HIV in Hong Kong on the basis of the number of positive HIV tests only. The model proposed has several advantages over the original back-projection method based on AIDS data only. First, not all HIV-infected individuals will develop AIDS by the time of analysis, but some of them may undertake an HIV test; therefore, the HIV data set contains more information than the AIDS data set. Second, the HIV diagnosis curve usually has a smoother pattern than the AIDS diagnosis curve, as it is not affected by redefinition of AIDS. Third, the time to positive HIV diagnosis is unlikely to be affected by treatment effects, as it is unlikely that an individual receives medication before the diagnosis of HIV. Fourth, the induction period from HIV infection to the first HIV positive test is usually shorter than the incubation period which is from HIV infection to diagnosis of AIDS. With a shorter induction period, more information becomes available for estimating the HIV incidence curve. Finally, this method requires the number of positive HIV diagnoses only, which is readily available from HIV-AIDS surveillance systems in many countries. It is estimated that, in Hong Kong, the cumulative number of HIV infections during the period 1979-2000 is about 2600, whereas an estimate based only on AIDS data seems to give an underestimate. Copyright 2003 Royal Statistical Society.

Avoidable mortality pattern in a Chinese population—Hong Kong, China

BACKGROUND We examined the avoidable mortality pattern in Hong Kong, and the influence of age and gender. Comparison with Paris, Inner London and Manhattan was performed, and we discussed the findings in terms of prevention programmes, ethnicity and lifestyles. METHODS Mortality and population data by age and gender were obtained from vital statistics sources. Two periods, 1999-2003 and 2004-06, were selected for analysis. Negative binomial regression and logistic regression were used to model, respectively, the number and proportion of avoidable mortality, in relation to age and gender. RESULTS The standardized total mortality rates (per 1000 population) were 2.51 in the period 1999-2003 and 2.25 in the period 2004-06, whereas the standardized avoidable mortality rates (per 1000 population) were 0.85 and 0.77 for the two periods, respectively. Cerebrovascular disease (stroke) was the leading cause of avoidable mortality. Women in the age range of 65-74 years had the highest avoidable mortality proportion. In 1999-2003, Hong Kong had the second lowest standardized avoidable mortality rate among the four cities compared, whereas the avoidable mortality proportion was the highest. CONCLUSION There might be room for improvement in the primary care system in Hong Kong, particularly in the development of effective prevention programmes targeting the leading causes of avoidable mortality.

Disagreement in preference for residential care between family caregivers and elders is greater among cognitively impaired elders group than cognitively intact elders group

This study examined the predictive factors of preference for residential care in cognitively intact and impaired elders and their family caregivers. It was hypothesized that disagreement in preference for residential care between the elders and their caregivers was greater in the cognitively impaired.

Comparing the Age-Friendliness of Different Neighbourhoods Using District Surveys: An Example from Hong Kong

Background To address the age-friendliness of living environment in cities, the World Health Organization (WHO) launched the “Age-friendly cities” (AFC) initiative in 2005. To date, however, no universal standard tool for assessing age-friendliness of a community has been agreed. Methodology Two quantitative studies on AFC conducted in two Hong Kong districts—Sha Tin and Tuen Mun—were compared. A total of 801 residents aged ≥50 years were interviewed using structured questionnaires based on the WHO’s AFC criteria. District-wide differences in age-friendliness were compared on the basis of eight domain scores. Multiple linear regression was used to examine associations with demographic and socio-economic characteristics. The provision of services and amenities was also compared to help explain the difference in domain scores. Results Variations in mean domain scores were observed in both districts. Sha Tin showed significantly lower scores in outdoor spaces and buildings, transportation, social participation, respect and social inclusion, civic participation and employment, communication and information, as compared with Tuen Mun. Although a significantly higher score on the housing domain was observed in Sha Tin, differences in community and health services domains were insignificant. Socio-demographic factors, such as age group, gender, area of residence, type of housing, experience of elderly care, employment status, self-rated health and income, were associated with domain scores. However, variations in services and amenities provision appeared not to be strongly associated with district-wide difference in domain scores. Conclusions District differences in public opinions towards age-friendly characteristics were observed in this study. Except for two of the eight domains, Sha Tin had significantly lower scores than Tuen Mun. Some socio-demographic indicators seemed predictive to the differences. Paradoxically, Sha Tin had better services and infrastructure and higher socio-economic status, but lower age-friendliness. This warrants detailed research on psychosocial factors that may influence residents’ perceptions of local environments.

Access to primary care in Hong Kong, Greater London and New York City.

We investigate avoidable hospital conditions (AHC) in three world cities as a way to assess access to primary care. Residents of Hong Kong are healthier than their counterparts in Greater London or New York City. In contrast to their counterparts in New York City, residents of both Greater London and Hong Kong face no financial barriers to an extensive public hospital system. We compare residence-based hospital discharge rates for AHC, by age cohorts, in these cities and find that New York City has higher rates than Hong Kong and Greater London. Hong Kong has the lowest hospital discharge rates for AHC among the population 15-64, but its rates are nearly as high as those in New York City among the population 65 and over. Our findings suggest that in contrast to Greater London, older residents in Hong Kong and New York face significant barriers in accessing primary care. In all three cities, people living in lower socioeconomic status neighborhoods are more likely to be hospitalized for an AHC, but neighborhood inequalities are greater in Hong Kong and New York than in Greater London.