Incidence of first ever stroke during Hajj ceremony

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Abstract

Background

The Hajj Ceremony, the largest annual gathering in the world, is the most important life event for any Muslim. This study was designed to evaluate the incidence of stroke among Iranian pilgrims during the Hajj ceremony.

Methods

We ascertained all cases of stroke occurring in a population of 92,974 Iranian pilgrims between November 27, 2007 and January 12, 2008. Incidence and risk factors of the first ever stroke in Hajj pilgrims were compared, within the same time frame, to those of the Mashhad residents, the second largest city in Iran. Data for the latter group were extracted from the Mashhad Stroke Incidence Study (MSIS) database.

Results

During the study period, 17 first-ever strokes occurred in the Hajj pilgrims and 40 first-ever stroke strokes occurred in the MSIS group. Overall, the adjusted incidence rate of first ever stroke in the Hajj cohort was lower than that of the MSIS population (9 vs. 16 per 100,000). For age- and gender-specific subgroups, the Hajj stroke crude rates were in general similar to or lower than the general population of Mashhad, Iran, with the exception of women aged 35 to 44 years and aged >75 years who were at greater risk of having first-ever stroke than the non-pilgrims of the same age.

Conclusion

The first ever stroke rate among Iranian Hajj pilgrims was lower than that of the general population in Mashhad, Iran, except for females 35–44 or more than 75 years old. The number of events occurring during the Hajj suggests that Islamic countries should consider designing preventive and screening programs for pilgrims.

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Most cited references 34

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Gender difference in neural response to psychological stress.

Hengyi Rao, J. Pluta, Yong Fan … (2007)

Gender is an important biological determinant of vulnerability to psychosocial stress. We used perfusion based functional magnetic resonance imaging (fMRI) to measure cerebral blood flow (CBF) responses to mild to moderate stress in 32 healthy people (16 males and 16 females). Psychological stress was elicited using mental arithmetic tasks under varying pressure. Stress in men was associated with CBF increase in the right prefrontal cortex (RPFC) and CBF reduction in the left orbitofrontal cortex (LOrF), a robust response that persisted beyond the stress task period. In contrast, stress in women primarily activated the limbic system, including the ventral striatum, putamen, insula and cingulate cortex. The asymmetric prefrontal activity in males was associated with a physiological index of stress responses-salivary cortisol, whereas the female limbic activation showed a lower degree of correlations with cortisol. Conjunction analyses indicated only a small degree of overlap between the stress networks in men and women at the threshold level of P < 0.01. Increased overlap of stress networks between the two genders was revealed when the threshold for conjunction analyses was relaxed to P < 0.05. Further, machine classification was used to differentiate the central stress responses between the two genders with over 94% accuracy. Our study may represent an initial step in uncovering the neurobiological basis underlying the contrasting health consequences of psychosocial stress in men and women.

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Excessive incidence of stroke in Iran: evidence from the Mashhad Stroke Incidence Study (MSIS), a population-based study of stroke in the Middle East.

Mahmoud Reza Azarpazhooh, G Donnan, Mahmoud Azarpazhooh … (2010)

The epidemiology of stroke and its subtypes in the Middle East is unclear. Most previous studies have been performed in Western countries, and incidence rates are unlikely to apply in the Middle East. We aimed to determine the incidence of stroke in Mashhad, northeastern Iran. During a 12-month period (2006-2007), we prospectively ascertained all strokes occurring in a population of 450 229. Multiple overlapping sources were used to identify people with stroke. A large number of volunteers assisted in finding stroke patients not admitted to hospital. Potential cases were reviewed by a group of stroke experts before inclusion. A total of 624 first-ever strokes occurred during the study period, 98.4% undergoing imaging. Despite a relatively low crude annual incidence rate of first-ever stroke FES (139; 95% CI, 128 to 149) per 100 000 residents, rates adjusted to the European population aged 45 to 84 years were higher than in most other countries: 616 (95% CI, 567 to 664) for ischemic stroke, 94 (95% CI, 75 to 113) for intracerebral hemorrhage, and 12 (95% CI, 5 to 19) for subarachnoid hemorrhage. Age-specific stroke incidence was higher in younger patients than is typically seen in Western countries. Comparison of age-specific incidence rates between regions revealed that stroke in Mashhad occurs approximately 1 decade earlier than in Western countries. The results of this study provide evidence that the incidence of stroke in Iran is considerably greater than in most Western countries, with stroke occurring at younger ages. Ischemic stroke incidence was also considerably greater than reported in other regions.

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Depressive symptoms and increased risk of stroke mortality over a 29-year period.

Judith Goldberg, S E Everson, R. Roberts … (1998)

Several lines of evidence indicate that depression is importantly associated with cardiovascular disease end points. However, little is known about the role of depression in stroke mortality. This study examined the association between depressive symptoms and stroke mortality in a prospective study of behavioral, social, and psychological factors related to health and mortality in a community sample of 6676 initially stroke-free adults (45.8% male; 79.1% white; mean age at baseline, 43.4 years) from Alameda County, California. Depressive symptoms were assessed by the 18-item Human Population Laboratory Depression Scale. Cox proportional hazards regression models were used to evaluate the impact of depressive symptoms after controlling for age, sex, race, and other confounders. A total of 169 stroke deaths occurred during 29 years of follow-up. Reporting 5 or more depressive symptoms at baseline was associated with increased risk of stroke mortality, after adjusting for age, sex, and race (hazard ratio, 1.66; 95% confidence interval, 1.16-2.39; P<.006). This association remained significant after additional adjustments for education, alcohol consumption, smoking, body mass index, hypertension, and diabetes (hazard ratio, 1.54; 95% confidence interval, 1.06-2.22; P<.02). Time-dependent covariate models, which allowed changes in reported depressive symptoms and risk factor levels during follow-up, revealed the same pattern of associations. This population-based study provides the strongest epidemiological evidence to date for a significant relationship between depressive symptoms and stroke mortality. These results contribute to the growing literature on the adverse health effects of depression.

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Author and article information

Contributors

Mahmoud Reza Azarpazhooh

Reza Bavarsad Shahripour

Moira K Kapral

Naghmeh Mokhber

Ali Shoeibi

Mohammad Taghi Farzadfard

Mohammad Reza Rafati

Amanda G Thrift

Negar Morovatdar

Seyed Aidin Sajedi

Amir Azarpazhooh

Journal

Journal ID (nlm-ta): BMC Neurol

Journal ID (iso-abbrev): BMC Neurol

Title: BMC Neurology

Publisher: BioMed Central

ISSN (Electronic): 1471-2377

Publication date Collection: 2013

Publication date (Electronic): 5 December 2013

Volume: 13

Page: 193

Affiliations

[1 ]Department of Neurology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

[2 ]Comprehensive Stroke Center, University of Alabama Hospital, Birmingham, AL, USA

[3 ]Department of Neurology, Golestan Hospital, Ahvaz University of Medical Sciences, Ahwaz, Iran

[4 ]Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Ontario, Canada

[5 ]Department of Neuropsychology, Ibn-e-Sina Hospital, Mashhad University of Medical Science, Mashhad, Iran

[6 ]Department of Internal Medicine, Red Crescent Society, Tehran, Iran

[7 ]Department of Medicine, Southern Clinical School, Monash University, Melbourne, and National Stroke Research Institute, Florey Neuroscience Institutes, Heidelberg Heights, Victoria, Australia

[8 ]Health System Research Committee, Treatment Affairs of vice chancellery, Mashhad University of Medical Sciences, Mashhad, Iran

[9 ]Discipline of Dental Public Health, Faculty of Dentistry, University of Toronto, Room 515-C, 124 Edward St, Toronto, ON M5G 1G6, Canada

[10 ]Toronto Health Economics and Technology Assessment Collaborative, University of Toronto, Toronto, Canada

Article

Publisher ID: 1471-2377-13-193

DOI: 10.1186/1471-2377-13-193

PMC ID: 4234064

PubMed ID: 24308305

SO-VID: 148633ed-0d65-4dd9-8f5e-46091a7a41fb

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 18 November 2012

Date accepted : 27 November 2013

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Incidence of first ever stroke during Hajj ceremony

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Abstract

Background

Methods

Results

Conclusion

Related collections

Stroke MRI

Most cited references 34

Gender difference in neural response to psychological stress.

Excessive incidence of stroke in Iran: evidence from the Mashhad Stroke Incidence Study (MSIS), a population-based study of stroke in the Middle East.

Depressive symptoms and increased risk of stroke mortality over a 29-year period.

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Cited by 3