The epidemiology and management of stroke in French Guiana

Abstract

Background French Guiana has the highest incidence of ischemic and hemorrhagic stroke of all French territories. However, there is no further information on the epidemiology and management of stroke in French Guiana. Our goal was to describe the characteristics of patients in French Guiana in order to generate hypotheses regarding the determinants explaining the magnitude of this public health problem. Methods We used the data of the French multicentre INDIA prospective cohort study which included consecutive patients aged > 18 years with a first-ever stroke from June 2011 to October 2014. For the present study, only patients with ischemic or hemorrhagic stroke admitted in one of the 3 participating hospitals were analyzed. Results Among the 298 patients (mean age 62.2 ± 14.5 years, 63.7% man) included in French Guiana, 52% were born abroad. Most strokes were ischemic strokes (79%), 14% of which were thrombolyzed. Hypertension (70.2%), history of smoking (22%) and diabetes (25%) were the most common risk factors and 28.4% of patients had known but untreated hypertension. Overall 89 (38%) patients with ischemic stroke were admitted less than 4.5 h after the first symptoms. In-hospital mortality was greater for intracerebral hemorrhage (18.7%) than for ischemic stroke (4.2%). Overall, 84.5% had health insurance coverage and among these, 41.9% had CMU, the universal health insurance for the poor. Conclusions The present study is the first epidemiologic description of stroke in French Guiana. The comparisons of these results show that stroke patients in French Guiana are epidemiologically atypical because they are younger, and more likely to be males than patients in mainland France. Stroke risk factors and delay between stroke and hospital admission were comparable with what is observed in France, suggesting that efforts should focus on primary care and social inequalities of health to alleviate the main determinants of stroke in French Guiana.

Diabetes Care in French Guiana: The Gap Between National Guidelines and Reality

“…Cardiovascular causes are the first cause of mortality in patients with diabetes ( 17 ). Cardiovascular complications are also important in French Guiana, particularly strokes, for which incidence is double that of other French territories ( 4 ).…”

“…The population of patients with treated diabetes has almost tripled in 12 years from 2467 in 2004 to 6795 patients in 2016 with a strong female predominance (61%). Moreover, the comparative mortality rate related to diabetes is 3 times higher than the national French rate per 100 000 inhabitants: 52 and 18% respectively ( 3 ), cardiovascular events being the main cause of death (the prevalence of stroke is one of the highest in France) ( 4 ). The renunciation of care –or non-demand of care— is important in French Guiana.…”

Cerebral function imaging of acupuncture treatment for stroke: A protocol for systematic review and meta-analysis

“…The World Health Organization (WHO) refers to stroke as the incoming epidemic of the 21st century, and it is expected to increasingly affect younger patients. In Europe, stroke cause over 1 million deaths, and worldwide, stroke cause 6.5 million deaths [2] . According to a report published in The Lancet, stroke has become the leading cause of death in China since 2017, and stroke burden in China has increased over the past 30 years, especially remains particularly high in rural areas [3,4] .…”

Risk factors for hypoglycaemia in people with diabetes admitted to the Emergency Department of a Hospital in French Guiana

“…It is associated with a high morbidity and mortality rates and a high prevalence of neurovascular disorders, which are a leading cause of premature death within the territory. 7 The most recent guidelines from the French Diabetes Society, published in 2019, 8 and the European and American guidelines 9 have highlighted the importance of adapting individualized glycaemic targets according to age, comorbidities and the duration of diabetes. Many studies before 2012 10,11 highlighted the deleterious effect of an overly strict glucose management in people with high cardiovascular risk, kidney failure or in the elderly with a long history of diabetes.…”

“…Diabetes is a major public health concern and is one of the main cardiovascular risk factors. It is associated with a high morbidity and mortality rates and a high prevalence of neurovascular disorders, which are a leading cause of premature death within the territory 7 . The most recent guidelines from the French Diabetes Society, published in 2019, 8 and the European and American guidelines 9 have highlighted the importance of adapting individualized glycaemic targets according to age, comorbidities and the duration of diabetes.…”