Stroke Epidemiology In Southwestern Iran
Stroke Epidemiology In Southwestern Iran
Harmonizing to the World Health Organization definition, shot is the rapid patterned advance of marks and symptoms caused by bound or widespread break of encephalon map which has vascular beginning and takes more than 24 hours ( 1, 2 ) .Stroke can be by and large divided into two classs: Ischemic and hemorrhagic ( 1 ) .
The disease is the 2nd prima cause of decease in the universe and considered as the 3rd in the United States and other industrialised states ( 3-8 ) .55 million deceases occur each twelvemonth in the universe where 10 % of them are due to stroke ( 9 ) .
In the United States about 780,000 shots occur each twelvemonth ( one every 40 seconds ) while 87 % is ischaemic and 13 % is haemorrhagic type. Annual mortality of the disease in this state is 150,000 people ( one out of every 4-3 proceedingss ) so it is estimated that one out of every 16 Americans die due to stroke ( 9 ) .
In aˆ‹aˆ‹the Middle East and North Africa deceases happening within 28 yearss of the morbid varies from 10 % in Kuwait to 31/5 % in Iran ( 4 ) . This disease, which two-thirds of all instances of it occurs in developing states, although preventable but is increasing ( 12, 13 ) . Prognosiss suggest that by 2030 deceases from shot will duplicate in the Middle East and North Africa ( 4 ) . Increasing age is such major hazard factor for the disease that after age 55, the hazard of shot doubles every 10 old ages ( 7 ) . High blood force per unit area as the most common preventable causes of the disease is an other hazard factor ( 11 ) . Other hazard factors include: diabetes, smoke, fleshiness, deficiency of exercising, eating a diet high in cholesterin and salt, intoxicant, atrial fibrillation, and household history of OCP usage ( 7, 11, 14, 15 ) . In add-on gender is deciding factor in this disease ; In general shot is more likely to happen in work forces However, due to the longer life anticipation of adult females on one manus and the high incidence of shot in older ages in the other manus, the figure of instances in adult females is more than in work forces ( 16 ) . Stroke Epidemiology In Southwestern Iran .
ORDER A PLAGIARISM-FREE PAPER NOW
Another note is that shot as the most of import factor for physical disablement in the universe, is one of the chief factors need long-run infirmary attention which led to a important addition in the cost of intervention ( 7, 8 ) . In general, the direct and indirect costs ( including old ages of lost benefits ) related to the disease in the United States is about 5.65 billion yearly ( 17 ) .
Consequences from few surveies in Iran shows incidence of shot about 43 instances per 100,000 people that 67 % is ischaemic and 23 % is haemorrhagic type ( 18, 19 ) . The most common hazard factor which has been achieved is high blood force per unit area with prevalence about 54 % ( 18, 19 ) . Incidence of shot was somewhat higher in adult females in all age classs ( 51-53 % ) However, in the age group 45-15 old ages occurs more in work forces ; while the mean age of incidence is in the 7th decennary of life. Death within 28 yearss of shot in a survey was 19.2 % , and in another 1 was 31.5 % ( 18 ) . Another survey refers to the unknown state of affairs of this disease in the Middle East and mismatch with informations in Western states ( 1 ) that one time once more makes clear the demand for more surveies in this respect.
The lone survey conducted in Shiraz investigates early encephalon bleeding due to high blood force per unit area in patients referred to Shiraz University of Medical Sciences infirmaries during 2002-2004 ( 20 ) .
Sing the preventable nature of the disease, it is necessary to make more surveies to find hazard factors and implicit in causes in a peculiar population in order to Sketch and be after for the bar of it ( 18 ) .
Sing that no epidemiological survey have been conducted to clear up assorted facets of shot in Shiraz since earlier, this survey was conducted in Shiraz Namazee learning Hospital as a referral centre for shot patients in Fars state and southwesterly Iran to obtain general information about the position of the disease in this part.
Material and Method:
We conducted this hospital-based survey between August 2010 and January 2011 in Shiraz Namazee learning infirmary. This infirmary is one of the chief referral centres for neurological diseases in southwesterly Iran and affiliated with the Shiraz University of Medical Sciences, Shiraz, Iran. As this survey was a cross-sectional one, all patients admitted in exigency and neurology ward with diagnosing of shot based on their clinical manifestations and imaging ( MRI or CT scan ) during this period were included. Patients with transeunt ischaemic onslaught and those who released by themselves during hospital coarse were excluded. Stroke Epidemiology In Southwestern Iran .Three medical pupils with supervising and part of one neurology occupant completed the informations assemblage sheet by reading patient paperss during and after study period. It contains the most of import informations about these patients including age, sex, type of shot, drug history, hazard factors, degree of consciousness, neurologic marks, continuance of hospitalization, result and prescribed medicines after discharge. We analyzed our informations with SPSS version 16 and considered P-Value less than 0.05 important.
Consequences:
305 CVA patients were investigated that 269 ( 88.2 % ) had ischaemic and 36 ( 11.8 % ) had hemorrhagic shot. 64 ( 21 % ) had recurrent stroke while others experienced their first of all time shot.
133 ( 43.6 % ) adult male and 172 ( 56.4 % ) adult female between 27- 97 old ages old ( mean:68.33±12.99 ) were classified to six age groups that most of them were between 61-80 old ages old, although informations analysis did n’t uncover important difference between mortality rates ( Table 1 ) . Average age of ischaemic shot was 68.6±13.1 and hemorrhagic was 66.2±12.1.
15.1 % of all patients expired during their hospital coarse while 11.4 % of ischaemic and 40.6 % of haemorrhagic shots lead to decease ( OR:5.34, 95 % C.I. :2.35-12.11 ) .
Most common hazard factors among all patients were high blood pressure and ischaemic bosom disease ( figure 1 ) . Hyperlipidemia, ischaemic bosom disease and diabetes had important different prevalence between age groups in a manner that their most prevalence were between 41-50, above 60 and between 41-60 old ages old, severally ( figure 2 ) .
In another categorization we categorized the patients into two groups: under and above 45 old ages old. 5 % were under 45 and 95 % were above 45 old ages old. CVA type and mortality rate was non significantly different between these two groups. Stroke Epidemiology In Southwestern Iran .
Most common neurologic marks of patients were right side failing, left side failing and dysarthria ( figure 3 ) .
In facet of degree of consciousness, 6.3 % were comatose, 7.2 % Stuporous, 22 % confused and 64.5 % were witting that 78.6 % , 31.3 % , 16.3 % and 5.6 % of them expired during their hospital coarse severally ( figure 4 ) .
Mean systolic blood force per unit area in dismissed patients was 148.2mmHg and in expired patients was 144.7mmHg. Besides mean diastolic blood force per unit area in dismissed and expired patients was 84.5mmHg and 86.6mmHg severally. Mean systolic blood force per unit area in ischaemic shots was 145mmHg and in haemorrhagic shots was 160mmHg ( P=0.006 ) . Besides mean diastolic blood force per unit area in ischaemic shots and haemorrhagic 1s was 83mmHg and 90mmHg severally ( P=0.013 ) .
Most common drugs used among patients was antihypertensive drugs ( 43.3 % ) and acetylsalicylic acid ( 26.9 % ) . Statins ( 32.7 % ) and acetylsalicylic acid ( 31.6 % ) were most common drugs prescribed for ischaemic patients who were discharged.
Median yearss of hospitalization for both types of shot and both discharged and expired patients was 2.
Background: Stroke is the main cause of physical disability and the second leading cause of death worldwide. Two-thirds of all strokes occur in the developing countries. Despite being preventable, stroke is increasingly becoming a major health issue in these countries. The aim of this study was to evaluate the epidemiology of stroke in Shiraz, Iran, one of the main referral centers in the southwestern part of Iran.
Methods: A cross-sectional study was conducted on all stroke patients admitted to the Namazee Hospital, affiliated to Shiraz University of Medical Sciences, between August 2010 and January 2011. Patients’ demographic data, atherosclerosis risk factors, type of stroke, drug history, outcomes, and neurological signs were recorded. Stroke Epidemiology In Southwestern Iran .Chi-square test, Kolmogorov–Smirnov test, t-test, and Mann–Whitney U-test were used to analyze the data.
Results: A total of 305 patients with stroke, aged 27-97 years (mean ± SD = 68.33 ± 12.99), 269 patients (88.2%) had ischemic stroke (IS) and 36 (11.8%) had hemorrhagic stroke (HS). 133 patients (43.6%) were men and 172 (56.4%) were women. 11.4% of the patients with IS and 40.6% with HS died during hospitalization, causing 12.1% death in all stroke patients [Odds ratio (Or) = 5.34, 95% Confidence intervals (CI) = 2.35-12.11]. Hypertension, ischemic heart disease, diabetes, and recurrent stroke were the most common risk factors.
Conclusion: This study provides evidence that the epidemiology of stroke in the southwestern part of Iran may be similar to other places. However, it seems necessary and helpful to design a registration system for patients with stroke in Shiraz Namazee Hospital.
Introduction
According to the World Health Organization, stroke is the rapid progression of signs and symptoms, caused by limited or widespread disruption of brain function, that has vascular origin and takes more than 24 h.1,2 Stroke can be generally divided into two categories: Ischemic stroke (IS) and hemorrhagic stroke (HS).1
Stroke is the second leading cause of death worldwide which is considered as the third one in the United States and other industrialized countries.3–8 Each year, 55 million deaths occur in the world that 10% of them are due to the stroke.9 In the United States, about 780,000 strokes occur each year (one in every 40 s) while 87% are IS and 13% are HS.9–11 Annual mortality of the disease in this country is 150,000 people (one in every 4-3 min), so it is estimated that one out of every 16 Americans dies due to stroke.9
The deaths occurring within 28 days after the stroke in the Middle East and North Africa vary from 10% in Kuwait to 31.5% in Iran.4 Two-thirds of all strokes occur in the developing countries which, in spite of their preventable nature, are increasingly becoming a major health problem.12,13 It is expected that the deaths resulting from stroke will nearly double in the Middle East and North Africa by 2030.4 A major risk factor for the stroke is increasing age as every 10 years after age 55 the risk of stroke doubles.8 Another risk factor is high blood pressure, which is the most common preventable cause of the disease.11 Other risk factors are diabetes, smoking, obesity, lack of exercise, taking a diet which is high in cholesterol and salt, alcohol, atrial fibrillation, family history, and oral contraceptive pill usage.7,11,14,15 In addition, gender is a determinant factor in this disease. In general, stroke is more common in men. Stroke Epidemiology In Southwestern Iran .However, because of the longer life expectancy for women and a high incidence of stroke in the older ages, the number of women with stroke is higher than men.16
Stroke, as the main cause of physical disability worldwide, is one of the main reasons for prolonged hospital stay that can lead to a significant increase in the cost of treatment.7,8The direct and indirect cost of the stroke in the United States was 65.5 billion in 2008.17
A few studies conducted in Iran reported that the incidence of stroke is about 43 patients per 100,000 population.18 In a population-based study conducted in Mashhad, Iran, IS was 81.9% and HS was 15.1% of all the patients.1 The most common risk factor was high blood pressure with a prevalence rate of 54%.18,19 Incidence of stroke was slightly higher in women in all age groups (51-53%). However, in the age group of 15-45 years, stroke was more common in men, while the average age of its incidence is in the seventh decade of life. The hospital-based 28 days case fatality rate is reported at 19.2%20 and 31.5%21 in Iran. Another study refers to an unknown situation of this disease in the Middle East, that mismatch with data in the Western Countries that once again shows the need for more studies in this regard.1
One of the few studies conducted in Shiraz, Iran, in this field investigated early brain hemorrhage due to high blood pressure in patients referring to the hospitals of Shiraz University of Medical Sciences during 2002-2004.22 Another retrospective study investigated the documents of 16351 patients with stroke from 2001 to 2010 in Shiraz.23Regarding the preventable nature of the disease, it is necessary to do more studies to determine the risk factors and the underlying causes in a particular population in order to outline and plan to prevent it.18
Considering that few epidemiological studies have been previously conducted in Shiraz, we conducted this study in Shiraz Namazee Hospital as a referral center for patients with stroke in the Fars province and southwestern part of Iran to obtain general information about the status of the disease in this region. Stroke Epidemiology In Southwestern Iran .
Materials and Methods
This prospective cross-sectional study was conducted in Shiraz Namazee Hospital between August 2010 and January 2011. All patients with stroke, who were diagnosed based on their clinical manifestations and imaging (magnetic resonance imaging or computerized tomography scan), were included in the study and the patients with transient ischemic attack were excluded. Patients’ demographic data, atherosclerosis risk factors, type of stroke, drug history, neurological signs, duration of admission, and final outcomes were recorded.
SPSS software for Windows (version 16, SPSS Inc., Chicago, IL, USA) was used for the statistical analysis of the data. Chi-square test was used for the comparison between categorical variables and Kolmogorov–Smirnov test was used to report normally distributed quantitative data. In the case of normal variables, t-test and Mann–Whitney U-test were employed. P < 0.050 was considered statistically significant.
Cerebrovascular disease is the second commonest cause of death, and over a third of stroke deaths occur in developing countries. To fulfil the current gap on data, this systematic review is focused on the frequency of stroke, risk factors, stroke types and mortality in Iran.
Methods
Thirteen relevant articles were identified by keyword searching of PubMed, Iranmedex, Iranian University index Libraries and the official national data on burden of diseases. Stroke Epidemiology In Southwestern Iran .
Results
The publication dates ranged from 1990 to 2008. The annual stroke incidence of various ages ranged from 23 to 103 per 100,000 population. This is comparable to the figures from Arab Countries, higher than sub-Saharan Africa, but lower than developed countries, India, the Caribbean, Latin America, and China. Similarly to other countries, ischaemic stroke was the commonest subtype. Likewise, the most common related risk factor is hypertension in adults, but cardiac causes in young stroke. The 28-day case fatality rate is reported at 19-31%.
Conclusions
Data on the epidemiology of stroke, its pattern and risk factors from Iran is scarce, but the available data highlights relatively low incidence of stroke. This may reflect a similarity towards the neighbouring nations, and a contrast with the West.
Background
Iran, known as Persia until 1935, is located in Southwest Asia (figure (figure1).1). With an area of 1,648,000 square kilometers, Iran ranks sixteenth in size among the countries of the world and its climate ranges from subtropical to subpolar[1]. Its has a population of 70 million, with more than 13 millions living in the capital Tehran[2]. Stroke Epidemiology In Southwestern Iran .One quarter of its people are 15 years of age or younger, compared with 7.26% of the population aged 60 or over[2]. Iran with its Indo-European origin and historically being a major crossroad for human migration is a country composed of different ethnic groups including Persian (51%), Azeri (24%), Gilaki and Mazandarani (8%), Kurd (7%), Arab (3%) as well as, Baluch, Turkman, Jews, Armenians, Assyrians and Zoarastians[1].
Map of Iran.
Over the last couple of decades, there has been major improvement in education and health services. The number of universities has grown from 22 in 1978 to 54 state universities and 289 major private universities in 2009[3]. The Iranian Medical Council reports over 100,000 physicians, including 660 neurologists, practising in the year 2009[4]. However, about 150 neurologists are based in Tehran with over 40 MRI scanning centres, at least double than the necessary epuipment for the population[5]. According to the World Health Organisation (WHO), life expectancy at birth in Iran is estimated at 69 years for male and 73 years for female in 2006[6]. The total expenditure on health in 2005 is covered by the government and the private sector at 55.8% and 44.2%, respectively[6].
Cerebrovascular disease is the second commonest cause of death, and the 6th leading cause of diseases burden globally and expected to move to the 4th place by 2020[7]. Over 80% of all stroke deaths in the world occur in the developing countries[8]. However, stroke is largely preventable, so knowledge of risk factors within a certain country is an essential step in reducing the stroke rate and resulting disease burden. Also, lifestyle and vascular risk factors such as hypertension and diabetes vary among different countries and cultures. An examination of stroke frequency and clinical pattern in various nations is therefore important to understand the pattern of the disease in a certain population with the ultimate aim of reducing the stroke rate.Stroke Epidemiology In Southwestern Iran . Effective prevention programmes should also be based on data relevant to the country under study. The literature representing the burden of stroke in developing countries and Asia is lacking comprehensive data on Iran. Epidemiological studies of stroke in these countries are constantly bound to numerous limitations such as inadequate nationwide data sets, lack of standard population-based studies, flawed medical registration and discontinuity of data maintenance between the family physicians, state healthcare system as well as private sector. Furthermore, those published, can remain inaccessible when written in the local or national Persian journals. The aim of this paper is to systematically review the data related to the frequency, risk factors, types and mortality of stroke in Iran. This should identify future potential research areas and help in medical service planning in the Iran. To our knowledge, no previous systematic reviews of stroke in Iran have been undertaken.
Methods
Data collection
The data was collected over four stages: –
Stage 1 – search through PubMed
Publications on Stroke in Iran were identified by searching the PubMed using the keywords:- “stroke”, “intracranial bleed”, “intracranial haemorrhage”, “brain infarction”, “cerebrovascular disorders”, “cerebrovascular disease”, “epidemiology”, “incidence”, “prevalence” combined with “Iran”, “Iranian”, “Persian”, “Persia” and “Farsi”.
Titles and abstracts were scanned by one author (AH) to identify eligible studies according to agreed inclusion and exclusion criteria. The full paper of potential studies was retrieved for more detailed assessment.
Stage 2 – search through “Iranmedex” and Iranian University Index Libraries
IranMedex is the website for Iranian medical index database (http://www.iranmedex.com). The website is a search engine to identify studies published in Persian or English, including articles in Persian or International journals, medical thesis or scientific reports. IranMedex enables one to purchase some articles or abstracts but not all.
The above mentioned keywords were used to identify articles by searching Iranmedex for further articles. The titles of all related articles and medical theses were reviewed. Since the full papers of many studies were not available in the website of “Iranmedex”, one author (DSR) searched medical index for each major medical school in Iran, and the well-known Iranian medical journals to get hold of the relevant papers. To access the medical theses, medical index libraries were visited to copy or scan the relevant parts and forward it to the co-author (AH). Stroke Epidemiology In Southwestern Iran .
Stage 3 – search the references of the relevant papers
Each reference in all relevant papers was checked for any additional articles.
Stage 4 – Official Data on “Burden of Disease in Iran”
The data for the year 2003 is published in a book “National Burden of Disease & Injury in Iran”, so-called “The Green Book”, with exclusive rights to the Ministry of Health. It reports the results of the study on the national burden of disease. The ongoing project is implemented by the Ministry of Health and Medical Education including a team of epidemiologists, sociologists, medical and dental specialists. The study is conducted in 6 provinces including: Eastern Azarbayejan, Booshehr, Chahar Mahal & Bakhtiari, Khorasan, Hormozgan and Yazd. A software coding system, which is comparable with global burden of disease studies, is designed for the study to collect the data from both hospitals and primary health care systems.
ORDER A PLAGIARISM-FREE PAPER NOW
The access to the official data was obtained via direct communication with the current Ministry of Health in Iran. Although the data has valuable information on the nationwide burden of diseases, it does not carry strong pathophysiological and epidemiological value[9]. The reported incidence and mortality statistics are limited by inaccuracy, variable diagnostic and coding methods by both medical and non-medical administrative staff, and the absence access to detailed information on the cases, pathology subtypes, methods and individual studies. We therefore, did not include the data in this study.
Inclusion and exclusion criteria
Papers were selected for this systematic review if they fulfilled the following criteria:
1. The study was conducted in Iran,
2. The stroke is clearly defined, the definition varied in different studies: mostly defined as a focal neurological deficit, confirmed by a trained physician, that persisted for at least 24 hours; all the cases recruited to the study had brain computed tomography (CT) or magnetic resonance imaging (MRI) and underwent batteries of standard investigations including at least electrocardiography, blood count, serum electrolytes, blood sugar and lipid profile. Stroke Epidemiology In Southwestern Iran .
3. The study contained data about frequency (incidence, prevalence) or clinical pattern (types, risk factors and outcome) or mortality rate of stroke,
4. The study was published before 2nd February 2009, and written in English or Persian,
5. Studies on cerebral venous sinus thrombosis and comparative studies on individual stroke risk factor analysis were excluded.
Data extraction
The following data were extracted from identified papers: stroke incidence, prevalence, patient sex and age, stroke type, risk factors, and clinical outcome. The included articles were reviewed and data was analysed descriptively. Statistical analysis or meta-analysis was not attempted due to significant variability in both data sources and study methodologies. Stroke Epidemiology In Southwestern Iran.
