Mapping within-country disparities in Ischemic stroke burden and trends by human development index, age and sex
Marilaura Nuñez1, Iris Delgado2, Alejandra Venegas Peña1
1Centro de Estudios Clínicos, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile.
Background:
Growing concern exists over stalled declines in acute ischemic stroke (AIS) incidence; understanding health determinants is key to addressing stroke burden. Therefore, we aimed to determine the burden of AIS and transient ischemic stroke attack (TIA) in 2021, and their trends from 2010 to 2021 at the national and subnational levels, disaggregated by age and sex, and examining the relationship with the regional Human Development Index (HDI).
Methods:
A population-based study in Chile was conducted using three national registries. Age-standardized incidence (ASIR), hospitalization (ASHR), and mortality rates (ASMR) per 100,000 population were determined for people aged ≥15 years with AIS/TIA between 2010 and 2021. The proportion receiving thrombolysis was estimated for 2021. National and subnational data were categorized in overall, younger (<50 years old) and older population (≥50 years old). Trends were assessed using annual percentage change (APC) with 95 % confidence intervals (95 % CI).
Results:
During 2021, 15,800 first-ever AIS/TIA events were recorded with an ASIR: 99.2, ASHR: 81.5, and an ASMR: 13.6. Compared to 2010, downward trends were observed in ASIR (APC -2.22, 95 % CI -3.17 to -1.26) and ASMR (APC -4.75, -6.42 to -3.06), and an upward trend in ASHR (APC 3.94, 3.05 to 4.84). ASIR was negatively correlated with HDI (p = 0.02), particularly among the younger population (p = 0.02). Younger females experienced a higher incidence compared to males (Incidence Rate Ratio female/male:1.04).
Conclusions:
These analyses revealed within-country disparities in AIS/TIA burden in a high-HDI country. These findings are crucial to address the rising ASIR among young people, especially females and people in regions with low-HDI.
