Abstract
Objective:To study the prevalence of stroke and associated risk factors in Khyber Pakhtunkhwa (KP) province of Pakistan.Methods:This study was a part of cross-sectional KP Integrated Population Health Survey 2016-17 conducted on population aging ≥18 years at 24 districts of KP. Primary (n=1061) and secondary sampling units (n=15724) were developed, based on urban/rural and socio-economic status. Each primary-unit comprised of 250-300 households. Sample was selected through a multi-staged stratified systematic cluster sampling technique by taking every 16th household per rural and every 12th household per urban-unit. A validated “Cincinnati Stroke Scale” for identification of stroke patients in community was used along with demographics and potential risk factors.Results:Among the 15724 randomly selected households, 22500 participants (51.4% females; 74.6% rural areas, mean age 42±12.6 years) were interviewed. Stroke was identified in 271 cases (137 males, 134 females; Mean age=43.39±0.85 years) and prevalence of stroke was 1.2% (1200 per 100,000 population). Obesity/overweight (38.8%), hypertension (21.8%), smoking (6.6%) and known diabetes mellitus (5.9%) were the common associated risk factors of stroke. Age groups >60 years (adjusted OR=1.68; 95% CI: 1.05-2.68); urban area (adjusted OR=1.68; 95% CI: 1.29-2.19); unemployment (adjusted OR=3.78; 95% CI: 2.49-5.73) and lower formal (primary) education (adjusted OR 2.18; 95% CI: 1.30-3.64) were significantly associated with stroke (p <0.05).Conclusion:Prevalence of stroke is 1.2% in the province of KP. Obesity, hypertension, smoking and Diabetes Mellitus are the common associated risk factors of stroke. Higher age, urban area, unemployment and lower formal education are significantly associated with stroke.
Highlights
Stroke is the second leading cause of global mortality after ischemic heart disease, accounting for about 10.2% of global deaths in 2016.1 Stroke contributed for 67.3% of deaths due to all neurological disorders.[2]
Stroke was responsible for 5.2% of global disability-adjusted life years (DALYs) lost in 2016.1 Worldwide, about 15 million new people develop a stroke on annual basis.[3]
Stroke in South Asia is different from rest of the world, in terms of higher prevalence rate, younger age, high mortality, increased burden of modifiable risk factors of stroke and some underresearched non-conventional risk factors.[7,8,9]
Summary
Stroke is the second leading cause of global mortality after ischemic heart disease, accounting for about 10.2% of global deaths in 2016.1 Stroke contributed for 67.3% of deaths due to all neurological disorders.[2]. Prevalence of stroke is increasing over the last three decades with annual increase of 14.3% being reported in low-incomes countries.[4] Significant variations in prevalence, morbidity and mortality of stroke have been reported across different geographic l ocations and regions, especially in countries with different socioeconomic status.[4,5,6]. South Asia, a major contributing region of the global stroke burden, showed gross difference in prevalence rates of stroke across different countries.[7] Stroke in South Asia is different from rest of the world, in terms of higher prevalence rate, younger age, high mortality, increased burden of modifiable risk factors of stroke and some underresearched non-conventional risk factors.[7,8,9]. Currently the sixth most populous country of the world, has limited populationbased, robust data on prevalence of stroke and its risk factors.
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