The Epidemiology and Spatial Analysis of Stroke in Trinidad and Tobago in the First Decade of the 21^st Century (2000-2009)

Kameel Mungrue, Kevin A. Saroop, Ambika B. Samsundar, Astrid Bhagwat, Nadi Braithwaite, Loraine P. Samai, S. Sampath, Sherrise Sandy, Keri Springer, Joella C. Subadar

Eric Williams Medical Sciences Complex, Public Health & Primary Care, Department of Paraclinical Sciences, Faculty of Medical Sciences, University of the West Indies, Mt Hope, Trinidad and Tobago.

DOI: 10.4236/health.2014.68094                

Abstract

Objective: To investigate the pattern and distribution of stroke in Trinidad and Tobago from 2000-2009. To identify the prevalence of co-morbid conditions among new stroke patients during the period under surveillance. Methods: Data were collected from May 2010 to July 2010 from the clinic of 728 new persons treated stroke at one of the main treatment centers. Variables measured included age, gender ethnicity, smoking status and co-morbid conditions. SPSS (Version 17) for Windows and ARC GIS version 9.3 were used to facilitate both descriptive and inferential data analysis. Results: Of the 728 new hospital admissions for the period January 2000-December 2009 for stroke, 369 (50.7%) were males and 359 (49.3%) were females. 59.8% were South-East Asian; 30.5% were African and 9.7% were mixed ethnicity. The predominant age group was 60 - 69 years (n = 215, 29.5%) while less than 1% were under 30. Ischemic stroke accounted for 352 (48.4%) of all new cases for the period; Hemorrhagic stroke accounted for 14.6% (n = 107), with 37% (n = 269) classified as other unspecified condition (including unknown). Of the 728 cases examined, 171 patients died before being discharged and 552 were treated and discharged. Information of 5 cases was not available. Using this data, the overall case fatality ratio was calculated as 23.5%, with the case fatality ratio for males being 23.2% and the equivalent ratio for females being 22.9%. Using a standard classification, the majority, (n = 389, 53.4%), of cases were classified as mild; 246 (33.8%) were deemed moderate, and 93 (12.8%) were severe cases. Hypertension was clinically diagnosed in 80.9% of the cases; 56.3% were diabetic, and 21.7% were classified as smokers having been either past or current smokers. Other lifestyle risk factors such as obesity and exercise were not examined due to the lack of the relevant data. The most frequent cardiovascular risk factor was chamber enlargement being present in 33.2%, while the second most frequent was left ventricular hypertrophy, 26.9%. The other cardiovascular risk factors examined included Ischemic heart disease, atrial fibrillation and previous myocardial infarction. All of which were present in less than 15% of the patients. Conclusion: The incidence of stroke in Trinidad and Tobago continues to be an important public health challenge as we complete the first decade of the 21 century. We provide important evidence on the changing epidemiological patterns of the disease, providing the first attempt to describe a possible stroke belt in the southern half of the island.

Keywords

Stroke; Epidemiology; Hypertension

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Murray, C.J.L. and Lopez, A.D. (1996) The Global Burden of Disease. 1. Harvard School of Public Health, Boston.
[2]	World Health Organization (2002) The World Health Report: 2002: Reducing Risks, Promoting Healthy Life. World Health Organization, Geneva.
[3]	Feigin, V.L., Forouzanfar, M.H., Krishnamurthi, R., Mensah, G.A., Connor, M., Bennett, D.A., Moran, A.E., Sacco, R.L., Anderson, L., Truelsen, T., O’Donnell, M., Venketasubramanian, N., Barker-Collo, S., Lawes, C.M., Wang, W., Shinohara, Y., Witt, E., Ezzati, M., Naghavi, M. and Murray, C. (2014) Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) and the GBD Stroke Experts Group. Global and Regional Burden of Stroke during 1990-2010: Findings from the Global Burden of Disease Study 2010. Lancet, 383, 245-254. http://dx.doi.org/10.1016/S0140-6736(13)61953-4
[4]	World Health Organization (2014) STEPwise Approach to Chronic Disease Risk Factor Surveillance (STEPS). www.who.int/chp/steps/riskfactors/en/index
[5]	Mahabir, D., Bickram, L. and Gulliford, M.C. (1998) Stroke in Trinidad and Tobago: Burden of Illness and Risk Factor. Pan American Journal of Public Health, 4, 233-237.
[6]	Marmot, M.G. and Poulter, N.R. (1995) Primary Prevention of Stroke. Lancet, 339, 344-347. http://dx.doi.org/10.1016/0140-6736(92)91659-V
[7]	Dunbabin, D.W. and Sandercock, P. (1990) Preventing Stroke by the Modification of Risk Factors. Stroke, 21, 36-39.
[8]	Eastern Stroke and Coronary heart Disease Collaborative Group (1998) Blood Pressure, Cholesterol, and Stroke in Eastern Asia. Lancet, 352, 1801-1807. http://dx.doi.org/10.1016/S0140-6736(98)03454-0
[9]	Singh, R.F., Suh, I.F., Singh, V.F., Chaithiraphan, S.F., Laothavorn, P.F., Sy, R.F., et al. (2000) Hypertension and Stroke in Asia: Prevalence, Control and Strategies in Developing Countries for Prevention. Journal of Human Hypertension, 14, 749-763.
[10]	WHO MONICA Project Investigators (1988) The World Health Organization MONICA Project (Monitoring Trends and Determinants in Cardiovascular Disease). Journal of Clinical Epidemiology, 41, 105-114. http://dx.doi.org/10.1016/0895-4356(88)90084-4
[11]	Easton, J.D., Saver, J.L., Albers, G.W., Alberts, M.J., Chaturvedi, S., Feldmann, E., Hatsukami, T.S., Higashida, R.T., Johnston, S.C., Kidwell, C.S., Lutsep, H.L., Miller, E. and Sacco, R.L. (2009) Definition and Evaluation of Transient Ischemic Attack: A Scientific Statement for Healthcare Professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. Stroke, 400, 2276-2293. http://dx.doi.org/10.1161/STROKEAHA.108.192218
[12]	Thorvaldsen, P., Asplund, K., Kuulasmaa, K., Rajakangas, A. and Schroll, M. (1995) Stroke incidence, case fatality, and mortality in the WHO MONICA project. Stroke, 26, 361-367. http://dx.doi.org/10.1161/01.STR.26.3.361
[13]	(2003) The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The Journal of the American Medical Association, 289, 2560-2571. http://dx.doi.org/10.1001/jama.289.19.2560
[14]	Bonita, R., Stewart, A. and Beaglehole, R. (1995) International Trends in Stroke Mortality: 1970-1985. Stroke, 21, 989-992. http://dx.doi.org/10.1161/01.STR.21.7.989
[15]	Vartiainen, E., Sarti, C., Tuomiletho, J. and Kuulassmaa, K. (1995) Do Changes in Cardiovascular Risk Factors Explain Changes in Mortality from Stroke in Finland? British Medical Journal, 310, 901-904. http://dx.doi.org/10.1136/bmj.310.6984.901
[16]	Sidney, S., Rosamond, W.D., Howard, V.J. and Luepker, R.V. (2013) The “Heart Disease and Stroke Statistics—2013 Update” and the Need for a National Cardiovascular Surveillance System, on Behalf of the National Forum for Heart Disease and Stroke Prevention. Circulation, 127, 21-23.
[17]	Lewington, S., Clarke, R., Qizilbash, N., Peto, R. and Collins, R. (2002) Age-Specific Relevance of Usual Blood Pressure to Vascular Mortality: A Meta-Analysis of Individual Data for One Million Adults in 61 Prospective Studies. Prospective Studies Collaboration. Lancet, 360, 1903-1913. http://dx.doi.org/10.1016/S0140-6736(02)11911-8
[18]	Whelton, P.K., He, J., Appel, L.J., Cutler, J.A., Havas, S., Kotchen, T.A., et al. (2002) Primary Prevention of Hypertension: Clinical and Public Health Advisory from the National High Blood Pressure Education Program. The Journal of the American Medical Association, 288, 1882-1888.