Stroke in Latin America: Systematic review of incidence, prevalence, and case-fatality in 1997–2021

Abstract

Background: Stroke is a major global cause of death and disability. Most strokes occur in populations of low-middle income (LMIC); therefore, the subsequent disease burden is greater than in populations of high-income countries. Few epidemiological data exist for stroke in Latin America, composed primarily of LMIC. Aims: To determine epidemiological measures of incidence, prevalence, and 1-month case-fatality for stroke in Latin America/Caribbean (LAC) during 1997-2021. Summary of review: A structured search was conducted to identify relevant references from MEDLINE, WOS, and LILACS databases for prospective observational and cross-sectional studies in LAC populations from January 1997 to December 2021. 9,242 records were screened and 12 selected for analysis, seven incidence studies and five prevalence studies. Case-fatality rate was reported in six articles. Sub-group analysis by age, sex and income countries was performed. A narrative synthesis of the findings was performed. Meta-analysis was performed using random-effect model to obtain pooled estimates with 95% confidence intervals. Studies quality was assessed according to the risk of bias criteria described in the Joanna Briggs Institute’s guide. The overall crude annual incidence rate of first-ever stroke in LAC was 119.0 (95%CI 95.9-142.1)/100,000 people per year (with high heterogeneity between studies [I2= 98.1%]). The overall crude prevalence was 3,060 (95%CI 95.9-142.1)/100,000 people (with high heterogeneity between studies [I2= 98.8%]). The overall case-fatality rate at 1 month after the first stroke was 21.1% (95% CI 18.6-23.7) (I2=49.40%). Conclusion: This review contributes to our understanding regarding the burden caused by stroke in LAC. More studies with comparable designs are needed to generate reliable data and should include both standardised criteria such as the WHO clinical criteria and updated standard methods of case assurance, data collection and reporting.

Disparities in stroke incidence over time by sex and age in Latin America and the Caribbean region: a systematic review and meta-analysis

“…The search strategy followed the same parameters of our previous publication 8 . A modified search strategy of the Cochrane Stroke Group filtered by terms for Latin American and the Caribbean was used to identify studies that met the selection criteria.…”

The global burden of stroke

“…International Journal of Stroke, 18 (6) sex, and admission blood pressure, while a lower risk was found in patients with the thalamic lacunar infarction. Furthermore, they found that END was associated with an unfavorable outcome, They concluded that high systolic blood pressure may be a potentially modifiable risk factor to prevent END, but this needs investigation in randomized controlled trials.…”

“…Their conclusions are consistent with an epidemiological study from Sierra Leone which found stroke affected younger people and resulted in high rates of fatality and functional impairment relative to global averages. 5 Delfino et al 6 from South Africa also highlight the need for studies to better understand the burden of stroke, and how it varies, across South America.…”

Reperfusion therapy for stroke: From improving global access, to thrombectomy beyond 24 hours

“…2,3 We have also recently published in this journal detailed analyses of stroke risk in various countries and continents including Africa, India, China, and South America. 4–7 Together these show major disparities in stroke incidence and mortality and worryingly upward trends in incidence in many LMICs, but more positively highlight how stroke risk could be reduced with environmental and cardiovascular risk factor initiatives.…”