Incidence, risk factors, prognosis, and health-related quality of life after stroke in a low-resource community in Chile (ÑANDU): a prospective population-based study

Abstract

Background Stroke is a leading cause of disability and death worldwide. The best estimates of local, national, and global burden of stroke are derived from prospective population-based studies. We aimed to investigate the incidence, risk factors, long-term prognosis, care, and quality of life after stroke in the Ñuble region of Chile. MethodsWe did a prospective community-based study with use of multiple overlapping sources of hospitalised, ambulatory, and deceased cases. Standardised diagnostic criteria were used to identify and follow up all cases occurring in the resident population of the Ñuble region, Chile (in a low-income rural-urban population including predominantly people of Indigenous-European heritage), for 1 year. Participants were included if they had a clinical diagnosis of stroke confirmed according to the study criteria. All cases were adjudicated by vascular neurologists. Incidence rates of first-ever stroke were calculated from the population of Ñuble according to the 2017 national census. FindingsFrom April 1, 2015, to March 31, 2016, we ascertained 1103 stroke cases, of which 890 (80•7%) were first-ever incident cases. The mean age of patients with first-ever stroke was 70•3 years (SD 14•1) and 443 (49•8%) were women. A CT scan was obtained in 801 (90%) of 890 patients (mean time from symptom onset to scan of 13•4 h (SD 29•8). The incidence of first-ever stroke age-adjusted to the world population was 121•7 (95% CI 113•7-130•1) per 100 000. The age-adjusted incidence rates, per 100 000 inhabitants, by main pathological subtypes were as follows: ischaemic stroke (101•5 [95% CI 90•9-113•0]); intracerebral haemorrhage (17•9 [13•5-23•4]), and subarachnoid haemorrhage (4•2 [2•1-7•3]). The 30-day case-fatality rate was 24•6% (21•9-27•6). At 6 months after the stroke, 55•9% (432 of 773) of cases had died or were disabled, which increased to 61•0% (456 of 747) at 12 months. Health-related quality of life in survivors was low at 6 months, improving slightly at 12 months after the stroke.Interpretation The incidence of stroke in this low-resource population was higher than our previous finding in northern Chile and within the mid-range of most population-based stroke studies. This result was due mainly to a higher incidence of ischaemic stroke, probably associated with increasing age and a high prevalence of cardiometabolic risk factors in the population studied. Our findings suggest that more should be done for the prevention and care of stroke in communities like the Ñuble population.

Assessment of Cerebrovascular Accident and Transient Ischemic Attack Risk Factors in Elderly vs. Non-Elderly Patients at a Tertiary Care Hospital in Eastern Province, Saudi Arabia

“…There was no significant difference in AF according to sex in patients aged 75 years and above [ 22 ]. A study in Chile showed that the frequency of AF in patients with ischemic stroke was similar to previous findings [ 23 ]; however, AF was more associated with females in another study conducted in China [ 12 ]. AF is also the most frequent risk factor for ischemic stroke among people with multiple vascular risk factors [ 10 ].…”

Tendencia de la mortalidad por enfermedades cerebrovasculares en Chile entre 1980 y 2015

“…Por otra parte, en un estudio ejecutado en la Región de Ñuble (2021) la incidencia de ECV ajustada por edad fue 163,4 por 100.000 habitantes. La letalidad a 30 días fue de 24,6% y de 30% a los 6 meses 9 .…”

Stroke risk and its association with quality of life: a cross-sectional study among Chinese urban adults

“…Although abundant evidence has shown stroke led to lower quality of life [ 8 , 15 – 17 ], few studies have explored the opposite direction–-the impact of quality of life on stroke. Using stroke risk as dependent variable, and quality of life and its four domains as dependent variables, our study has consistently shown that lower quality of life (including lower physical health, psychological health, social relationships, and environment) was associated with higher risk of stroke in multinominal logistic regressions.…”

“…The association between psychosocial factors such as quality of life and stroke risk has also been widely studied, with most studies showing that people’s quality of life significantly decreased after stroke [ 8 , 15 – 17 ]. Although quality of life has been frequently assessed as a poststroke outcome, evidence has shown that quality of life also serves as an important predictor for some major diseases such as myocardial infarction (MI), heart failure, diabetes mellitus, and hemodialysis [ 18 – 23 ].…”