Stroke: The Neglected Epidemic, an Indian perspective

PK Sethi; I Anand; R Ranjan; NK Sethi; J Torgovnick

摘要

It is well known that in most developed countries cerebrovascular disease (CVD) or stroke is a common cause of death and disability. In U.S.A. and U.K., stroke ranks third as a cause of death after heart disease and cancer. The annual economic consequence due to CVD has been estimated to exceed 7 billion dollars in USA1, 2. Prevalence rates reported for cerebrovascular accident (CVA) worldwide vary between 500 to 800 per 100,000 population. Oriental studies have shown higher prevalence and incidence rates.1 Precious little is known about the epidemiology of stroke in India and of the Indian subcontinent in general. Is this burden same as in the West? Expectation rate of 600 in the occident and perhaps 900 in orient for the prevalence seems pausible1.Do we have enough data to estimate the burden of stroke in India? India's population is one billion plus, taking a prevalence rate of 900 per 100,000 into account, stroke is then indeed occurring in epidemic proportions in India. It is a matter of regret that our knowledge about epidemiology of stroke in India is so poor. So if stroke is occurring in epidemic proportions, then indeed it is a neglected epidemic. Stroke in India Epidemiology, originally signified the study of epidemics, but it is now used more broadly for the study of groups: epi=among; demos= people; logos=study. India is a vast country with diverse geographic variation. The population stands above one billion and life style of people varies in different parts of the country. It is a multi-ethnic, multi-cultural, multi-religious society. There are many religions sects with different life styles. Food habits vary in different religious groups. Some like the Jains and Buddhists are strict vegetarians while meat and meat products are an integral part of the diet of the Sikhs and Punjabis. Some literally drink “Ghee” a native cooking oil rich in saturated fats. Some till recently have not used salt in cooking as people from Mizoram. Some don't smoke but instead eat tobacco. It would be interesting and highly educative to study the epidemiology of stroke in such a diverse group.Unfortunately in India, epidemiological information on annual incidence, prevalence rates, morbidity and mortality trends in well defined populations is not available. Most of data published is from retrospective analysis of subjects admitted to urban medical hospitals though the majority of Indian population lives in small towns and villages. Some of the studies lack proper stroke terminology and baseline investigations. Despite these limitations, analysis of data collected from major urban hospitals suggests that nearly 2% of all hospital admissions; 4-5% of medical and 20% of neurological admission have CVD. The incidence of stroke in the young (< 40 years of age) is high (13 to 32%) when compared to similar data from the west. Literature is available suggesting that risk of coronary artery disease (CAD) is higher in Indians specially in the young population.3,4,5,6 We know that the risk factors for stroke and coronary artery disease are same. We also know that coronary artery disease is being reported more and more in people of Indian origin, whether staying in India or abroad, as compared to Western population. Will it then be fair to assume that incidence of stroke and its prevalence may be higher in Indians too? 3, 4, 5 Many studies on epidemiology of stroke in India are deficient with respect to randomization of data, making comparison between them difficult. In addition, many of these studies are published in local journals, which are not indexed and therefore difficult to retrieve from, or have been only published as abstracts. Table I presents a summary of crude prevalence rate by survey of hemiplegia presumed to be CVD from different parts of India namely the north, south, west and east 7,8,9,10,11,12,13,14,15,16 This data show prevalence of CVD in the range of 52 to 843 per 100,000 population. Only data from the Paris Community (Bomba

机译：众所周知，在大多数发达国家，脑血管疾病（CVD）或中风是导致死亡和残疾的常见原因。在美国和英国，中风是导致心脏病和癌症之后死亡的第三位。据估计，美国每年因CVD造成的经济后果超过70亿美元1。2据报道，全世界脑血管意外（CVA）的患病率在每100,000人口中有500至800人不等。东方的研究显示较高的患病率和发病率。1关于印度和整个印度次大陆的中风流行病学知之甚少。这个负担与西方一样吗？西方人的期望率为600，东方人的期望率为900。1。我们是否有足够的数据来估计印度的中风负担？印度的人口超过10亿，考虑到每100,000人中有900人患病率，因此在印度确实确实以流行病的比例发生了中风。遗憾的是，我们对印度中风流行病学的了解如此薄弱。因此，如果中风以流行病的比例发生，那么实际上这是一种被忽视的流行病。印度中风流行病学最初是对流行病的研究，但现在更广泛地用于群体研究：epi = among;演示=人;徽标=研究。印度是一个幅员辽阔，地理分布多样的国家。人口超过10亿，该国不同地区的人们的生活方式各异。这是一个多种族，多文化，多宗教的社会。有许多宗教派别具有不同的生活方式。不同宗教群体的饮食习惯不同。像the那教和佛教徒这样的人是严格的素食主义者，而肉和肉制品则是锡克教徒和旁遮普人饮食中不可或缺的一部分。有些人从字面上喝“酥油”，这是一种富含饱和脂肪的天然食用油。直到最近，有些人还是像米佐拉姆邦一样没有在烹饪中使用盐。有些人不吸烟，而是吃烟草。在如此多样化的人群中研究中风的流行病学将是有趣且具有高教育意义的。不幸的是，在印度，尚无明确人群的年发病率，患病率，发病率和死亡率趋势的流行病学信息。尽管大多数印度人口居住在小城镇和乡村，但发布的大多数数据来自对城市医疗医院收治的受试者的回顾性分析。一些研究缺乏适当的中风术语和基线研究。尽管有这些局限性，但对从主要城市医院收集的数据进行的分析表明，将近2％的医院入院;药物治疗的4-5％和神经系统的20％。与来自西方的类似数据相比，年轻人（<40岁）中风的发生率很高（13％至32％）。有文献表明，印度人尤其是年轻人中冠心病的风险更高。3,4,5,6我们知道中风和冠心病的危险因素相同。我们也知道，与西方人相比，无论是在印度还是国外，印度裔人冠状动脉疾病的报道越来越多。那么假设印第安人中风的发生率及其患病率也可能更高吗？ 3、4、5在印度，许多中风流行病学研究缺乏数据随机性，因此很难进行比较。另外，这些研究中有许多是在当地期刊上发表的，这些期刊没有被索引，因此很难检索，或者仅作为摘要发表。表一通过调查印度北部，南部，西部和东部不同地区的偏瘫而得出的粗略患病率汇总表，7,8,9,10,11,12,13,14,15,16该数据显示CVD的患病率为每10万人52至843。仅来自巴黎社区（Bomba）的数据

Stroke: The Neglected Epidemic, an Indian perspective

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