The influence of the war events on the epidemiology of cerebrovascular diseases and strokes among residents of Kyiv, Ukraine

Abstract

Background. In Ukraine, mortality rates from cerebrovascular diseases (CVD) are 10–17 % higher than in Europe. The number of registered cases of strokes is increasing in the world and this tendency is expected to continue in the coming years. One of the factors affecting epidemiological indicators is military conflicts. This mostly applies to low- and middle-income countries due to the complexity of providing medical care. Large studies testify to the negative impact of military actions on the morbidity and mortality from CVD, a change in the structure of strokes due to an increase in the proportion of intracerebral hemorrhages, and an increase in the number of young and middle-aged patients. People who live in war zones have a higher risk of heart disease and stroke, even years after the war ends. This is due to an increase in the share of both medical and non-medical risk factors. Considering world tendency, the study of epidemiological indicators regarding the prevalence, morbidity, and mortality of both cardiovascular disease in general and cerebral strokes in particular and the comparison of these data in the pre-war and war periods is relevant not only for Ukraine. The purpose was to provide an epidemiology of CVD and cerebral stroke among the adult population of Kyiv in the prewar and wartime periods. Materials and methods. The data from the statistical reports of CVD and stroke in Kyiv from 2007 to 2023 were analyzed using statistical methods and the systematic approach. Results. There was a decrease in the prevalence and morbidity of cerebrovascular diseases and cerebral stroke among adult residents of Kyiv in the pre-war period. These epidemiological findings were comparable to the general level in Ukraine but remained higher than in Western Europe. The most common risk factors were hypertension (28 % of the population), coronary heart disease (18.1 %), diabetes (1.3 %) as well as a high percentage of bad habits. In the first year of the war, the incidence rate of CVD and stroke in Ukraine decreased, and in the second year, it increased by 15 and 22 %, respectively. The incidence of cerebral strokes was the lowest in 2022 and amounted to 82.1 per 100,000 adult population, increasing in 2023 by 22.4 % to 100.5 per 100,000 population. The number of stroke patients in the city during 2022–2023 increased by 26.6 % compared to 2016. An increase in stroke hospitalizations was due to repeated strokes. The ratio of stroke types had also changed: in prewar times, it was 8.4 cases of ischemic strokes to 1 case of hemorrhagic stroke, during the war — 12.7 : 1. In 2022–2023, the mortality from CVD and all forms of cerebral strokes increased in Kyiv. Conclusions. The results of the study prove the negative impact of war on the epidemiology of CVD and stroke. An increase in the number of patients with CVD and cerebral strokes as well as a change in the ratio of stroke types and an increase in hospital mortality were noted.