Incidence, Types, Risk Factors, and Outcome of Stroke in a Developing Country

Abstract

Background and Purpose-Despite increasing burden of stroke in developing countries, population-based data are rare.Through the Trivandrum Stroke Registry, we intend to assess incidence, types, risk factors, and outcome of stroke among urban and rural dwellers of a South Indian community. Methods-We ascertained all first-ever strokes occurring among 741 000 urban and 185 000 rural inhabitants of Trivandrum, Kerala. In addition to Steps 1 and 2 of World Health Organization STEPS Stroke Manual, we used multiple supplementary methods to maximize ascertainment of nonfatal and nonhospitalized fatal stroke events in the community. Results-During a 6-month period, 541 strokes were registered, 431 in the urban and 110 in the rural communities. Stroke occurred at a median age of 67 years; only 3.8% of patients were aged Յ40 years. Adjusted annual incidence rates per 100 000 were 135 (95% confidence interval 123 to 146) for total, 135 (122-148) for urban, and 138 (112-164) for rural populations, and 74.8 (66.3 to 83.2), 10.1 (7.0 to 13.2), and 4.2 (2.2 to 6.1) for ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage, respectively. There was more stroke of undetermined type in the rural community. One or more modifiable risk factors were identified in 90% patients. More rural male patients smoked tobacco. The 28th day case fatality rate was 24.5% for urban and 37.1% for rural populations (Pϭ0.011). Conclusions-There are more similarities than differences between developing and developed countries in the epidemiology of stroke. Compared to urban stroke patients, rural ones are less likely to be optimally investigated and treated. (Stroke. 2009;40:1212-1218.)

Epidemiology of Macrovascular Complications of Diabetes in South Asians and Comparison with Other Ethnicities

“…Most of these studies reveal diabetes to be an important risk factor for stroke. Diabetes was present in about half of stroke patients in a community based Stroke Registry in Trivandrum, South India [63]. However, one case control study with 201 subjects from a rural tertiary care hospital in Nagpur, central India did not find diabetes to be a statistically significant risk factor for ischemic stroke [64].…”

“…The average annual incidence rate of stroke in India currently is 145 per 100,000 population [44], which is higher than developed countries. In India 10% to 15% of strokes occur in people aged below 40 years and about 80% of strokes are ischaemic [45] The problem is compounded by poor awareness about warning symptoms and risk factors of stroke amongst Indians [46] Table 2 lists the studies reporting the prevalence of diabetes in people with stroke [47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62]. Most of these studies reveal diabetes to be an important risk factor for stroke.…”

Young Ischemic Stroke in South Asia: A review

“…48 Various studies in India and Pakistan reported significant incidence of obesity among stroke patients. 35,49 Unique anthropometry and Thinfat phenotype among South Asians, where there is low Basal metabolic index and higher amount of central obesity, are the cardiometabolic risk factors. 50 Abdominal obesity in young, which is more associated with atherosclerosis, hypertension and diabetes, is found to be more common in South Asians than westerners.…”

Measuring the impact of evidence: the Cochrane systematic review of organised stroke care

“…The evidence for this, documented in a systematic review initially in 1997, was the catalyst for a marked change in stroke service organisation across the NHS'' [16]. In recent years, multiple activities supporting organised stroke care sprouted in Eastern European and developing countries, enlarging the borders of applied science outside the countries where the knowledge was produced [18,19]. In Italy both regional and scientific society guidelines put emphasis on the implementation of stroke units [20,21].…”