Poorer countries, those spending less on health care have more strokes, deaths
Poorer countries and those that spend proportionately less money on health care have more stroke and stroke deaths than wealthier nations and those that allocate more to health care, according to new research in Stroke: Journal of the American Heart Association.
Poorer countries also had a greater incidence of Hemorrhagic stroke - caused by a burst blood vessel bleeding in or near the brain - and had more frequent onset at younger ages.
Regardless of overall wealth, countries that spend less money proportionately on health care also had higher incidences of all four outcomes.
“Not only is the economic wellness of a country important, but also significant is what proportion of their gross domestic product is expended on health,” said Luciano A. Sposato, M.D., M.B.A., study lead author and director of the neurology department at the Vascular Research Institute at INECO Foundation in Buenos Aires, Argentina. “This is very important for developing healthcare strategies to prevent stroke and other cardiovascular diseases.”
In the large-scale literature review, researchers took a unique approach to identify stroke risk by correlating it to nationwide socioeconomic status.
Previous research tended to focus on the link between stroke and individual or family financial standing, said Sposato, also director of the Stroke Center at the Institute of Neurosciences, University Hospital Favaloro Foundation.
The terms intracerebral hemorrhage (ICH) and Hemorrhagic stroke are used interchangeably in this discussion and are regarded as separate entities from hemorrhagic transformation of ischemic stroke. Intracerebral hemorrhage accounts for 10-15% of all strokes and is associated with higher mortality rates than cerebral infarctions.
Acute ischemic stroke refers to stroke caused by thrombosis or embolism and is more common than Hemorrhagic stroke. Previous literature indicates that only 8-18% of strokes were hemorrhagic.
Although a 2010 retrospective review from a stroke center found that 40.9% of 757 strokes were hemorrhagic, nonetheless, the authors stated that the increased percentage of Hemorrhagic stroke may be due to improvement of computed tomography (CT) scanning availability and implementation, unmasking a previous underestimation of the actual percentage, or it may be due to an increase in therapeutic use of antiplatelet agents and warfarin causing an increase in the incidence of hemorrhage.
Patients with Hemorrhagic stroke present with similar focal neurologic deficits but tend to be more ill than patients with ischemic stroke. Patients with intracerebral bleeds are more likely to have headache, altered mental status, seizures, nausea and vomiting, and/or marked hypertension; however, none of these findings reliably distinguishes between Hemorrhagic stroke and ischemic stroke. Though stroke is less common in children, the clinical presentation is similar.
The study linked lower gross domestic product to
* 32 percent higher risk of strokes;
* 43 percent increase of post-stroke deaths at 30 days;
* 43 percent increase in Hemorrhagic stroke; and
* 47 percent higher incidence of younger-age-onset stroke.
Similarly, a lower percentage of health spending correlated to a comparable increase in the 30-day death rate and
* 26 percent higher risk of strokes;
* 45 percent increase of post-stroke deaths at 30 days;
* 32 percent increase in Hemorrhagic stroke;
* 36 percent higher incidence of younger-age-onset stroke.
Investigators analyzed 30 population-based studies conducted between 1998 and 2008 in 22 countries. They used statistical methods to link stroke risk, 30-day death rate, Hemorrhagic stroke incidence and age at disease onset to three internationally accepted economic indicators. The indicators included gross domestic product, health expenditure per capita and unemployment rate. Unlike the other two indicators, unemployment rate didn’t affect stroke or other outcomes.
“It is important to further discuss the health priorities for different countries,” said Gustavo Saposnik, M.D., M.Sc., study co-author and director of stroke outcomes research at St. Michael’s Hospital, University of Toronto, Canada. “This will provide the necessary background to help countries make the changes in how different resources and money are allocated.”
Stroke is the fourth leading cause of death in the United States and a major cause of long-term disability. Worldwide, stroke is the second leading killer.
###
Author disclosures are on the manuscript.
Dr. Sposato’s participation was funded in part by the INECO Foundation.
Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content.
###
Carrie Thacker
.(JavaScript must be enabled to view this email address)
214-706-1665
American Heart Association