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Pasokh Z, Seif M, Ghaem H, Rezaianzadeh A, Johari MG. Age at natural menopause and development of chronic diseases in the female population of Kharameh, Iran: A historical cohort study. Health Sci Rep 2024; 7:e2042. [PMID: 38650726 PMCID: PMC11033488 DOI: 10.1002/hsr2.2042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/25/2024] Open
Abstract
Background and Aims Declines in estradiol levels after menopause have been reported to be associated with several health outcomes. This study aimed to determine the effect of age at natural menopause (ANM) on some of the most common chronic diseases. Methods This historical cohort study was performed on 2636 postmenopausal women aged 40-70 years participating in phase one of the PERSIAN cohort study in Kharameh, Iran, during 2015-2017. The effect of early (<45 years), intermediate (45-53 years), and late menopause (>53 years) on chronic diseases such as hypertension, diabetes, ischemic heart diseases, stroke, thyroid diseases, and depression was assessed using classic logistic regression for diseases with an incidence rate of more than 10% and Firth's logistic regression for diseases with an incidence of less than this amount. Results The mean age of women was 53.48 ± 8.59. Respectively, early and intermediate menopause was associated with ischemic heart disease (odds ratio [OR = 1.61, 95% confidence interval [CI]: 1.08-2.42; p = 0.020), (OR = 1.57, 95% CI: 1.13-2.21; p = 0.008) and thyroid diseases (OR = 3.10, 95% CI: 1.64-6.24; p < 0.001), (OR = 1.83, 95% CI: 1.02-3.57; p = 0.042). furthermore, early menopause was a risk factor for diabetes (OR = 1.46, 95% CI: 1.07-2.00; p = 0.018), depression (OR = 4.79, 95% CI: 2.20-11.79; p = <0.001) and stroke (OR = 3.00, 95% CI: 1.08-9.32; p = 0.034). Conclusions In this study, women with diabetes, ischemic heart diseases, stroke, thyroid disorders, and depression had a younger ANM compared to their healthy counterparts. Therefore, applying appropriate strategies to postpone the age of menopause, can reduce the incidence of these types of chronic diseases.
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Affiliation(s)
- Zahra Pasokh
- Student Research Committee, Department of Epidemiology, School of HealthShiraz University of Medical SciencesShirazIran
| | - Mozhgan Seif
- Non‐Communicable Diseases Research Center, Department of Epidemiology, School of HealthShiraz University of Medical SciencesShirazIran
| | - Haleh Ghaem
- Non‐Communicable Diseases Research Center, Department of Epidemiology, School of HealthShiraz University of Medical SciencesShirazIran
| | - Abbas Rezaianzadeh
- Colorectal Research Center, Department of Epidemiology, School of HealthShiraz University of Medical SciencesShirazIran
| | - Masoumeh Ghoddusi Johari
- Breast Diseases Research Center, Community Medicine DepartmentShiraz University of Medical SciencesShirazIran
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Rangamani S, Huliyappa D, Kulothungan V, Saravanan S, Murugan P, Mahadevan R, Rachel Packiaseeli C, Bobby E, Sunitha K, Mallick AK, Nayak SD, Swain SK, Behera M, Nath BK, Swami A, Kalwar AK, Difoesa B, Sardana V, Maheshwari D, Bhushan B, Mittal D, Chaurasia RN, Meena L, Vinay Urs KS, Koli RR, Suresh Kumar N, Mathur P. Stroke incidence, mortality, subtypes in rural and urban populations in five geographic areas of India (2018-2019): results from the National Stroke Registry Programme. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 23:100308. [PMID: 38404513 PMCID: PMC10884975 DOI: 10.1016/j.lansea.2023.100308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/30/2023] [Accepted: 10/11/2023] [Indexed: 02/27/2024]
Abstract
Background Increasing stroke burden in India demands a long-term stroke surveillance framework. Earlier studies in India were urban-based, short term and provided limited data on stroke incidence and its outcomes. This gap is addressed by the establishment of five population-based stroke registries (PBSRs) of the National Stroke Registry Programme, India. This paper describes stroke incidence, mortality and age, sex, and subtypes distribution in the five PBSRs with urban and rural populations. Methods First-ever incident stroke patients in age group ≥18 years, resident for at least one year in the defined geographic area, identified from health facilities were registered. Death records with stroke as the cause of death from the Civil Registration System (CRS) were included. Transient ischemic attack (TIA) was excluded. Three PBSRs (Cuttack, Tirunelveli, Cachar) included urban and rural populations. PBSRs in Kota and Varanasi were urban areas. The crude and age-standardized incidence rate (ASR) by age, sex, and residence (urban and rural), rate ratios of ASR, case fatality proportions and rates at day 28 after onset of stroke were calculated for years 2018-2019. Findings A total of 13,820 registered first-ever stroke cases that included 985 death certificate-only cases (DCOs) were analysed. The pooled crude incidence rate was 138.1 per 100,000 population with an age-standardized incidence rate (ASR) of 103.4 (both sexes), 125.7 (males) and 80.8 (females). The risk of stroke among rural residents was one in seven (Cuttack), one in nine (Tirunelveli), and one in 15 (Cachar). Ischemic stroke was the most common type in all PBSRs. Age-standardized case fatality rates (ASCFR) per 100,000 population for pooled PBSRs was 30.0 (males) and 18.8 (females), and the rate ratio (M/F) ranged from 1.2 (Cuttack) to 2.0 (Cachar). Interpretation Population-based registries have provided a comprehensive stroke surveillance platform to measure stroke burden and outcomes by age, sex, residence and subtype across India. The rural-urban pattern of stroke incidence and mortality shall guide health policy and programme planning to strengthen stroke prevention and treatment measures in India. Funding The National Stroke Registry Programme is funded through the intramural funding of the Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, India.
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Affiliation(s)
- Sukanya Rangamani
- ICMR-National Centre for Disease Informatics and Research, II Floor of Nirmal Bhawan, ICMR Complex Kannamangala Post, Bengaluru, 562 110, India
| | - Deepadarshan Huliyappa
- ICMR-National Centre for Disease Informatics and Research, II Floor of Nirmal Bhawan, ICMR Complex Kannamangala Post, Bengaluru, 562 110, India
| | - Vaitheeswaran Kulothungan
- ICMR-National Centre for Disease Informatics and Research, II Floor of Nirmal Bhawan, ICMR Complex Kannamangala Post, Bengaluru, 562 110, India
| | | | - P.K. Murugan
- Tirunelveli Medical College, Tirunelveli, 627011, India
| | | | | | - Esakki Bobby
- Tirunelveli Medical College, Tirunelveli, 627011, India
| | | | - Ashok Kumar Mallick
- SCB Medical College & Hospital, Cuttack, Behera Colony, Mangalabag, Cuttack, Odisha, 753001, India
| | - Soumya Darshan Nayak
- SCB Medical College & Hospital, Cuttack, Behera Colony, Mangalabag, Cuttack, Odisha, 753001, India
| | - Santosh Kumar Swain
- SCB Medical College & Hospital, Cuttack, Behera Colony, Mangalabag, Cuttack, Odisha, 753001, India
| | - Manoranjan Behera
- SCB Medical College & Hospital, Cuttack, Behera Colony, Mangalabag, Cuttack, Odisha, 753001, India
| | - Bhaskar Kanti Nath
- Silchar Medical College, Beside Indian Post, Ghungoor, Masimpur, Silchar, Assam, 788014, India
| | - Abhijit Swami
- Silchar Medical College, Beside Indian Post, Ghungoor, Masimpur, Silchar, Assam, 788014, India
| | - Amit Kumar Kalwar
- Silchar Medical College, Beside Indian Post, Ghungoor, Masimpur, Silchar, Assam, 788014, India
| | - Bijush Difoesa
- Silchar Medical College, Beside Indian Post, Ghungoor, Masimpur, Silchar, Assam, 788014, India
| | - Vijay Sardana
- Govt Medical College, MBS Hospital, Nayapura, Kota, Rajasthan, 324001, India
| | - Dilip Maheshwari
- Govt Medical College, MBS Hospital, Nayapura, Kota, Rajasthan, 324001, India
| | - Bharat Bhushan
- Govt Medical College, MBS Hospital, Nayapura, Kota, Rajasthan, 324001, India
| | - Deepika Mittal
- Govt Medical College, MBS Hospital, Nayapura, Kota, Rajasthan, 324001, India
| | - Rameshwar Nath Chaurasia
- Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, 221005, India
| | - L.P. Meena
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, 221005, India
| | - K S Vinay Urs
- ICMR-National Centre for Disease Informatics and Research, II Floor of Nirmal Bhawan, ICMR Complex Kannamangala Post, Bengaluru, 562 110, India
| | - Rahul Rajendra Koli
- ICMR-National Centre for Disease Informatics and Research, II Floor of Nirmal Bhawan, ICMR Complex Kannamangala Post, Bengaluru, 562 110, India
| | - Natesan Suresh Kumar
- ICMR-National Centre for Disease Informatics and Research, II Floor of Nirmal Bhawan, ICMR Complex Kannamangala Post, Bengaluru, 562 110, India
| | - Prashant Mathur
- ICMR-National Centre for Disease Informatics and Research, II Floor of Nirmal Bhawan, ICMR Complex Kannamangala Post, Bengaluru, 562 110, India
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Kalkonde YV, Rangamani S, Suwanwela NC, Mathur P, Injety RJ, Sebastian IA, Vijayanand PJ, Chawla NS, Sylaja P, Sharma M, Pandian JD. Surveillance of stroke: a South-East Asia Region (SEAR) perspective. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 17:100286. [PMID: 37849929 PMCID: PMC10577148 DOI: 10.1016/j.lansea.2023.100286] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/13/2023] [Accepted: 09/16/2023] [Indexed: 10/19/2023]
Abstract
Surveillance of stroke is critical to track its burden and assess progress in prevention and treatment. We reviewed the literature to evaluate stroke surveillance efforts in the South-East Asia Region (SEAR) countries, identify progress and assess gaps. Epidemiological data on all the major parameters such as the incidence, prevalence and mortality of stroke were available for India and Thailand but for none of the other SEAR countries. Most of the epidemiological data came from investigator-initiated studies. National stroke surveillance was present only in India in the form of a National Stroke Registry Programme and Thailand has a national database that was used to obtain epidemiological data for stroke. Research on novel methods for stroke registration, such as using information technology, was absent. This review identified serious gaps in the monitoring and surveillance of stroke in SEAR countries. Systematic efforts are needed to fill those gaps.
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Affiliation(s)
| | - Sukanya Rangamani
- National Centre for Disease Informatics and Research, Indian Council of Medical Research, Bangalore, Karnataka, India
| | - Nijasri C. Suwanwela
- Division of Neurology, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Prashant Mathur
- National Centre for Disease Informatics and Research, Indian Council of Medical Research, Bangalore, Karnataka, India
| | - Ranjit J. Injety
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, Punjab, India
| | - Ivy A. Sebastian
- Consultant Neurologist, St. Stephen's Hospital, New Delhi, India
| | - Pranay J. Vijayanand
- Department of Neurology, Christian Medical College & Hospital, Ludhiana, Punjab, India
| | - Nistara S. Chawla
- Department of Neurology, Christian Medical College & Hospital, Ludhiana, Punjab, India
| | - P.N. Sylaja
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Meenakshi Sharma
- Division of Non-Communicable Diseases, Indian Council of Medical Research, New Delhi, India
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Varkey BP, Joseph J, Varghese A, Sharma SK, Mathews E, Dhandapani M, Narasimha VL, Kuttan R, Shah S, Dabla S, Dhandapani S. The Distribution of Lifestyle Risk Factors Among Patients with Stroke in the Indian Setting: Systematic Review and Meta-Analysis. Ann Neurosci 2023; 30:40-53. [PMID: 37313337 PMCID: PMC10259149 DOI: 10.1177/09727531221115899] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/08/2022] [Indexed: 09/29/2023] Open
Abstract
Background The burden of stroke is increasing in India, but there is limited understanding of the distribution of reported risk factors in the Indian setting. It is vital to generate robust data on these modifiable risk factors to scale up appropriate strategies for the prevention of cerebrovascular diseases in this setting. Summary The objective of this study is to estimate the overall proportion of life style risk factors of patients with stroke in the Indian setting. We searched PubMed and Google Scholar and relevant studies published till February 2022 were included. The risk of bias assessment was considered for the study selection criterion in the meta-analysis. The publication bias was evaluated by funnel plots and Egger's test. We identified 61 studies in the systematic review and after quality assessment, 36 studies were included for meta-analysis. Random effect model was used due to the significant inconsistency among the included studies (I2 > 97%). The mean age of the participants was 53.84±9.3 years and patients with stroke were predominantly males (64%). Hypertension (56.69%; 95% CI: - 48.45 - 64.58), obesity (36.61%; 95% CI: - 19.31 - 58.23), dyslipidemia (30.6%; 95% CI: - 22 - 40.81) and diabetes mellitus (23.8%; 95% CI: - 18.79 - 29.83) are the leading intermediate conditions associated with stroke. The Physical inactivity - 29.9% (95% CI: - 22.9 - 37.1), history of tobacco use (28.59 %; 95% CI: - 22.22 - 32.94) and alcohol use (28.15 %; 95% CI: - 20.49 - 37.33) were reported as the behavioral risk factors for stroke in this setting. Key Messages The current meta-analysis provides robust estimates of the life style related risk-factor of stroke in India based on the observational studies conducted from 1994 to 2019. Estimating the pooled analysis of stroke risk factors is crucial to predict the imposed burden of the illness and ascertain the treatment and prevention strategies for controlling the modifiable risk factors in this setting.
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Affiliation(s)
- Biji P. Varkey
- Department of Neurology, Postgraduate Institute of Medical Sciences, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Jaison Joseph
- Department of Psychiatric Nursing, College of Nursing, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, Haryana, India
| | | | - Suresh K. Sharma
- College of Nursing, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Elezebeth Mathews
- Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, India
| | - Manju Dhandapani
- National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Chandigarh, India
| | | | - Radha Kuttan
- College of Nursing, Bhopal Memorial Hospital and Research Centre, ICMR, Bhopal, Madhya Pradesh, India
| | - Saleena Shah
- Government College of Nursing Thiruvananthapuram, Kerala, India
| | - Surekha Dabla
- Department of Neurology, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, Haryana, India
| | - Sivashanmugam Dhandapani
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Chandigarh, India
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Jones SP, Baqai K, Clegg A, Georgiou R, Harris C, Holland EJ, Kalkonde Y, Lightbody CE, Maulik PK, Srivastava PMV, Pandian JD, Kulsum P, Sylaja PN, Watkins CL, Hackett ML. Stroke in India: A systematic review of the incidence, prevalence, and case fatality. Int J Stroke 2022; 17:132-140. [PMID: 34114912 PMCID: PMC8821978 DOI: 10.1177/17474930211027834] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 06/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The burden of stroke is increasing in India; stroke is now the fourth leading cause of death and the fifth leading cause of disability. Previous research suggests that the incidence of stroke in India ranges between 105 and 152/100,000 people per year. However, there is a paucity of available data and a lack of uniform methods across published studies. AIM To identify high-quality prospective studies reporting the epidemiology of stroke in India. SUMMARY OF REVIEW A search strategy was modified from the Cochrane Stroke Strategy and adapted for a range of bibliographic databases from January 1997 to August 2020. From 7717 identified records, nine studies were selected for inclusion; three population-based registries, a further three population-based registries also using community-based ascertainment and three community-based door-to-door surveys. Studies represented the four cities of Mumbai, Trivandrum, Ludhiana, Kolkata, the state of Punjab, and 12 villages of Baruipur in the state of West Bengal. The total population denominator was 22,479,509 and 11,654 (mean 1294 SD 1710) people were identified with incident stroke. Crude incidence of stroke ranged from 108 to 172/100,000 people per year, crude prevalence from 26 to 757/100,000 people per year, and one-month case fatality rates from 18% to 42%. CONCLUSIONS Further high-quality evidence is needed across India to guide stroke policy and inform the development and organization of stroke services. Future researchers should consider the World Health Organization STEPwise approach to Surveillance framework, including longitudinal data collection, the inclusion of census population data, and a combination of hospital-registry and comprehensive community ascertainment strategies to ensure complete stroke identification.
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Affiliation(s)
| | - Kamran Baqai
- University of Central Lancashire, Preston, Lancashire, UK
| | - Andrew Clegg
- University of Central Lancashire, Preston, Lancashire, UK
| | | | - Cath Harris
- University of Central Lancashire, Preston, Lancashire, UK
| | | | - Yogeshwar Kalkonde
- Society for Education, Action and Research in Community Health, Gadchiroli, India
| | | | - Pallab K Maulik
- The George Institute for Global Health, New Delhi, India
- University of New South Wales, Sydney, Australia
- Manipal University, Manipal, India
| | | | | | - Patel Kulsum
- University of Central Lancashire, Preston, Lancashire, UK
| | - PN Sylaja
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | | | - Maree L Hackett
- University of Central Lancashire, Preston, Lancashire, UK
- The George Institute for Global Health, University of New South Wales, New South Wales, Australia
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Arshad F, MM S, Paplikar A, Rajendran S, Kalkonde Y, Alladi S. Vascular cognitive impairment in India: Challenges and opportunities for prevention and treatment. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2021; 3:100034. [PMID: 36324418 PMCID: PMC9616277 DOI: 10.1016/j.cccb.2021.100034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/22/2021] [Accepted: 11/23/2021] [Indexed: 06/16/2023]
Abstract
The burden of vascular contribution to cognitive impairment and dementia is substantially high in India. There are approximately 5.3 million dementia patients in India and nearly 40% are estimated to be due to vascular dementia. Several factors pose unique challenges to reducing the burden of vascular dementia and vascular cognitive impairment (VCI) in India. Wide heterogeneity in vascular risk factor profile, diversity in socioeconomic, ethnic and dietary factors, as well as regional and rural-urban differences impact uniform implementation of preventive and therapeutic strategies. There is limited evidence on the natural history of vascular disease from longitudinal cohorts in India. Additionally, the lack of advanced brain imaging and genetic information pose challenges to understanding pathophysiology and treatment response to VCI in India. Efforts are now being made to implement programmes to reduce cardiovascular risk and VCI at the population level. Cognitive and functional measures appropriate to the diverse linguistic and educational context have been developed to diagnose VCI across India. Multicentric clinical and research cohorts of stroke are also being established. Filling research gaps and developing intervention strategies for the Indian context are crucial to address the growing burden of VCI.
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Affiliation(s)
- Faheem Arshad
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Samim MM
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Avanthi Paplikar
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Srijithesh Rajendran
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
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Kalra LP, Khatter H, Ramanathan S, Sapehia S, Devi K, Kaliyaperumal A, Bal D, Sebastian I, Kakarla R, Singhania A, Rathore S, Klinsing S, Pandian JD, Foerch C. Serum GFAP for stroke diagnosis in regions with limited access to brain imaging (BE FAST India). Eur Stroke J 2021; 6:176-184. [PMID: 34414293 PMCID: PMC8370074 DOI: 10.1177/23969873211010069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/19/2021] [Indexed: 12/28/2022] Open
Abstract
Introduction Despite a high burden of stroke, access to rapid brain imaging is limited in many middle- and low-income countries. Previous studies have described the astroglial protein GFAP (glial fibrillary acidic protein) as a biomarker of intracerebral hemorrhage. The aim of this study was to test the diagnostic accuracy of GFAP for ruling out intracranial hemorrhage in a prospective cohort of Indian stroke patients. Patients and methods This study was conducted in an Indian tertiary hospital (Christian Medical College, Ludhiana). Patients with symptoms suggestive of acute stroke admitted within 12 h of symptom onset were enrolled. Blood samples were collected at hospital admission. Single Molecule Array technology was used for determining serum GFAP concentrations. Results A total number of 155 patients were included (70 intracranial hemorrhage, 75 ischemic stroke, 10 stroke mimics). GFAP serum concentrations were elevated in intracranial hemorrhage patients compared to ischemic stroke patients [median (interquartile range) 2.36 µg/L (0.61–7.16) vs. 0.18 µg/L (0.11–0.38), p < 0.001]. Stroke mimics patients had a median GFAP serum level of 0.14 µg/L (0.09–0.26). GFAP values below the cut-off of 0.33 µg/L (area under the curve 0.871) ruled out intracranial hemorrhage with a negative predictive value of 89.7%, (at a sensitivity for detecting intracranial hemorrhage of 90.0%). Discussion The high negative predictive value of a GFAP test system allows ruling out patients with intracranial hemorrhage. Conclusion In settings where immediate brain imaging is not available, this would enable to implement secondary prevention (e.g., aspirin) in suspected ischemic stroke patients as soon as possible.
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Affiliation(s)
- Love-Preet Kalra
- Department of Neurology, Goethe-University, Frankfurt am Main, Germany
| | - Himani Khatter
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | | | - Sameer Sapehia
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Kavita Devi
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | | | - Deepti Bal
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Ivy Sebastian
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Raviteja Kakarla
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Anusha Singhania
- Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Shubhra Rathore
- Department of Radiology, Christian Medical College, Ludhiana, Punjab, India
| | - Svenja Klinsing
- Department of Neurology, Goethe-University, Frankfurt am Main, Germany
| | | | - Christian Foerch
- Department of Neurology, Goethe-University, Frankfurt am Main, Germany
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8
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Affiliation(s)
- Ganesan Karthikeyan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029, India
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9
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Klochihina OA, Shprakh VV, Stakhovskaya LV, Polunina EA. [An analysis of the long-term stroke morbidity and mortality in the regions of the Russian Federation included in the Federal patient assistance reorganization program]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 120:37-41. [PMID: 33449531 DOI: 10.17116/jnevro202012012237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To analyze the average long-term incidence of stroke and mortality in the regions of Russia in the territories included in the Federal program for the reorganization of care for stroke patients from 2009 to 2016. MATERIAL AND METHODS The study is based on data from the territorial population register for an eight-year period for seven territories in the regions of Russia included in the Federal program for the reorganization of care for stroke patients. The study included the following territories: Stavropol krai, the Republic of Bashkortostan, Sverdlovsk region, Irkutsk region, Sakhalin region, and the Republic of Tatarstan. The total number of stroke cases in the study areas was 29 779. RESULTS The highest average incidence was shown in the Republic of Tatarstan, which had significant differences with all regions (p<0.001). The level of mean annual mortality was identified in Stavropol krai, which had significant differences with all regions (p=0.008-p<0.001). Significant differences in the average long-term stroke incidence were typical for nine pairs of territories out of 21 of the territories, and the average long-term stroke mortality was typical for six pairs of territories. CONCLUSION The incidence of stroke does not depend on the geographical location of the region, its economic development and ethnic composition of the population. The quality and effectiveness of primary prevention of cardiovascular diseases comes to the fore. In regions where it is not carried out at the proper level, the incidence of stroke is the highest. Only high-quality implementation of appropriate preventive measures will significantly reduce these indicators. Stroke mortality rates depend primarily on the quality of diagnosis and specialized medical care provided to stroke patients. The decrease in the mortality rate of these patients is possible only with the mandatory implementation of the approved clinical guidelines and protocols for treatment.
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Affiliation(s)
- O A Klochihina
- Prevent Age - International Institute of Integrative Preventive and Anti-Aging Medicine, Moscow, Russia
| | - V V Shprakh
- Irkutsk State Medical Academy of Postgraduate Education - branch of the Russian Medical Academy of Continuous Professional Education, Irkutsk, Russia
| | - L V Stakhovskaya
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - E A Polunina
- Astrakhan State Medical University, Astrakhan, Russia
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Kalkonde Y, Jadhao S, Deshmukh M, Sen Gupta S, Bang A. Gaps in secondary prevention among stroke survivors in rural Gadchiroli, India: a community-based cross-sectional study. Wellcome Open Res 2020; 5:263. [PMID: 33313419 PMCID: PMC7721060 DOI: 10.12688/wellcomeopenres.16377.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 01/19/2023] Open
Abstract
Background: With epidemiological transition, stroke has emerged as a public health priority in rural India. However, population-level information on secondary prevention of stroke from rural areas of India and other low- and middle-income countries remains exceedingly rare. Methods: In a cross-sectional community-based survey, trained surveyors screened a well-defined population of 74,095 individuals living in 64 villages in Gadchiroli district of India for symptoms of stroke. A trained physician evaluated screen positive patients, diagnosed stroke, measured blood pressure and collected information on prior diagnosis of risk factors and current use of medications using a structured questionnaire. Results: A total of 265 stroke survivors were identified. Prior diagnosis of hypertension was made in 57.4%, diabetes in 9.8%, hyperlipidaemia in 0.4%, ischaemic heart disease in 1.5%. and atrial fibrillation in 1.1%. Blood pressure was uncontrolled (>140/90) in 46% of stroke survivors. Among men 71.2% used tobacco and 30% used alcohol, while among women 38.2% used tobacco and none used alcohol. Only 40.8% of stroke survivors were receiving antihypertensive medications, while 10.6% were on antiplatelet agents and 4.9% were on statins. In a multivariate analysis, age <50 years (OR 0.2, 95% CI 0.1-0.5), male sex (OR 0.2, 95% CI 0.2-0.8) and lower economic status (no assets vs four assets; OR 0.3, 95% CI 0.1-0.9) were associated with lower odds of receiving medications for secondary prevention of stroke. Conclusions: There were significant gaps in secondary prevention of stroke in rural Gadchiroli. Healthcare programmes for secondary prevention of stroke in rural areas will have to ensure that blood pressure is adequately controlled, alcohol and tobacco cessation is promoted and special attention is paid to those who are younger, men and economically weaker.
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Affiliation(s)
- Yogeshwar Kalkonde
- Society for Education, Action and Research in Community Health (SEARCH), Gadchiroli, Maharashtra, 442605, India
| | - Sunil Jadhao
- Society for Education, Action and Research in Community Health (SEARCH), Gadchiroli, Maharashtra, 442605, India
| | - Mahesh Deshmukh
- Society for Education, Action and Research in Community Health (SEARCH), Gadchiroli, Maharashtra, 442605, India
| | - Shoummo Sen Gupta
- Society for Education, Action and Research in Community Health (SEARCH), Gadchiroli, Maharashtra, 442605, India
| | - Abhay Bang
- Society for Education, Action and Research in Community Health (SEARCH), Gadchiroli, Maharashtra, 442605, India
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Srivastava MP, Bhatia R, Vishnu VY, Goyal M. Essential Workflow and Performance Measures for Optimizing Acute Ischemic Stroke Treatment in India. Stroke 2020; 51:1969-1977. [DOI: 10.1161/strokeaha.119.026733] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- M.V. Padma Srivastava
- Head of Department (Neurology), All India Institute of Medical Sciences (AIIMS), New Delhi (M.V.P.S.)
| | | | | | - Mayank Goyal
- Department of Radiology, Seaman Family MR Research Centre, Foothills Medical Centre, Calgary, Canada (M.G.)
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Sudharsanan N, Deshmukh M, Kalkonde Y. Direct estimates of disability-adjusted life years lost due to stroke : a cross-sectional observational study in a demographic surveillance site in rural Gadchiroli, India. BMJ Open 2019; 9:e028695. [PMID: 31699719 PMCID: PMC6858195 DOI: 10.1136/bmjopen-2018-028695] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To directly estimate disability-adjusted life years (DALYs) lost due to stroke in rural Gadchiroli, India and measure the contribution of mortality and disability to total DALYs lost. DESIGN Cross-sectional descriptive study using population census, vital registration and stroke prevalence data. SETTING A demographic surveillance site of 86 villages in Gadchiroli, a rural district in Maharashtra, India. PARTICIPANTS Population counts and mortality information were drawn from a census and vital registration system covering a population of approximately 94 154 individuals; stroke prevalence information was based on a door-to-door evaluation of all 45 053 individuals from 39 of the 86 villages in the surveillance site. PRIMARY OUTCOME MEASURES Years of life lost (YLL), years lived with disability (YLD) and DALYs lost due to stroke. RESULTS There were 229 stroke deaths among the total population of 94 154 individuals and 175 stroke survivors among the subpopulation of 45 053 individuals. An estimated 2984 DALYs were lost due to stroke per 100 000 person-years with a higher burden among men compared with women (3142 vs 2821 DALYs). Over three-fourths (80%) of the total DALYs lost due to stroke were between ages 30 and 70 years. YLL accounted for 98.9% of total DALYs lost. CONCLUSIONS There was a high burden of stroke in rural Gadchiroli with a significant burden at premature ages. These results reveal a substantial need for surveillance and improved preventive and curative services for stroke in rural India.
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Affiliation(s)
- Nikkil Sudharsanan
- Center for Population and Development Studies, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- Heidelberg Institute of Global Health, Heidelberg University, Heidelberg, Germany
- Population Studies Center, University of Pennsylvania, Philadelphia, PA, United States
| | - Mahesh Deshmukh
- Society for Education Action and Research in Community Health, Gadchiroli, Maharashtra, India
| | - Yogeshwar Kalkonde
- Society for Education Action and Research in Community Health, Gadchiroli, Maharashtra, India
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13
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Urban Versus Rural Egypt: Stroke Risk Factors and Clinical Profile: Cross-Sectional Observational Study. J Stroke Cerebrovasc Dis 2019; 28:104316. [PMID: 31416762 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 07/19/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Egypt is a densely populated country with living habits and health care services that differ from urban to rural regions. We aimed to study how characteristics of stroke vary among these regions. METHODS This is a cross-sectional observational study of ischemic stroke, thus hemorrhagic and venous strokes were excluded. A total of 1475 ischemic stroke patients were recruited for analysis from a tertiary hospital in Cairo representing urban area and from a secondary care hospital in Suhag representing rural region. RESULTS Analysis was done for 1143 ischemic stroke patients from urban and 332 from rural area. Onset to door was shorter in urban. Urban patients showed an older age and higher prevalence of hypertension and diabetes (65.9%, 48.6% respectively), while rural patients were characterized by female preponderance (51.5%), more dyslipidemia, smoking 44.6%, stroke in young 20.5%, atrial fibrillation 23.8% % and recurrent stroke 44.3%. Rural cases showed a severer deficit at onset and poorer outcome. CONCLUSION Vascular risk factors, stroke type, and presentation tend to differ in Egypt according to the geographic distribution whether urban or rural. Studying patterns of such difference may aid in planning specific targeted preventive and therapeutic strategies for stroke in urban and rural Egypt.
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Venugopalan VY, Bhatia R, Pandian J, Khurana D, Kaul S, Sylaja PN, Arora D, Khatter H, Padma MV, Singhal AB. Regional differences in ischemic stroke in India (north vs. south). Int J Stroke 2019; 14:706-714. [PMID: 30702415 DOI: 10.1177/1747493019828538] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND India is a large country with geographically diverse populations and varying risk factors. Identification of regional differences can improve healthcare policy decisions. AIM To study regional differences in stroke between North and South India. METHODS We analyzed data from the Indo-US Collaborative Stroke Project, a National Institute of Health-funded multicentre prospective study conducted in five academic centers in India with a US-based coordinating center. Risk factors, severity, mechanisms, management, complications, and outcomes among ischemic stroke patients were compared between North and South Indian centers. RESULTS Of the 2066 patients enrolled from North (n = 1060) and South India (n = 1006), North Indian patients were significantly older with fewer men and had lower rates of diabetes (32.8% vs. 38.7%, p < 0.01), dyslipidemia (3.5% vs. 25.7%, p < 0.01), tobacco use (27% vs. 38%, p < 0.001), and alcohol use (30.1% vs. 38.6%, p < 0.01). North Indian patients had higher median National Institute of Health stroke scale scores (10 vs. 9, p < 0.01), more frequent large-artery atherosclerosis mechanism (34% vs. 25.6%, p < 0.001), intravenous thrombolysis (14.0% vs. 6.1%, p < 0.001), and lower rates of pneumonia (10.5% vs. 15.1%, p = 0.02). The three-month outcome (modified Rankin Scale score 0-2, 45.8% vs. 50.3%, p = 0.08) did not differ; however, North Indian patients had higher 90-day mortality (23.5% vs. 13.5%, p < 0.0001). CONCLUSIONS The substantial regional differences in stroke risk factors and mechanisms may be partly explained by factors such as differing dietary habits and lifestyle, which can be addressed at a national level. Differences in acute and inpatient stroke care suggest a need for better adoption of national stroke management guidelines.
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Affiliation(s)
- Vishnu Y Venugopalan
- Department of Neurology, All-India Institutes of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All-India Institutes of Medical Sciences, New Delhi, India
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, India
| | - Dheeraj Khurana
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhash Kaul
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - P N Sylaja
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | - Deepti Arora
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, India
| | - Himani Khatter
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, India
| | - M V Padma
- Department of Neurology, All-India Institutes of Medical Sciences, New Delhi, India
| | - Aneesh B Singhal
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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