Population-Based Stroke Survey in Mumbai, India: Incidence and 28-Day Case Fatality

Abstract

Objectives: The aims of this study were (1) to establish a prospective community-based stroke registry in Mumbai of subjects having ‘first-ever stroke’ (FES) and (2) to collect standardized data on annual incidence, stroke subtypes, and case fatality rate at 28 days during the years 2005 and 2006. Background: An estimated 5.8 million people died from stroke (cerebrovascular disease) in 2005, two thirds of them were from low-/middle-income countries but reliable population-based studies are scarce. Methods: The manual on WHO STEPwise approach to stroke surveillance (STEPS Stroke; http://www.who.int/chp/steps/Manual pdf) was the operational protocol. We selected a well-defined community (H-district) having verifiable census data and being representative of the population structure of Mumbai (Bombay). Of 337,391 permanent residents, 156,861 persons between the age of 25 and 94+ years who were eligible for survey were screened. The responses to a predefined questionnaire (version 2.0) were entered in coded data sheets for analysis. Results: During the 2-year study period (January 2005 to December 2006), 456 (238 males and 218 females) had FES, indicating an annual incidence in subjects of 25 years and above of 145/100,000 persons (CI 95%: 120–170); for males it is 149/100,000 persons (CI 95%: 120–170) and for females it is 141/100,000 persons (CI 95%: 120–160). The age-standardized rate for study population (both sexes) by the direct method using Segi’s 1996 world population is 152/100,000/year (CI 95%: 132–172). Stroke diagnosis was supported by computed tomography in 407 (89.2%) of 456 FES cases: 366 (80.2%) had ischemic stroke, 81 (17.7%) had hemorrhagic stroke and 9 (1.9%) were in the unspecified category. The mean age was 66 ± (SD) 13.60 years, women were older as compared to men (mean age 68.9 ± 13.12 years vs. 63.4 ± 13.53 years). Case fatality: at 28 days, 320 (70%) of 456 FES cases were still alive and 136 (29.8%) had died. Of the 320 surviving patients 38.5% had moderate to severe disability by the modified Rankin scale. Conclusions: The results of Mumbai stroke study, using uniform definitions and methodologies, show that the annual standardized incidence rates, stroke subtypes and case fatality rate are very similar to those reported from developed nations. To plan effective intervention and prevention strategies, standardized data in representative samples of regional populations are urgently needed.

Efficacy of Mā-Ul-Ūsool, Mus'hil-E-Balgham and Inkibāb With Marzanjosh in Management of Post- Stroke Disability With Respect to Adl: A Black Box Study

“…Of 29 patients, 10 (35%) were in age group 31-45 years followed by 10 (34%) in 46-60, and 8 (28%) in age group of 61-70. The observed data did not coincide with previous studies 18,19 but the average age of cases with stroke in developing countries is 15 years younger than that of developed countries 4 By gender, there were 86% male compared to female participants as confirmed by Sethi, suggesting that India men are more susceptible to stroke than women in a ratio of 7:1 20 attributed to the differences in risk factors such as smoking and drinking being more prevalent in men than women 21 Socioeconomically, 11 (38%) were from lower middle class in conformity with observations made by Tripathi et al 4 Going by risk factors of stroke, out of 30 participants, 15 (52%) had history of stroke between 3-9 months, 5 (17%) between 10-15 months, 4 (14%) between 22-36 months of illness duration. This prolonged period of illness allows for accommodation of soft tissue changes while patient becoming customary to do his daily activities keeping the spastic limbs in fixed position.…”

“…As a result, set of neural patterns are changed with rearrangement of underlying neural circuits 22,23 Risk factors such as alcoholism, smoking, diabetes mellitus and TIA were found as 24%, 17%, 14% and 10% respectively. The observed data strengthens the causal associations of these major risk factors with stroke 1,18 which is in coincidence with the findings of Feigin et al 24 and Almani et al 25 Ingredients of Ma-ul-Usool, especially Beekh-e-Karafs, Beekhe-Izkhar, Badyan, Beekh-e-Badyan, Beekh-e-Kibr, Aslas'soos and Khardal possess pharmacological actions like resolvent, morcellator, attenuant, phlegmatic concoctive, deobstruent, phlegmatic purgative, brain and nerve tonic. The Nuskha Mus'hil-e-Balgham contains Turbud, Barg-e-Sana, Khayar Shambar, Roghan Zard, and Ustukhudoos.…”

A study on clinical and laboratory profiles of hemorrhagic and ischemic strokes in an Eastern Indian teaching Hospital

“…In a study done, smoking, alcoholism, increased BMI, DM and HT were significantly associated with strokes. 7 Of course, recurrent CVA was most commonly seen in < 45-year age in 25% patients, corroborating this study, in which it was 10%. 8 In the Group-2, the most common risk factor was HT followed by equal percentages of dyslipidemia and smoking history of CVA, DM, abuse of alcohol, past history of coronary artery disease and history of cancer.…”

Trial of ORG 10172 in acute stroke treatment classification and associated risk factors of ischemic stroke: a prospective study from a tertiary care center in South India

“…Our findings were in concordance with Mumbai, Trivandrum and Bangalore stroke registries. [18][19][20] Male sex is considered as an important risk factor for stroke. 21,22 Present study also had male preponderance.…”