The epidemiology and management of stroke in French Guiana

Dévi Rita Rochemont,Martine Papaix-Puech,Mathieu Nacher,Caroline Misslin-Tritsch,Emmanuel Delmas,Yannick Bejot,Emmanuelle Mimeau,Isabelle Fournel,Bertrand Detoffol

doi:10.1186/s12883-020-01650-2

Abstract

BackgroundFrench 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.MethodsWe 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.ResultsAmong 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.ConclusionsThe 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.

Highlights

French Guiana has the highest incidence of ischemic and hemorrhagic stroke of all French territories
French Guiana benefits from a universal health care system just like mainland France, the administrative goal of equity struggles with the field reality of French Guiana: Health
Study design The design was a cross-sectional analysis of prospective data collection from patients presenting a first episode of stroke in French Guiana described in detail in [17]

Summary

Introduction

French Guiana has the highest incidence of ischemic and hemorrhagic stroke of all French territories. There is no further information on the epidemiology and management of stroke in French Guiana. The major stroke risk factors – both for French Guiana is a French territory in South America situated between Brazil and Suriname. French Guiana benefits from a universal health care system just like mainland France, the administrative goal of equity struggles with the field reality of French Guiana: Health. Rochemont et al BMC Neurology (2020) 20:109 professional density is a third of the average in mainland France and access to care is generally more difficult with geographical heterogeneities. French Guiana is marked by socio-economic difficulties, which may lead to social inequalities regarding health and access to care [13, 14]

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