Risk profile, clinical presentation, and determinants of stroke subtypes among patients with stroke admitted to public referral hospitals, Northwest Ethiopia in 2021: A cross-sectional study

Abstract

BackgroundStroke is the second leading cause of death worldwide, with a significant increase in stroke burden over the last two and half decades, especially in developing countries. African countries are undergoing an epidemiological transition from being dominated by infectious diseases to being double-burdened by non-communicable diseases, with existing infectious diseases driven by sociodemographic and lifestyle changes and a weak healthcare system. Data on the risk profile, clinical presentation, and predictors of stroke subtypes are still limited. Therefore, the main aim of this study was to assess the risk profile, clinical presentation, and predictors of stroke in public referral hospitals of Northwest Ethiopia.MethodsFor this study, 554 patients with stroke admitted to three public referral hospitals were prospectively followed up. Data were collected using a pre-tested interviewer-administered questionnaire. STATA version 16 was used for data analyses. Candidate variables significant in bivariate analysis were selected for multivariate binary logistic regression, and statistical significance was set at a p < 0.05.ResultsOf the 554 patients with stroke, 60.3% had an ischemic stroke. The mean age of the participants was 61 ± 12.85 years, and more than half (53.25%) of them were women. The most common risk factor identified was hypertension (29.7%), followed by congestive heart failure. The most common clinical presentation was hemiparesis, which was reported by 57.7% of the patients, followed by loss of consciousness (20.7%) and aphasia (9%). Through multivariable logistic regression, age (AOR = 1.03, 95% CI:1.01–1.05), sedentary physical activity level (AOR = 6.78, 95% CI:1.97–23.32), absence of a family history of chronic illness (AOR = 3.79, 95% CI:2.21–6.48), hypertension (AOR=0.51, 95% CI:0.31–0.85), and past stroke (AOR = 3.54, 95% CI:0.93–13.49) were found to be independent determinants of the stroke subtype.ConclusionAge, the level of sedentary physical activity, absence of a family history of chronic illness, hypertension, and past stroke were independent determinants of stroke subtype.

Association of socioeconomic status and poststroke cognitive function: A systematic review and meta‐analysis

“…In terms of stroke type, 12 studies exclusively enrolled patients diagnosed with ischemic stroke, 23–34 whereas the remaining included a combination of different stroke types or did not provide information about the stroke type. A total of 17 studies provided data on stroke severity on admission, 13 of which were assessed using the National Institutes of Health Stroke Scale 26,27,29,30,34–42 . Fourteen studies only enrolled participants who experienced their first‐time stroke, 12,28,31,34,36,39,40,42–48 and 16 studies included participants with stroke history 24–27,29,32,33,37,38,41,49–54 .…”

“…Fifteen studies tested more than one SES indicator, 12,23–25,28,29,35,38–41,43,46,50,52 while the remaining studies focused solely on a single indicator. Education was examined by most authors ( N = 32).…”

“…divided years of education into 4 levels 27 . Occupation was tested in 16 studies 12,23–25,28,29,35,39–43,45,46,50,52 . Occupational categories such as professionals and skilled workers were considered to have a higher SES, while those who were unemployed, retired, unskilled, or engaged in manual occupations had a lower SES.…”

“…Most of the research presented results derived from adjusted models. Three studies just reported frequencies of poststroke cognitive dysfunction by the level of SES, 33,35,41 so we used these frequencies to calculate unadjusted ORs. See Supplement for detailed definitions of SES.…”

“…Premorbid cognitive impairment and dementia were screened in most studies. Twenty‐eight studies excluded patients with pre‐stroke cognitive impairment or dementia, 12,23–32,34–44,46–48,50,51,53 either by medical history or by certain cognitive tests. One study provided the incidence of pre‐stroke cognitive impairment 49 .…”