The epidemiology of stroke in the Middle East

Epidemiology of coronary artery disease and stroke and associated risk factors in Gaza community -Palestine

AIM OF STUDY

To determine the prevalence of cardiovascular disease and associated risk factors in the population of Gaza strip in Palestine.

METHODS

A cross-sectional stratified cluster sample design was applied in this study. A sample of 2240 participant (1121 males and 1119 females) aged ≥25 years participated in the study. For each individual, trained staff administered a questionnaire, where all variables of interest followed WHO's STEP wise approach to surveillance chronic disease risk factors (STEPS) (WHO, 2001). Sociodemographic data, anthropometric measure (body mass index, blood pressure), and biochemical test (blood sugar and lipids profiles) were measured. Short International Physical Activity (IPAQ) questionnaire form was used. Bivariate analysis and logistic regression were used with SPSS (version 22.0) to analyze the data.

RESULTS

The most common condition was coronary artery disease (8.3%), followed by stroke events (3%). The associated risk factors were obesity (47.8%), hypertension (28.4%), current smoking account for (23.2%), diabetes mellitus (19.1%), high cholesterol level (8.8%), and high triglycerides level (40.2%). Additionally, the proportion of being physical active was found to be low (48.3%); particularly with increasing age. More than 30% of the population has less than 4 days of consumption of fruit and vegetables per week and 65.9% has less than 2 servings per day.

CONCLUSION

The burden of CVDs and their associated risk factors is considerable in Gaza and represents a major public health concern. Effective strategies in management, education and healthcare centers are required for an accurate management and implementation of preventive measure in this area.

Care and Discharge Outcome of Acute Stroke in Lebanon: A Hospital-Based Study

The present study was conducted to assess stroke care and outcomes in two Lebanese hospitals. Patients admitted in 2012 and 2013 were retrospectively selected. Data were extracted from medical records for time to hospital arrival, stroke severity, management, and discharge outcomes. A Cox regression analysis was then conducted to predict time to in-hospital death. A total of 201 patients were included (mean age = 69.2 years), among whom 50% arrived within a delay of 3.75 hours. Half underwent brain imaging in the first hour, and nine patients received an acute intervention. Forty-four patients died at the hospital; 142 were discharged home, among whom 98 patients were dependent in their daily activities. Stroke severity on admission and time from onset to arrival were found to be significantly associated to the time to in-hospital death (adjusted hazard ratio [HRa] = 1.13 and HRa = 0.98 respectively; p < 0.05). The study sheds light on high case fatality and dependency rates at discharge among stroke patients in Lebanese hospitals.

Stroke Prevalence in a Coastal Town on the Black Sea Coast in Turkey: Community Based Study

BACKGROUND

This study aims to determine the stroke prevalence in Akçakoca which is a rural area in Turkey.

METHODS

The study was designed as a cross-sectional, door-to-door survey. The stroke questionnaire was completed by a trained team in the presence of the participants according to their answers. Based on the screenings, patients who had been diagnosed with stroke previously were reexamined by a neurologist and determined the prevalence values, risk factors, and stroke types.

RESULTS

A total of 3750 people over 44 years old were reached in the screenings. It was determined that 83 people had previously suffered a stroke. The prevalence rate of stroke in those above 44 years was found to be 2.2 (98% confidence level and ± 2% margin of error). 70 (84.3%) patients had suffered an ischemic stroke while 12 (14.5%) had suffered a hemorrhagic stroke. Male/female ratio was 1.1.

CONCLUSION

The results of this study give the prevalence rate of stroke among the Turkish population living in a rural area. Due to a lack of other similar studies, it is impossible to make any data comparison. However, the results of this study help shed light on the stroke prevalence rate.

In Hospital Stroke Mortality: Rates and Determinants in Southwestern Saudi Arabia

Objectives: The present study analyzed in-hospital first-time stroke mortality in southwestern Saudi Arabia over one-year to assess the in-hospital stroke case fatality rate, mortality rate and explore the factors associated with in-hospital stroke mortality. Study Design: Hospital based follow-up study. Methods: First-time stroke patients admitted to all hospitals in Asser region over one-year period (January through December 2016) were included in the study. Data about personal characteristics, pre-stroke history and clinical criteria, on admission clinical criteria, in-hospital complications and survival status were collected. The last reported Aseer region population was used to calculate age and sex stroke mortality rate per 100,000 population/year. Hazard ratios (HR) and concomitant 95% confidence intervals (95% CI) were computed using multivariate Cox regression survival analysis. Kaplan-Meier curve survival analysis for stroke patients were plotted. Results: A total of 121 in-hospital deaths out of 1249 first-time stroke patients giving an overall case fatality rate (CFR) of 9.7%. Non-significant difference with gender and age were observed in CFR. Overall, in-hospital stroke mortality rate was 5.58 per 100,000/year. Males and elders showed a significantly higher mortality rates. Multivariable Cox regression analyses revealed pre-stroke smoking (HR = 2.36), pre-stroke hypertension (HR = 1.77), post-stroke disturbed consciousness (HR = 6.86), poor mobility (HR = 2.60) and developing pulmonary embolism (HR = 2.63) as significant predictors of in-hospital stroke mortality. Conclusions: In Southwestern Saudi Arabia, the in-hospital stroke mortality rate is higher in men and increases with aging. The prognosis of acute stroke could be improved by smoking cessation, better control of hypertension and prevention of in hospital complication particularly pulmonary embolism.

Study of Stroke Incidence in the Aseer Region, Southwestern Saudi Arabia

Recent data regarding first-stroke incidence in Saudi Arabia in general and in the Aseer region in particular are scarce and even lacking. The aim of this work was to study the first-time stroke incidence in the Aseer region, southwestern Saudi Arabia. All first-stroke patients admitted to all hospitals in the Aseer region over a one-year period (January through December 2016) were included. Stroke patients outside the Aseer region were excluded from the study. The incidence per 100,000 patients and the concomitant 95% CI (Confidence Intervals) were computed. The present study included 1249 first-time stroke patients and calculated an overall minimal incidence rate of hospitalized first-time stroke of 57.64 per 100,000 persons per year (95% CI: 57.57-57.70). A steady increase was noticed depending on the patients' age, reaching a figure of 851.81 (95% CI: 849.2-854.5) for those patients aged 70 years and more. Overall, the incidence rate for females (48.14; 95% CI: 48.04-48.24) was lower compared to males (65.52; 95% CI: 65.1-66.0). Taking into consideration the expected rise of the elderly because of the prominent medical services provided by the Saudi government, leading to a subsequent change in the horizontal and vertical age distribution structure of the population, an increase in the number of stroke patients is expected. It is suggested to establish a nationwide stroke surveillance system in the Kingdom, with the objective to report, analyze, and maintain an updated overview of the stroke status in Saudi Arabia.

Stroke burden in Egypt: data from five epidemiological studies

PURPOSE

Accurate data on the epidemiology of stroke in Egypt is scarce. The aim of this review is to address this issue based on available community-based studies and compare the resulting findings to those of other regional and international studies.

METHOD

A systematic literature search was conducted to identify population-based epidemiological studies of stroke in Egyptians. Original articles published in English between 1990 and 2016 were included. Five studies from five different governorates in southern Egypt fulfilled the study criteria (Qena, Sohag, Assiut, New Valley and Red Sea).

RESULTS

The mean and median crude prevalence rates (CPRs) across the five studies, which were conducted in southern Egypt were 721.6/100,000 and 655/100,000, respectively. The mean and median crude incidence rates (CIRs) were 187/100,000 and 180.5/100,000, respectively. The average CPR weighted by sample population size was 613/100,000 and the average CIR weighted by sample population size was 202/100,000.

CONCLUSION

The incidence and prevalence of stroke in Egypt are high. More population-based studies are urgently needed in northern Egypt and in Cairo - the capital of Egypt.