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Research Article *Corresponding author Roghayeh Aslanian, Department of Neurology, Ardabil University of Medical Science, Iran, Email: Epidemiological Study of Stroke r[email protected] Submitted: 07 September 2017 in Ardabil, Iran: a Hospital Accepted: 25 September 2017 Published: 27 September 2017 Copyright Based-Study © 2017 Aslanian et al. Vahid Abbasi, Firouz Amani, Roghayeh Aslanian*, Ali OPEN ACCESS Hoseinkhani, and Anahita Zakeri Keywords Department of Neurology, School of medicine, Ardabil University of Medical Science, • Stroke; Epidemiology; Neurologic diseases Ardabil, Iran Abstract Introduction: Stroke is one of the neurologic diseases and the third common causes of death in USA after cancer and heart disease. Two-thirds of strokes occur in developing countries and people up 65 years old. Based on WHO report, the country Iran with 97.4 deaths per 100000 is in the 90th ranking between world countries. The aim of this study was epidemiological study on stroke in Ardabil city at 2015. Methods: A cross sectional study was conducted on 207 hospitalized stroke patients in Ardabil city hospital. The necessary data collected from patient’s hospital records and analyzed by statistical methods in SPSS.16. Results: 52% of patients were male and rest of them was female. 98% of patients were married and 67% were from urban. The mean age of patients was 70 ± 13 years. 71% of patients have hypertension and 47% history of stroke. Of all patients, 25.6% had the diabetes and Hypertension at the same time that the rate of mortality in these patients was 22.6%. Conclusion: This study showed that the epidemiology of stroke in the Ardabil city is similar to other places and doing more studies in future is essential.
INTRODUCTION stroke had prevalence about 87% in society [2]. Early diagnosis and proper management of strokes is very important in good The pattern of mortality in Iran and world had been changed prognosis patients and many efforts in processing at societies to from infection diseases such as AIDS and Malaria to chronic reduce disability and mortality in stroke patients. The aim of this diseases such as heart diseases and cancers. According to the study was epidemiological study of stroke in Ardabil city at 2015. WHO report, the four main reasons for mortality in 2030 will be heart failure, stroke, chronic obstructive pulmonary disease and MATERIALS AND METHODS lower respiratory tract infections [1]. A cross sectional study was conducted on 207 stroke patients Stroke is a non-communicable disease among the elderly from Apr 2014 to May 2015. The necessary data included age, population that is the third leading cause of death in developed gender, residence place, marital status, history of hypertension, countries after coronary artery diseases and cancers. According diabetes, myocardial infarction and previous stroke, vital WHO report, 56.4 million deaths occurred worldwide in 2015 symptoms such as pulse rate, heart rate, fever, and length of that 54% of them were among the top ten causes of death [2,3]. stay in hospital and treatment outcome collected from patient’s There was wide geographic variation in the rate of mortality, hospital records by researchers and entered in the checklist and especially among older people and meanwhile, the mortality rate of stroke in some countries such as Japan, North America and finallyRESULTS collected data analyzed by statistical methods in SPSS.16. West Europe has declined [4-6]. Of all patients, 108(52%) were male and rest of them were Several factors including age, sex, alcohol, smoking and HTN female. The mean age of all stroke patients was 70 ± 13. 25.6% of have main role in the incidence of stroke among people [7-10]. patients have diabetes and HTN together that the rate of mortality Stroke is the main cause of physical disability among society’s was 22.6% among them. The mean length of stay in hospital was people which takes more than 24 hours. The onset and duration 9 days. Of all patients, 82% discharged from hospital with partial of symptoms determined by getting history and neurological recovery and 12% with personal satisfaction and 6% were died. The rate of disability and mortality in women were 18% and MRI [7,11,12]. 78%, respectively which upper than men (Table 1). examination of patients and finally confirmed by CT-scan and The mean of systolic blood pressure in women and men were (IS), subarachnoid hemorrhage (SH), primary intracerebral 141.8 ± 27.6 and 141.3 ± 29 mmHg, respectively and the mean of Stroke is classified in four types included: ischemic stroke hemorrhage and unknown stroke that from them ischemic diastolic blood pressure were 81.4 ± 1.6 and 80.2 ± 1.8 mmHg,
Cite this article: Abbasi V, Amani F, Aslanian R, Hoseinkhani A, Zakeri A, et al. (2017) Epidemiological Study of Stroke in Ardabil, Iran: a Hospital Based- Study. J Neurol Disord Stroke 5(3): 1128. 1/5 Aslanian et al. (2017) Email: [email protected]
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Table 1:
Compare the risk factors and outcomes by gender.male female total Sex p-value N % N % N %
74 7/35 73 3/35 147 71 9/0
DM 56 27 41 20 97 46.9 1/0 Risk factors BP History of stroke 31 15 33 16 64 31 8/0 Smoking 28 5/13 5 5/2 33 16 *001/0 MI 12 6 10 5 22 10.6 6/0 Dead 15 7 18 9 33 16 6/0 Outcomes Disability 60 29 78 38 138 66.7 1/0
Of all risk factors, only smoking was the significant factor between two sexes. (p=0.001) respectively which was similar between two sexes.4percent of patients have cerebral hemorrhage and 0.5% thrombosis risk of stroke [7,13,14]. Researchers showed that the 10 mmHg of peripheral veins. 98% of patients were married and 67% 160 mmHg and DBP more than 90 mmHg showed the higher o’clock in night to 6 o’clock in morning and 29% in winter season. aboutincrement twice of [10,13]. DBP accompany In this study, with thetwice history increasing of HTN risk is theof stroke most urbanization.33% of patients referred to hospital during 20 riskand thefactor decreasing which in 5-6 line mmHg with otherin DBP studies. decrease In theO’Donnell risk of andstroke et fever, pulse rate and heart rate. 71% of patients have history of al study, HTN is the most risk factor for all strokes. In Lawes and HTNThere and were 47% no historysignificant of stroke differences that history between of twoHTN sexes is the in most the risk factors in all age groups (Figures 1,2). incidence of stroke and in Warlow study pointed to the role of HTNet al study,in stroke the decreaseincidence of [7,10,14]. BP is known In this as astudy predictable apart from factor age in 52% of patients were male and among all age groups, most of patients in age group 50-65 were men and in other age groups factor. There are several studies about role of gender and age in thegroup incidence <50 in other of stroke age groups, which showedthe history that of an BP increased is the important risk of 2). were women that were statistically significant (p=0.008) (Table stroke is increased in every decade of life. For example, in people <45 years, the rate of stroke annually was 0.1-0.3 per 1000 and years old have the highest rate of mortality and disability among in people 75-84 years reach to 12-20 per 1000 that revealed the all agePatients groups upper (Figure than 3). 80 years old and in age group 65-80 direct relationship between prevalence of stroke and increment of age [2]. In this study, the mean age of women was 70.6 and a DISCUSSION man was 69.5 and apart from age group 50-65, in other age groups There were many evidence about role of HTN in epidemiology the most of cases were women. In a cohort study done on 3378 people, the mean age of women and men was 61.1 and 59 years the predictable variables for stroke incidence and the risk of respectively, that lower than our study [15]. Appelros and et al in of stroke and prospective studies showed that SBP and DBP are a study showed that the rate of stroke in men was 33% more than stroke increased with increment of BP as the SBP more than 80 71 70
60
50 47
40 31 30
20 16 11 10
0 Blood Pressur Diabetes history of stroke smoking history of MI
Figure 1 Risk factors for stroke in patients.
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HTN CVA DM SMOKE MI 83.3 68.5 62.5 56.3 53.3 40 35.4 34.4 33.3 29.6 29.2 25.9 13.3 13.3 13.3 12.5 11.1 9.3 9.3 6.7
AGE GROUP < 5 0 5 0 - 6 5 6 5 - 8 0 > 8 0
Figure 2 Risk factors in age groups of the patients with stroke.
74.4 100
73.3 90 80 62.5 70 60 21.7 50 40 22.2 30 18.9 20 6.3 6.7 10 0 >80 65-80 50-65 <50
dead pleji
Figure 3 The rate of mortality and disability by age groups. women who can be related to the genetic factors, the inhibitory the second important factor in this study which was seen in 47% effect of estrogen and blood pressure level differences between of patients and in age group <50 years, the frequency of women was more than men [18-20]. History of diabetes is the third risk in men was more than women in similar age groups but in our factor and 31% of patients with stroke have history of diabetes men and women [9]. Many studies showed that the level of BP and this rate in some studies was 14-38.3%. In epidemiologic ourstudy study, there other wasn’t studies significant showed difference that the in rate term of of stroke history in of men BP, The result of a cohort study in Iranian population showed that rate of SBP and DBP between two sexes [9,13,16,17]. In line with studies done in Shiraz and Qom diabetes is the second risk factor. have more shares in the risk of stroke and in more studies, the Disease and diabetes. 25.6% of patients have diabetes and HTN occurrencewas more than of stroke women. predicted Patients after with Transient transient ischemicischemic attack.attack atmost the of same accidence time related and the to ratestroke of due mortality to HTN, in Chronic these patients Kidney About 4-20% of patients with transient ischemic attack lead to was 22.6% of all death. However, control of blood pressure in patients with type 2 diabetes as part of a plan to reduce the risk this attack suffered to stroke. The history of previous stroke is of cardiovascular disease and stroke are recommended in adults stroke in the first 90 days and half of them in two first days after
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Table 2: male female total Patient’sSex frequency in age groups by sex. Age groups N % N % N % <50 10 7/66 5 3/33 15 7.2 50-65 13 1/27 35 9/72 48 23.2 65-80 48 3/53 42 7/46 90 43.5 >80 28 9/51 26 1/48 54 26.1 with diabetes [15,21,22]. A meta-analysis from 32 research and Life Expectancy in Zahedan (South-East Iran) in 2014. Glob J showed that the risk of ischemic stroke in smokers was 1.9 times more than non-smokers. In this study, 16% of patients were 2. Health Sci. 2016; 9: 135. smokers that most of them were men. In line with our study, a review of population-based studies of incidence, prevalence, and the rate of smoking in Daneshfar and et al study was 15.4% and Feigin VL, Lawes CM, Bennett DA, Anderson CS. Stroke epidemiology: in other studies smoking is the main risk factor for stroke in 3. case-fatality in the late 20th century. Lancet Neurol. 2003; 2: 43-53. 73% of patients and after cutting smoking the risk of stroke is al. Alcohol consumption and the risk of morbidity and mortality for declined and leave smoking use is an essential for each stroke Patra J, Taylor B, Irving H, Roerecke M, Baliunas D, Mohapatra S, et prevention program [7,15,22]. About one third of patients with ischemic stroke have history of coroner heart disease such as different stroke types--a systematic review and meta-analysis. BMC 4. Public Health. 2010; 10: 258. angina and MI. In a study done about the risk factor of stroke in 22 countries, results showed that heart etiology known as factor Sarti C, Rastenyte D, Cepaitis Z, Tuomilehto J. International trends in for increasing ischemic stroke risk and in our study history of 5. mortalityBonita R, from Stewart stroke, A, 1968 Beaglehole to 1994. R. Stroke. International 2000; 31: trends 1588-1601. in stroke MI known as the last risk factor [7,14,23]. 31% of patients with stroke have disability that most of them care in their home by 6. mortality: 1970-1985. Stroke. 1990; 21: 989-992. family members which are the important resources for patients 7. Bonita R. Epidemiology of stroke. Lancet. 1992; 339: 342-344. care. Stroke, is one of the main disability causes in world that Risk factors for ischaemic and intracerebral haemorrhagic stroke in associated with long stay in hospital and increment treatment O’Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, et al. costs while the direct and indirect costs due to stroke in year 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2008 in USA was 65.5 billion and 67% of patients have disability 8. 2010; 376: 112-123. in a half-body that most of them were in women and age groups 65-80 years old [24]. Most of patients in our study discharged Wolf PA, D’Agostino RB, Belanger AJ, Kannel WB. Probability of stroke: 9. ént A. Sex differences in stroke with partial recovery but 16% died and patients with up 80 years a risk profile from the Framingham Study. 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Cite this article Abbasi V, Amani F, Aslanian R, Hoseinkhani A, Zakeri A, et al. (2017) Epidemiological Study of Stroke in Ardabil, Iran: a Hospital Based-Study. J Neurol Disord Stroke 5(3): 1128.
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