This analysis of Takashima Stroke Registry data revealed that stroke incidence has decreased significantly from 1990 to 2010. After 2000, speed of reduction in stroke incidence seems to have slowed down, there is a need for continuous public health measures to achieve further protection against stroke.

• Researchers identified 2,371 patients with first-ever stroke during the period 1990–2010.

• In the early (1990–2001) and late periods (2002–2010), crude incidence rates of total stroke (per 100,000 person-years) were estimated to be 225 and 187, respectively, and mean age at onset of stroke rose from 71.9 years in the early period to 74.8 years in the late period.

• A decline in age- and gender-standardized incidence rates of stroke (per 100,000 person-years), from 327 in the early part of this study period and 206 in the later period, was observed.

• A statistically significant age- and gender-standardized average annual relative reduction in stroke incidence was evident during the 21-year span.

• On stratifying into early and late periods, there was an adjusted annual relative reduction in stroke incidence during the early period (−2.1% per year), and no significant changes occurred during the late period.