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      Stroke in the 21 st Century: A Snapshot of the Burden, Epidemiology, and Quality of Life

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      Publication date (Electronic):
      Journal: Stroke Research and Treatment
      Publisher: Hindawi

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          Abstract

          Stroke is ranked as the second leading cause of death worldwide with an annual mortality rate of about 5.5 million. Not only does the burden of stroke lie in the high mortality but the high morbidity also results in up to 50% of survivors being chronically disabled. Thus stroke is a disease of immense public health importance with serious economic and social consequences. The public health burden of stroke is set to rise over future decades because of demographic transitions of populations, particularly in developing countries. This paper provides an overview of stroke in the 21 st century from a public health perspective.

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          Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modelling.

          S Johnston, Shanthi Mendis, Colin D Mathers (2009)
          Recent improvements in the monitoring and modelling of stroke have led to more reliable estimates of stroke mortality and burden worldwide. However, little is known about the global distribution of stroke and its relations to the prevalence of cardiovascular disease risk factors and sociodemographic and economic characteristics. National estimates of stroke mortality and burden (measured in disability-adjusted life years [DALYs]) were calculated from monitoring vital statistics, a systematic review of studies that report disease surveillance, and modelling as part of the WHO Global Burden of Disease programme. Similar methods were used to generate standardised measures of the national prevalence of cardiovascular risk factors. Risk factors other than diabetes and disease burden estimates were age-adjusted and sex-adjusted to the WHO standard population. There was a ten-fold difference in rates of stroke mortality and DALY loss between the most-affected and the least-affected countries. Rates of stroke mortality and DALY loss were highest in eastern Europe, north Asia, central Africa, and the south Pacific. National per capita income was the strongest predictor of mortality and DALY loss rates (p<0.0001) even after adjustment for cardiovascular risk factors (p<0.0001). Prevalences of cardiovascular risk factors measured at a national level were generally poor predictors of national stroke mortality rates and burden, although raised mean systolic blood pressure (p=0.028) and low body-mass index (p=0.017) predicted stroke mortality, and greater prevalence of smoking predicted both stroke mortality (p=0.041) and DALY-loss rates (p=0.034). Rates of stroke mortality and burden vary greatly among countries, but low-income countries are the most affected. Current measures of the prevalence of cardiovascular risk factors at the population level poorly predict overall stroke mortality and burden and do not explain the greater burden in low-income countries.
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            Mechanisms of ischemic brain damage.

            Kristian Doyle, Roger P. Simon, Mary Stenzel-Poore (2008)
            In the United States stroke is the third leading cause of death and the leading cause of disability. Brain injury following stroke results from the complex interplay of multiple pathways including excitotoxicity, acidotoxicity, ionic imbalance, peri-infarct depolarization, oxidative and nitrative stress, inflammation and apoptosis. There are very few treatments for stroke and the development of new treatments requires a comprehensive understanding of the diverse mechanisms of ischemic brain damage that are responsible for neuronal death. Here, we discuss the underlying pathophysiology of this devastating disease and reveal the intertwined pathways that are the target of therapeutic intervention.
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              Development of a stroke-specific quality of life scale.

              L Williams, M. Weinberger, L E Harris … (1999)
              Clinical stroke trials are increasingly measuring patient-centered outcomes such as functional status and health-related quality of life (HRQOL). No stroke-specific HRQOL measure is currently available. This study presents the initial development of a valid, reliable, and responsive stroke-specific quality of life (SS-QOL) measure, for use in stroke trials. Domains and items for the SS-QOL were developed from patient interviews. The SS-QOL, Short Form 36, Beck Depression Inventory, National Institutes of Health Stroke Scale, and Barthel Index were administered to patients 1 and 3 months after ischemic stroke. Items were eliminated with the use of standard psychometric criteria. Construct validity was assessed by comparing domain scores with similar domains of established measures. Domain responsiveness was assessed with standardized effect sizes. All 12 domains of the SS-QOL were unidimensional. In the final 49-item scale, all domains demonstrated excellent internal reliability (Cronbach's alpha values for each domain >/=0.73). Most domains were moderately correlated with similar domains of established outcome measures (r2 range, 0.3 to 0.5). Most domains were responsive to change (standardized effect sizes >0.4). One- and 3-month SS-QOL scores were associated with patients' self-report of HRQOL compared with before their stroke (P<0.001). The SS-QOL measures HRQOL, its primary underlying construct, in stroke patients. Preliminary results regarding the reliability, validity, and responsiveness of the SS-QOL are encouraging. Further studies in diverse stroke populations are needed.
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                Author and article information

                Contributors
                Eric S. Donkor:
                ORCID: http://orcid.org/0000-0002-5179-546X
                Journal
                Journal ID (nlm-ta): Stroke Res Treat
                Journal ID (iso-abbrev): Stroke Res Treat
                Journal ID (publisher-id): SRT
                Title: Stroke Research and Treatment
                Publisher: Hindawi
                ISSN (Print): 2090-8105
                ISSN (Electronic): 2042-0056
                Publication date Collection: 2018
                Publication date (Electronic): 27 November 2018
                Volume: 2018
                Electronic Location Identifier: 3238165
                Affiliations
                School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Accra, Ghana
                Author notes

                Academic Editor: Alejandro Spiotta

                Author information
                http://orcid.org/0000-0002-5179-546X
                Article
                DOI: 10.1155/2018/3238165
                PMC ID: 6288566
                PubMed ID: 30598741
                SO-VID: 00399851-ce3b-4030-b91e-381eae652c15
                Copyright © Copyright © 2018 Eric S. Donkor.
                License:

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 14 January 2018
                Date revision received : 29 July 2018
                Date accepted : 9 October 2018
                Categories
                Subject: Review Article

                ScienceOpen disciplines: Cardiovascular Medicine
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine

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