Objectives This study examines the recent trends in ischaemic heart disease (IHD) incidence and case fatality in Hong Kong and explores the possible risk factors.

Design Retrospective observational study.

Setting All public hospitals in Hong Kong.

Outcome measures Incidence rate was defined as the number of IHD inpatient episodes divided by the size of the corresponding population. Short-term and long-term case fatality rate was defined as deaths from all causes occurring within 30 and 31–365 days, respectively, divided by the number of IHD inpatient episodes among the corresponding population.

Methods Poisson and logistic regression models were used to examine the IHD incidence and short-term/long-term case fatality trends, respectively, for different age and sex groups.

Results IHD incidence was stable in most age groups. However, the incidence in men aged 15–24, 35–44 and ≥85 years showed increasing trends, whereas the incidence in men aged 55–64 years and women aged 35–74 years showed decreasing trends. Overall, the short-term/long-term case fatality rates were unchanged over time for both sexes. Short-term case fatality showed increasing trends in women aged 65–74 and ≥85 years, while long-term case fatality in men aged 55–64 and 75–84 years and women aged ≥75 years showed increasing trends.

Conclusions Hong Kong trends resembled those in the USA, England and Wales, showing stable or slow decline in the IHD rates, while increasing trends were observed for some age groups, particularly young adults. Public health promotion efforts should focus on reducing cardiovascular risk factors, such as hypertension prevalence.