Abstract
BackgroundThe burden of cerebrovascular disease in developing countries is rising sharply. The prevalence of established risk factors of stroke is exceptionally high in Pakistan. However, there is limited data on the burden of stroke and transient ischemic attack (TIA) in South Asia. We report the first such study conducted in an urban slum of Karachi, Pakistan.MethodsIndividuals 35 years of age or older were invited for participation in this investigation through simple random sampling. A structured face-to-face interview was conducted using a pre-tested stroke symptom questionnaire in each participant to screen for past stroke or TIA followed by neurological examination of suspected cases. Anthropometric measurements and random blood glucose levels were recorded. Multivariable logistic regression was used to determine the association of vascular risk factors with prevalence of stroke.ResultsFive hundred and forty five individuals (49.4% females) participated in the study with a response rate of 90.8%. One hundred and four individuals (19.1%) were observed to have a prior stroke while TIA was found in 53 individuals (9.7%). Overall, 119 individuals (21.8% with 66.4% females) had stroke and/or TIA. Female gender, old age, raised random blood glucose level and use of chewable tobacco were significantly associated with the prevalence of cerebrovascular disease.ConclusionThis is the first study demonstrating an alarmingly high life-time prevalence of cerebrovascular disease in Pakistan. Individual and public health interventions in Pakistan to increase awareness about stroke, its prevention and therapy are warranted.
Highlights
The burden of cerebrovascular disease in developing countries is rising sharply
The risk of stroke has increased by 100% in low and middle income countries over the last decade and the developing world accounts for 85.5% of mortality due to all stroke deaths worldwide[1] Socioeconomic transition in low and middle income countries is likely to increase the burden of cerebrovascular disease[2] Patients who suffer from stroke in countries such as Pakistan are almost a decade younger than their western counterparts and the disability in stroke survivors and resulting economic losses may be greater[3]
Hypertension affects one in three adults aged greater than 45 years and 19% of the population aged 15 years and above[4] The National Health Survey of Pakistan showed that diabetes mellitus is present in 35% of people older than 45 years[4] The overall prevalence of obesity is 28% in women and 22% in men while the prevalence of tobacco use is 33% in men and 4.7% in women[5,6] Given the wide prevalence of risk factors, the burden of stroke in Pakistan is likely to be substantial
Summary
The burden of cerebrovascular disease in developing countries is rising sharply. The prevalence of established risk factors of stroke is exceptionally high in Pakistan. The risk of stroke has increased by 100% in low and middle income countries over the last decade and the developing world accounts for 85.5% of mortality due to all stroke deaths worldwide[1] Socioeconomic transition in low and middle income countries is likely to increase the burden of cerebrovascular disease[2] Patients who suffer from stroke in countries such as Pakistan are almost a decade younger than their western counterparts and the disability in stroke survivors and resulting economic losses may be greater[3]. No multiethnic prevalence studies of stroke or TIA have been reported from Pakistan to date. The present study reports the life-time prevalence of stroke and TIA and their associated modifiable risk factors in a multiethnic urban population. 50% have received no education while 10% have received religious education only
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