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Pacheco‐Barrios K, Giannoni‐Luza S, Navarro‐Flores A, Rebello‐Sanchez I, Parente J, Balbuena A, de Melo PS, Otiniano‐Sifuentes R, Rivera‐Torrejón O, Abanto C, Alva‐Diaz C, Musolino PL, Fregni F. Burden of Stroke and Population‐Attributable Fractions of Risk Factors in Latin America and the Caribbean. J Am Heart Assoc 2022; 11:e027044. [DOI: 10.1161/jaha.122.027044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Stroke burden characterization studies in low‐ and middle‐income countries are scarce. We estimated the burden of stroke and its risk factors in Latin America and the Caribbean (LAC).
Methods and Results
We extracted GBD (Global Burden of Disease) study 2019 data on overall stroke and 3 subtypes (ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage) for 20 LAC countries. We estimated absolute and age‐standardized rates of disability‐adjusted life years, years of life lost, years lived with disability, and deaths. The population‐attributable fractions of 17 risk factors were estimated. All analyses were performed at regional and national levels by stroke subtype, sex, and age subgroups. In 2019, the LAC region had the fourth largest stroke burden worldwide (6.8 million disability‐adjusted life years), predominantly attributable to premature deaths (89.5% of disability‐adjusted life years). Intracerebral hemorrhage was the primary cause of the overall stroke burden (42% of disability‐adjusted life years), but ischemic stroke was the leading cause of disability (69% of total years lived with disability). Haiti and Honduras had the highest age‐standardized rates. Older adults and men had the largest burdens, although women had the highest rate of disability. Socioeconomic development level did not influence the burden. The major risk factor clusters were metabolic (high systolic blood pressure [population‐attributable fraction=53%] and high body mass index [population‐attributable fraction=37%]), which were more influential in hemorrhagic events, women, and older adults. Household air pollution was an important risk factor in low‐income countries in LAC.
Conclusions
The stroke burden and stroke‐related mortality in LAC are higher than the worldwide averages. However, stroke is a highly preventable disease in this region. Up to 90% of the burden could be reduced by targeting 2 modifiable factors: blood pressure and body mass index. Further research and implementation of primary and secondary prevention interventions are needed, as well as integrated national stroke care programs for acute, subacute, and rehabilitation management in LAC.
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Affiliation(s)
- Kevin Pacheco‐Barrios
- Research Department SYNAPSIS Mental Health and Neurology Non‐Profit Organization Lima Peru
- Neuromodulation Center and Center for Clinical Research Learning Spaulding Rehabilitation Hospital and Massachusetts General Hospital Boston MA USA
- Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud Lima Peru
- Department of Epidemiology Harvard T.H. Chan School of Public Health Boston MA
| | - Stefano Giannoni‐Luza
- Research Department SYNAPSIS Mental Health and Neurology Non‐Profit Organization Lima Peru
- Neuromodulation Center and Center for Clinical Research Learning Spaulding Rehabilitation Hospital and Massachusetts General Hospital Boston MA USA
| | - Alba Navarro‐Flores
- Research Department SYNAPSIS Mental Health and Neurology Non‐Profit Organization Lima Peru
- International Max Planck Research School for Neurosciences, Georg‐August‐University Göttingen Göttingen Germany
| | - Ingrid Rebello‐Sanchez
- Neuromodulation Center and Center for Clinical Research Learning Spaulding Rehabilitation Hospital and Massachusetts General Hospital Boston MA USA
| | - Joao Parente
- Neuromodulation Center and Center for Clinical Research Learning Spaulding Rehabilitation Hospital and Massachusetts General Hospital Boston MA USA
| | - Ana Balbuena
- Neuromodulation Center and Center for Clinical Research Learning Spaulding Rehabilitation Hospital and Massachusetts General Hospital Boston MA USA
| | - Paulo S. de Melo
- Neuromodulation Center and Center for Clinical Research Learning Spaulding Rehabilitation Hospital and Massachusetts General Hospital Boston MA USA
| | | | - Oscar Rivera‐Torrejón
- Facultad de Medicina Universidad Nacional Mayor de San Marcos Lima Peru
- Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI) Hospital Daniel Alcides Carrión Callao Peru
- Red de Eficacia Clínica y Sanitaria, REDECS Lima Peru
| | - Carlos Abanto
- Departamento de Enfermedades Neurovasculares Instituto Nacional de Ciencias Neurológicas Lima Peru
| | - Carlos Alva‐Diaz
- Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI) Hospital Daniel Alcides Carrión Callao Peru
- Red de Eficacia Clínica y Sanitaria, REDECS Lima Peru
- Universidad Señor de Sipán Chiclayo Peru
| | - Patricia L. Musolino
- Department of Neurology Massachusetts General Hospital, Harvard Medical School Boston MA
- Center for Genomic Medicine, Center for Rare Neurological Disorders Massachusetts General Hospital, Harvard Medical School Boston
| | - Felipe Fregni
- Neuromodulation Center and Center for Clinical Research Learning Spaulding Rehabilitation Hospital and Massachusetts General Hospital Boston MA USA
- Department of Epidemiology Harvard T.H. Chan School of Public Health Boston MA
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