Mohammad Taghi Farzadfard1, Amanda G Thrift2, Amin Amiri1, Moira K Kapral3, Peyman Hashemi4, Luciano A Sposato5, Maryam Salehi6, Ali Shoeibi1, Alireza Hoseini7, Naghmeh Mokhber8, Mahmoud Reza Azarpazhooh9. 1. Department of Neurology, Ghaem hospital, Mashhad University of Medical Sciences, Mashhad, Iran. 2. Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia. 3. Department of Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada; Institute for Clinical Evaluative Sciences, Toronto General Research Institute, Toronto, Canada. 4. Department of Orthopedic Surgery, Iran University of Medical Sciences, Tehran, Iran. 5. Department of Clinical Neurological Science, University Hospital, Western University, Ontario, Canada. 6. Research center for patient safety, Mashhad University of Medical Sciences, Mashhad, Iran. 7. Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran. 8. Department of Psychiatry & Behavioural Neurosciences, Western University, London, Ontario, Canada; Department of Psychiatry, Mashhad University of Medical Sciences, Mashhad, Iran. 9. Department of Neurology, Ghaem hospital, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Clinical Neurological Science, University Hospital, Western University, Ontario, Canada; Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Dentistry, Western University, London, Ontario, Canada. Electronic address: reza.azarpazhooh@lhsc.on.ca.
Abstract
BACKGROUND AND PURPOSE: Despite recent declines in stroke mortality in high-income countries, the incidence and mortality of stroke have increased in many low- and middle-income countries. Population-based information on stroke in such countries is a research priority to address this rising trend. This study was designed to evaluate 5-year stroke mortality and its associated factors. METHODS: During a 12-month period beginning from November 2006, 624 patients with first-ever stroke (FES) living in Mashhad, Iran, were recruited and followed longitudinally. Kaplan-Meier analyses were used to determine the cumulative risk of death. Prognostic variables associated with death were assessed using a Cox proportional hazard, backward logistic regression model. RESULTS: The 5-year cumulative risk of death was 53.8% for women and 60.5% for men (log rank = .1). The most frequent causes of death were stroke (41.2%), myocardial infarction/vascular diseases (16.4%), and pneumonia (14.2%). In multivariable Cox proportional hazard analysis, male gender (hazard ratio [HR]: 1.29, 95% confidence interval [CI]: 1.01-1.64), age (HR: 1.04, 95% CI: 1.03-1.05, per 1-year increase), National Institute of Health Stroke Scale score at admission (HR: 1.11, 95% CI: 1.09-1.12, per 1-point increase), atrial fibrillation (HR: 1.78, CI: 1.24-2.54), and education < 12 years (HR: 1.61, 95% CI: 1.08-2.4) were associated with greater 5-year case fatality. CONCLUSIONS: Long-term case fatality following stroke in Iran is greater than that observed in many high-income countries. Targeting strategies to reduce the poor outcome following stroke, such as treating AF, is likely to reduce this disparate outcome.
BACKGROUND AND PURPOSE: Despite recent declines in stroke mortality in high-income countries, the incidence and mortality of stroke have increased in many low- and middle-income countries. Population-based information on stroke in such countries is a research priority to address this rising trend. This study was designed to evaluate 5-year stroke mortality and its associated factors. METHODS: During a 12-month period beginning from November 2006, 624 patients with first-ever stroke (FES) living in Mashhad, Iran, were recruited and followed longitudinally. Kaplan-Meier analyses were used to determine the cumulative risk of death. Prognostic variables associated with death were assessed using a Cox proportional hazard, backward logistic regression model. RESULTS: The 5-year cumulative risk of death was 53.8% for women and 60.5% for men (log rank = .1). The most frequent causes of death were stroke (41.2%), myocardial infarction/vascular diseases (16.4%), and pneumonia (14.2%). In multivariable Cox proportional hazard analysis, male gender (hazard ratio [HR]: 1.29, 95% confidence interval [CI]: 1.01-1.64), age (HR: 1.04, 95% CI: 1.03-1.05, per 1-year increase), National Institute of Health Stroke Scale score at admission (HR: 1.11, 95% CI: 1.09-1.12, per 1-point increase), atrial fibrillation (HR: 1.78, CI: 1.24-2.54), and education < 12 years (HR: 1.61, 95% CI: 1.08-2.4) were associated with greater 5-year case fatality. CONCLUSIONS: Long-term case fatality following stroke in Iran is greater than that observed in many high-income countries. Targeting strategies to reduce the poor outcome following stroke, such as treating AF, is likely to reduce this disparate outcome.