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One-year case fatality rate following stroke in the Mashhad Stroke Incidence Study: a population-based study of
Ali Shoeibi1, Maryam Salehi2,3, Amanda G Thrift4,5
1School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Insights
This study found a high one-year stroke case fatality rate in Iran, similar to developed countries. Key mortality factors included stroke type, age, and initial severity, highlighting the need for improved stroke care in developing nations.
Area of Science:
- Neurology
- Public Health
- Epidemiology
Background:
- Limited data exists on post-stroke mortality in developing countries.
- Stroke is a significant health concern globally, particularly in low- and middle-income nations.
Purpose of the Study:
- To determine the one-year case fatality rate of stroke in Iran.
- To identify factors associated with mortality following stroke in a population-based study.
Main Methods:
- A one-year follow-up was conducted on 684 stroke patients recruited in the Mashhad Stroke Incidence Study.
- Verbal autopsy via telephone was used for deceased patients to determine cause of death.
Main Results:
- The one-year case fatality rate was 34.3%, with higher rates for hemorrhagic stroke (53.0%) versus ischemic stroke (30.6%).
- Deaths were concentrated in the first 28 days post-stroke.
- Hemorrhagic stroke, older age, prior transient ischemic attack, and higher NIH Stroke Scale scores were linked to increased one-year mortality.
Conclusions:
- Despite younger stroke onset in Iran, one-year fatality rates are comparable to developed countries.
- These findings underscore the urgent need for enhanced stroke management strategies in Iran and similar settings.
Background:
In developing countries, there are few comprehensive studies of mortality following stroke.
Aims And/Or Hypothesis:
We aimed to determine the one-year case fatality rate following stroke and to identify factors associated with death in a population-based stroke incidence study in Iran.
Methods:
Six hundred eighty-four patients who had suffered a stroke between November 21, 2006, and November 20, 2007, and were recruited to the Mashhad Stroke Incidence Study were followed up at one-year. Most patients were seen in an outpatient visit. When patients had died, a verbal autopsy was conducted by telephone with the next of kin.
Results:
A total of 226 (34·3%) patients died during the first year following stroke. The cumulative one-year case fatality rate was 30·6% following ischemic stroke and 53·0% following hemorrhagic stroke (55·8% after intracerebral hemorrhage and 35·7% after subarachnoid hemorrhage). The majority of these deaths occurred in the first 28 days after stroke (17·7% with ischemic and 43·0% with hemorrhagic stroke). Factors associated with greater mortality at one-year (excluding those who died during the first week) were hemorrhagic stroke [hazard ratio (HR) 3·99; 95% confidence interval 1·90-8·37], age (HR 1·05; 95% confidence interval 1·03-1·08), previous transient ischemic attack (HR 2·45; 95% confidence interval 1·00-5·99), and National Institutes of Health Stroke Scale on admission (HR 1·14; 95% confidence interval 1·10-1·17).
Conclusion:
Despite the younger age of stroke occurrence in Iran, the one-year case fatality rate following stroke is similar to that reported in developed countries.
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