Burden of stroke attributable to selected lifestyle risk factors in rural South Africa.

Stephen M Tollman,Melanie Y Bertram,Mandy Maredza,Xavier F Gómez-Olivé

doi:10.1186/s12889-016-2805-7

Abstract

BackgroundRural South Africa (SA) is undergoing a rapid health transition characterized by increases in non-communicable diseases; stroke in particular. Knowledge of the relative contribution of modifiable risk factors on disease occurrence is needed for public health prevention efforts and community-oriented health promotion. Our aim was to estimate the burden of stroke in rural SA that is attributable to high blood pressure, excess weight and high blood glucose using World Health Organization’s comparative risk assessment (CRA) framework.MethodsWe estimated current exposure distributions of the risk factors in rural SA using 2010 data from the Agincourt health and demographic surveillance system (HDSS). Relative risks of stroke per unit of exposure were obtained from the Global Burden of Disease Study 2010. We used data from the Agincourt HDSS to estimate age-, sex-, and stroke specific deaths and disability adjusted life years (DALYs). We estimated the proportion of the years of life lost (YLL) and DALY loss attributable to the risk factors and incorporate uncertainty intervals into these estimates.ResultsOverall, 38 % of the documented stroke burden was due to high blood pressure (12 % males; 26 % females). This translated to 520 YLL per year (95 % CI: 325-678) and 540 DALYs (CI: 343-717). Excess Body Mass Index (BMI) was calculated as responsible for 20 % of the stroke burden (3.5 % males; 16 % females). This translated to 260 YLLs (CI: 199-330) and 277 DALYs (CI: 211-350). Burden was disproportionately higher in young females when BMI was assessed.ConclusionsHigh blood pressure and excess weight, which both have effective interventions, are responsible for a significant proportion of the stroke burden in rural SA; the burden varies across age and sex sub-groups. The most effective way forward to reduce the stroke burden requires both population wide policies that have an impact across the age spectra and targeted (health promotion/disease prevention) interventions on women and young people.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-016-2805-7) contains supplementary material, which is available to authorized users.

Highlights

Rural South Africa (SA) is undergoing a rapid health transition characterized by increases in non-communicable diseases; stroke in particular
It builds on our previous work that showed that stroke as a marker condition for cardiovascular disease has increased significantly over the years in rural South Africa [2]
Our results provide the first estimates of the stroke burden that could be averted by controlling the selected risk factors in rural areas of South Africa and provide crucial information that policy makers could use to determine the best course of action to effectively reduce the stroke burden in such settings

Summary

Introduction

Rural South Africa (SA) is undergoing a rapid health transition characterized by increases in non-communicable diseases; stroke in particular. The major risk factors for stroke are common to other noncommunicable diseases (NCDs) and are modifiable with effective interventions. They include high blood pressure, Increasing the nation’s life expectancy through prevention of premature deaths from NCDs and related lifestyle risk factors is a key health agenda for the South African government. This is the driving principle behind the five-year strategic plan called “Strategic Plan for the Prevention and Control of Non-Communicable Diseases. Few other studies corroborate these findings and indicate that in general, NCDs as well as risk factors have increased rural South Africa [7, 8]

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