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Syndemic analysis of stroke in Indonesia
Andi Alfian Zainuddin1, Rais Reskiawan A Kadir2,3, Nurul Qalby1
1Department of Public Health and Community Medicine, Faculty of Medicine, Hasanuddin University, Makassar, 90245, Indonesia.
The Lancet Regional Health. Western Pacific
|April 20, 2026
Summary
Stroke in Indonesia is a complex outcome of interconnected diseases like diabetes mellitus and chronic kidney disease, alongside poverty. Addressing these syndemic factors is crucial for reducing the national stroke burden.
Area of Science:
- Public Health
- Epidemiology
- Health Economics
Background:
- Stroke is the leading cause of mortality in Indonesia.
- A comprehensive syndemic approach integrating co-occurring diseases and socio-economic factors is lacking for stroke determinants.
- This study addresses this gap by analyzing prevalent clinical conditions and socio-economic indicators.
Purpose of the Study:
- To identify interacting factors contributing to stroke incidence in Indonesia using a syndemic framework.
- To analyze the complex interplay between metabolic diseases, hepatic conditions, and socio-economic factors in stroke etiology.
- To understand the upstream and downstream effects of conditions like diabetes mellitus and chronic kidney disease on stroke.
Main Methods:
- Analysis of national health insurance data from over 12 million patients (2018-2023).
- Integration with provincial socio-economic indicators and aggregation at the provincial level.
- Application of advanced statistical approaches including Bayesian Gaussian Network Analysis, Path Analysis, Geographically and Temporally Weighted Regression, and Principal Component Analysis.
Main Results:
- Stroke, diabetes mellitus (DM), chronic kidney disease (CKD), and poverty showed consistent increases.
- Strong associations were found between stroke and CKD, DM, and cirrhosis; poverty showed a moderate correlation.
- DM strongly influenced CKD and cirrhosis, while CKD directly impacted poverty and stroke. Stroke was the most probable downstream outcome (51.85%) in the syndemic network.
Conclusions:
- Stroke in Indonesia is a convergent outcome of interconnected metabolic, hepatic, and socio-economic factors.
- These findings highlight the necessity of a syndemic framework for effective stroke burden reduction.
- Interventions must address the interplay of diseases and poverty to combat stroke incidence.
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