Stroke incidence trends and the role of chronic disease management in a universal health coverage system: a retrospective observational study in Macao, 2019–2024

Abstract

Abstract 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.