Introduction

Article by: Rashmi Gadkari, Research Assistant, Interdisciplinary School of Health Sciences. Pune University, India

Stroke has a major share in long-term disability-related deaths worldwide. High rates of mortality have been reported due to stroke (Cerebro-vascular accident, CVA). Thus, it is an important public health problem and a major cause of chronic non-communicable diseases (NCDs). A stroke occurs if the flow of oxygen-rich blood to a portion of the brain is blocked. Without oxygen, brain cells start to die after a few minutes. Sudden bleeding in the brain also can cause a stroke if it damages brain cells. A stroke can cause long-lasting brain damage, long-term disability, or even death. Stroke is the second leading cause of long-term disability and death worldwide. Quality of life declines after stroke with relation to age, mood, stroke severity, urinary incontinence, functional status, and cognition.

Previous epidemiological studies have mainly concentrated on incidence but, as many stroke patients survive with some disability for many years, the impact of stroke on the community is best assessed by prevalence studies. More information is needed, especially concerning the influence of social demographics on stroke outcome in addition to many other predictor variables.

Burden

In 2010, 6.8 million US adults were stroke survivors, and these prevalence rates are predicted to increase by up to 25% over the next two decades.  Stroke is the leading cause of disability in the United States and affects 15 million people worldwide. CVA is the leading cause of death in Brazil and the second cause worldwide and in developed countries in the WHO’s ranking, only behind ischemic heart disease. Stroke is both the third most common cause of death in the United Kingdom and a major cause of morbidity. Studies from the developed world have an estimated prevalence of 410–715/100 000. A recent review on stroke epidemiology data in Hong Kong, Taiwan, South Korea, Singapore, Malaysia, Thailand, Philippines, and Indonesia, reported that the proportion of ischemic and hemorrhagic strokes varied from 17 % to 33 %. Prevalence in China has been reported as 200-300 per 100,000. There is an increase in the number of individuals affected by stroke. Factors like tobacco smoking, physical inactivity, alcohol use, and obesity are responsible for about 60% of stroke cases in Canada.

People who are relatively more deprived in socioeconomic status suffer poorer outcomes after ischemic stroke. Similarly, people with low socioeconomic status (SES) have an increased incidence of stroke and higher mortality after stroke. In developed countries stroke is mainly a problem of elderly people but in the Oxford shire Community Stroke Project (OCSP) only 8% of strokes occurred in those aged 54 and under. An increase in blood pressure, both diastolic and systolic, within a healthy population is strongly associated with subsequent stroke risk. Older age, lower education level, previous history of stroke, stroke severity at admission, depression, cognitive impairment at 3 months, and stroke recurrence within 5 years follow up were all significantly associated with post-stroke disability in China. The younger onset of stroke in the Western Cape, South Africa, implicates that stroke survivors could have a longer life to live with the devastating consequences of stroke if left untreated. Most myocardial infarction and stroke hospitalizations were associated with significant increases in functional disability at the time of the event and in the decade afterward. Survivors of myocardial infarction and stroke warrant screening for functional disability over the long term.

Wagering on functional disability as a reliable indicator of disability, it is possible to conclude that 24% to 49% of the population that survives stroke has some level of disability, which can vary according to age, stroke recurrence, time of evaluation and instrument applied. Factors associated with death and functional outcome were largely non-modifiable. Age is an important factor in the incidence of cardiovascular accidents or stroke (CVA), since the risk increases twice every ten years after 55 years of age. The impact of CVA on the language, participation, and functionality of the group studied by analyzing, using the ICF. Old age, high blood pressure, prior stroke or Transient Ischemic Attack (TIA), diabetes, high cholesterol, tobacco smoking, and atrial fibrillation were the major risk factors for stroke. High blood pressure is the most important modifiable risk factor of stroke. The risk factors significant for stroke in the Saudi population are systemic hypertension (38%), diabetes mellitus (37%), and heart disease such as atrial fibrillation, ischemic heart disease, valvular disease, cardiomyopathy (27%), smoking (19%) and family history of stroke (14%). Among the various treatable risk factors, hypertension was found to be the most important risk factor for stroke among the Saudi population.

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