STROKE CASES

STROKE CASES: 1.

Dr Lily Neo asked the Minister for Health (a) whether the prevalence of stroke cases is on the increase; and (b) has the Ministry any plans to reverse this trend.

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The Senior Minister of State for Health (Dr Balaji Sadasivan) (for the Minister for Health): The recent study conducted by the National Neuroscience Institute estimated the crude prevalence of stroke at approximately 4% in people aged 50 years and above. As this was the first such local study, we do not know if the prevalence is on the rise. However, our hospitalisation records show that there are about 7,500 cases of stroke every year and this has been so for quite some time despite the fact that our population numbers have been going up.

Age is the single most important risk factor for stroke. With our ageing population and improving survival rates, we can expect the prevalence of chronic diseases such as stroke to increase.

Conditions such as high blood pressure, smoking, obesity, diabetes and high cholesterol further increase the risk for stroke. Fortunately, these risk factors can be modified through active lifestyle changes.

There are two key strategies to address this problem. First, improve the overall risk profile of the population through initiatives such as the National Healthy Lifestyle Programme. Second, detect and treat those who have developed risk factors for stroke.

In this connection, the recent National Health Survey has been encouraging. The prevalence of most risk factors has moderated. Management of those with diabetes and hypertension also appears to be improving.

We should therefore press on with our healthy lifestyle campaign. If Singaporeans continue to improve their risk factor profile, hopefully we can control the prevalence of stroke even as our population ages.

Dr Lily Neo (Jalan Besar): May I ask the Senior Minister of State, in view of

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the fact that stroke is on the increase, especially with an ageing population and the fact that stroke can be prevented by early detection and better care of hypertension, diabetes and cholesterol, is the Senior Minister of State happy with the present available preventive measures and what else can be done to improve this situation?

Dr Balaji Sadasivan: I agree with Dr Neo that prevention is better than cure. In terms of managing stroke, we have a three-pronged approach. First, there is primary prevention. Primary prevention is mainly geared towards raising awareness and providing the skills and means for people to adopt a healthy lifestyle. Then, there is secondary prevention. This detects people who may have developed risk factors such as stroke and diabetes and manage these people so that their chance of developing a stroke would be less. For tertiary prevention, this is managing people when they come to the hospital with their TIA or minor stroke and managing them so that their outcomes are better.

In terms of actual numbers, in the year 1998, we had about 7,350 stroke patients, giving us a rate of 332 per 100,000 persons and it has remained about the same level. The actual figure in 2004 was 7,345. But because our population has increased, the rate has actually come down to 211 per 100,000. Likewise, because of improvements in the tertiary care, the mortality rate has come down. In 1997, the mortality rate from stroke was about 38 per 100,000. Last year, it was 28 per 100,000. However, we should continue to work and see if we can bring these rates down further.

Dr Lily Neo: Mr Speaker, may I ask the Senior Minister of State, in view of the fact that more than 50% of stroke survivors in Singapore end up with moderate or severe disability and the fact that disability can be lessened by early

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detection and treatment for 70% of ischemic stroke, will the Minister step up awareness in the prevention and disability from stroke with the medical profession and the public as well as offering better and earlier stroke detection and care in our public hospitals?

Dr Balaji Sadasivan: Again, Dr Neo is correct. Educating our general practitioners and increasing their awareness is part of stroke prevention. That is why we have a lot of education programmes for our primary healthcare physicians with regard to stroke and other risk factors for cardiovascular disease. This is because most patients would see their general practitioners and primary healthcare physicians for management of minor diseases and for other reasons. These physicians are in the best position for primary and secondary healthcare. We think this has improved with new requirements for CME which came in several years ago so that now, our primary health physicians are also in tune with what the hospitals are doing and what the Ministry is doing in terms of bringing our stroke rates and cardiovascular disease rates down since the risk factors for both are quite similar.

Dr Lily Neo: The Senior Minister of State did not answer about the care in hospital. Could I just also ask for the support schemes available to stroke patients and their family members in terms of medical and social support since stroke disability can be long term and imposes great medical, social and financial burden on the families, especially those who have lost their breadwinners?

Dr Balaji Sadasivan: With regard to our hospitals, our hospitals are also improving their treatment as indicated by the drop in the mortality rates which I have just given her a little while earlier.

Stroke is a burden on families, especially if they are left with disabilities.

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There are welfare workers and a whole lot of social support work that is provided for these patients. It is managed partly by my Ministry and also by MCYS. If the Member wants to know more details about this, she could table a Question at the next Parliament sitting because that is not in her Question.