Younger age of stroke in low‐middle income countries is related to healthcare access and quality

Abstract

Stroke is the second leading cause of mortality globally with higher burden and younger age in low‐middle income countries (LMICs) than high‐income countries (HICs). However, it is unclear to what extent differences in healthcare access and quality (HAQ) and prevalence of risk factors between LMICs and HICs contribute to younger age of stroke in LMICs. In this systematic review, we conducted meta‐analysis of 67 articles and compared the mean age of stroke between LMICs and HICs, before and after adjusting for HAQ index. We also compared the prevalence of main stroke risk factors between HICs and LMICs. The unadjusted mean age of stroke in LMICs was significantly lower than HICs (63.1 vs. 68.6), regardless of gender (63.9 vs. 66.6 among men, and 65.6 vs. 70.7 among women) and whether data were collected in population‐ (64.7 vs. 69.5) or hospital‐based (62.6 vs. 65.9) studies (all p < 0.01). However, after adjusting for HAQ index, the difference in the mean age of stroke between LMICs and HICs was not significant (p ≥ 0.10), except among women (p = 0.048). In addition, while the median prevalence of hypertension in LMICs was 23.4% higher than HICs, the prevalence of all other risk factors was lower in LMICs than HICs. Our findings suggest a much larger contribution of HAQ to the younger mean age of stroke in LMICs, as compared with other potential factors. Additional studies on stroke care quality and accessibility are needed in LMICs.

A Clinical Audit on Longer-Term Stroke Management as A Specific Service in A Primary Care Setting: Assessing Adherence of Service and Clinical Parameters

“…The clinical profiles of patients who received care at the LTSC facility revealed that the average age of stroke occurrence was 57.68 years ± 12.04. Although this age was below the global average for stroke, which was reported as 64.4 years (16), it corresponded to the recent mean age for stroke prevalence in Malaysia (54.5 - 62.6 years old) (17). This finding mirrored the current scenario in Malaysia, where stroke affects a much younger population compared to western countries.…”

Stroke signs knowledge and factors delaying acute stroke patients’ hospital arrival in the absence of stroke care systems. A Kinshasa multicenter cross-sectional study

“…An earlier age of onset is also evidenced in lowmiddle-income countries compared with high-income countries, regardless of sex, stroke subtype, and whether data were collected at the population or hospital level (37)(38)(39)]. This age variability of stroke occurrence could be explained by healthcare access and quality (40)] and could be attributed to the early onset of stroke risk factors such as hypertension in the DRC and elsewhere in Africa ( 41)].…”

Effect of Community Based Program on the Knowledge, Treatment Adherence and Quality of Life of Hypertensive Adults Through Precede Proceed Model

“…21,22 The study of researchers 23 even noted that conducting a community-based intervention with exercise and counseling sessions for 6 months significantly enhanced the physical fitness scores and self-care behaviors of patients with hypertension. 23,24 It should be noted, however, that lifestyle modifications should be tailor-fit and should be devised in consultation with the patient. By making these modifications fit to the patient, they can adhere to such changes based on their daily activities, and the factors that may lead to non-adherence can be mitigated.…”