Background
Methods
Study Population
Study Design
Sample Size Estimation
Data Collection and Diagnosis
Statistical Analysis
Results
Males(n = 276) | Females(n = 269) | Total (n = 545) | |
---|---|---|---|
N (%) | n(%) | n(%) | |
Age (years)
| |||
35 - 45 | 123(44.6) | 164(61.0) | 287(52.7) |
46 - 55 | 52(18.8) | 64(23.8) | 116(21.3) |
56 - 65 | 48(17.4) | 29(10.8) | 77(14.1) |
65 - 75 | 33(12.0) | 10(3.7) | 43(7.9) |
More than 75 | 20(7.2) | 2(0.7) | 22(4.0) |
Ethnicity
| |||
Pathan | 91(33.0) | 58(21.6) | 149(27.3) |
Punjabi | 72(26.1) | 71(26.4) | 143(26.2) |
Sindhi | 52(18.8) | 37(13.8) | 89(16.3) |
Balochi | 3(1.1) | 6(2.2) | 9(1.7) |
Afghan | 3(1.1) | 19(17.1) | 22(4.0) |
Others | 55(19.9) | 79(29.0) | 133(24.4) |
Education
| |||
None | 136(49.3) | 148(55.0) | 284(52.1) |
Religious only | 36(13.0) | 82(30.5) | 118(21.7) |
Some school | 103(37.3) | 39(14.5) | 142(26.1) |
Marital Status
| |||
Married | 261(95.6) | 221(82.5) | 482(88.4) |
Single | 7(2.6) | 8(3.0) | 15(2.8) |
Divorced/Widowed | 5(1.9) | 39(14.6) | 44(8.1) |
Stroke (n = 104) | TIA (n = 53) | Stroke/TIA (n = 119) | ||||
---|---|---|---|---|---|---|
n | % (95% CI) | n | % (95% CI) | n | % (95% CI) | |
Gender
| ||||||
Male | 32 | 11.6 (7.8-15.4) | 16 | 5.8 (3.0-8.6) | 40 | 14.5 (10.3-18.7) |
Female | 72 | 26.8 (21.4-32.1) | 37 | 13.7(9.6-17.9) | 79 | 29.4 (23.9-34.8) |
Age (years)
| ||||||
35 - 45 | 50 | 17.4 (13.2-22.3) | 27 | 9.4 (6.3-13.4) | 55 | 19.2 (14.8-24.2) |
46 - 55 | 25 | 21.6 (14.5-30.1) | 11 | 9.5 (4.1-14.9) | 29 | 25.0 (17.4-33.9) |
56 - 65 | 15 | 19.5 (11.3-30.1) | 8 | 10.4 (3.4-17.4) | 19 | 24.7 (15.6-35.8) |
66 - 75 | 9 | 20.9 (10.0-36.0) | 3 | 7.0 (1.5-19.1) | 10 | 23.3 (11.8-38.6) |
More than 75 | 5 | 22.7 (7.8-45.4) | 4 | 18.2 (5.2-40.3) | 6 | 27.2 (10.7-50.2) |
Ethnicity
| ||||||
Pathan | 24 | 16.1 (10.6-23.0) | 13 | 8.7 (4.7-14.5) | 29 | 19.5 (13.4-26.7) |
Punjabi | 27 | 18.9 (12.8-26.3) | 17 | 11.9 (7.1-18.4) | 32 | 22.4 (15.8-30.1) |
Sindhi | 16 | 18.0 (10.6-27.5) | 10 | 11.2 (5.5-19.7) | 18 | 20.2 (12.4-30.1) |
Balochi | 4 | 44.4 (13.7-78.8) | 2 | 22.2 (2.8-60.0) | 4 | 44.4 (13.7-78.8) |
Afghan | 9 | 41.0 (20.7-63.6) | 5 | 22.7 (7.8-45.4) | 9 | 31.0 (20.7-63.6) |
Others | 24 | 18.0 (11.9-25.6) | 6 | 4.5 (1.7-9.6) | 27 | 20.3 (13.8-28.1) |
Total
| 104 | 19.1 (15.9-22.6) | 53 | 9.7 (7.4-12.5) | 119 | 21.8 (18.4-25.5) |
No CVD | Stroke/TIA | Non-adjusted odds ratio | P-value | |
---|---|---|---|---|
n (%)a
| n (%)a
| OR (95% CI) | ||
Age, years (SD)
| 48.3 (12.7) | 50.0 (12.8) | 1.01 (0.99-1.03) | 0.192 |
Female gender
| 190 (44.6) | 79 (66.4) | 2.45 (1.60-3.75) | < 0.001 |
Family history of CAD or Stroke
| 86 (20.2) | 37 (31.1) | 1.78 (1.13-2.81) | 0.013 |
Past Myocardial Infarction
| 24 (5.6) | 11 (11.8) | 2.23 (1.12-4.47) | 0.023 |
Systolic BP, mmHg (SD)
| 128.6 (21.0) | 134.9 (27.3) | 1.06 (1.02-1.11)b
| 0.008 |
Diastolic BP, mmHg (SD)
| 81.8 (12.1) | 84.2 (14.2) | 1.08 (0.997-1.167)b
| 0.061 |
Hypertension
c
| 203 (47.7) | 76 (63.9) | 1.94 (1.28 - 2.95) | 0.002 |
Random Blood Glucose, mg/dL (SD)
| 141.6 (69.6) | 164.1 (86.9) | 1.02 (1.005-1.030)2
| 0.004 |
Elevated RBS
d
| 74 (17.4) | 36 (30.3) | 2.06 (1.30-3.28) | 0.002 |
Smoking
| 123 (28.9) | 25 (21.0) | 0.66 (0.40-1.07) | 0.090 |
Pan, Gutka or Supari Use
e
| 78 (18.3) | 30 (25.2) | 1.50 (0.93-2.43) | 0.096 |
Weight, kg (SD)
| 67.7 (17.3) | 69.0 (19.2) | 1.00 (0.99-1.02) | 0.468 |
Body mass index, kg/m
2
(SD)
| 26.6 (8.0) | 27.5 (6.1) | 1.01 (0.99-1.04) | 0.269 |
Obesity
f
| 229 (53.8) | 81 (68.1) | 1.83 (1.19-2.82) | 0.006 |
Waist Circumference, cm (SD)
| 93.2 (13.6) | 94.7 (16.0) | 1.01 (0.99-1.02) | 0.301 |
Waist-Hip Ratio (SD)
| 0.94 (0.09) | 0.93 (0.08) | 0.46 (0.05-4.72) | 0.516 |
Elevated WHR
g
| 375 (88.0) | 109 (91.6) | 1.48 (0.73-3.02) | 0.278 |
Menopause
h
| 98 (57.7) | 47 (62.7) | 1.23 (0.71-2.15) | 0.462 |
No CVD | Stroke/TIA | Adjusted odds ratio | P-value | |
---|---|---|---|---|
n (%)a
| n (%)a
| OR (95% CI) | ||
Age, years (SD)
| 48.3 (12.7) | 50.0 (12.8) | 1.022 (1.003-1.041) | 0.021 |
Female gender
| 190 (44.6) | 79 (66.4) | 2.62 (1.56-4.40) | < 0.001 |
Family history of CAD or Stroke
| 86 (20.2) | 37 (31.1) | 1.65 (1.02-2.69) | 0.042 |
Past Myocardial Infarction
| 24 (5.6) | 11 (11.8) | 1.62 (0.77-3.39) | 0.205 |
Hypertension
b
| 203 (47.7) | 76 (63.9) | 1.25 (0.78-2.00) | 0.504 |
Elevated RBS
c
| 74 (17.4) | 36 (30.3) | 1.76 (1.07-2.90) | 0.026 |
Smoking
| 123 (28.9) | 25 (21.0) | 1.03 (0.58-1.83) | 0.921 |
Pan, Gutka or Supari Use
| 78 (18.3) | 30 (25.2) | 2.06 (1.22-3.49) | 0.007 |
Obesity
d
| 229 (53.8) | 81 (68.1) | 1.49 (0.92-2.41) | 0.104 |
Discussion
Author | Method of Diagnosis of Stroke | Study Method | Sample Population | Year | Important Findings |
---|---|---|---|---|---|
Bharucha et al[24] | Clinical diagnosis by a neurologist | Population-based door-to-door survey | India, Bombay (n = 14 010) | 1988 | Crude prevalence was 842 per 100 000 population; age-specific rates were higher in men |
Mittelmark et al[25] | Self-reported history plus medical record confirmation | Population based longitudinal study | Four regions, USA (n = 5,201) | 1989-90 | Crude prevalence rate was 246 per 100,000a |
Bots et al[26] | Self-reported history plus medical record confirmation | Population-based, cohort | Rotterdam, Netherlands (n = 7983) | 1990-93 | A total of 352 individuals out of 7983 were reported to have a stroke, while an additional 285 were reported with clinical data. This represents a crude prevalence rate of 7979 per 100,000a |
Geddes et al[27] | Self-reported stroke questionnaire through postal service | Population based, point prevalence study | Yorkshire, UK (n = 18,827) | 1991 | Crude prevalence rate was 4680 per 100,000, with males having a higher prevalence |
Bonita et al[28] | Clinical diagnosis using WHO definition | Retrospective analysis of hospital, clinical and autopsy record | Auckland, New Zealand (n = 854000 and 945 000)b
| 1991-92 | Age-adjusted rate was 833 per 100, 000 |
Prencipe et al[29] | Self-reported history followed by neurological examination | Community-based, door-to-door survey | L'Aquila, Italy (n = 1032) | 1992 | Crude prevalence rate was 7300 per 100,000. Prevalence of stroke was higher in men and increased with age in both sexes |
O'Mahony et al[30] | Screening questionnaire followed by clinical confirmation using WHO criteria | Population based, point prevalence study | Newcastle, UK (n = 2000) | 1993 | Crude prevalence rate was 4740 per 100,000, while age adjusted rates were 1750 per 100,000. Prevalence increased proportionately in older age groups |
Huang et al[31] | unclear | Population-based, Cross sectional?? | Taiwan, China (n = 11, 925) | 1994 | Crude prevalence rate was 595 per 100,000 |
Nicoletti et al[32] | WHO Stroke screening instrument | Population based door-to-door survey | Cordillera, Bolivia (n = 9955) | 1994 | Crude prevalence rate was 663 per 100,000 for those >/= 35 years. Prevalence in men was 2× greater than women |
Banergee et al[33] | Clinical diagnosis by a neurologist or CT imaging | Population-based cluster survey | India, Calcutta (n = 50 291) | 1998-1999 | Crude prevalence was 147 and age-adjusted rate was 334 per 100 000 population; females had higher prevalence in all age groups |
Anand et al[34] | Self-reported history or clinical diagnosis by physician | Population-based cross-sectional | Canada (n = 985) | 2000 | Crude prevalence rates were similar among ethnic groups: South Asians: 300, European whites: 1800, and Chinese: 600 per 100 000 population |
AASAP[35] | Unclear | Based on national health records of individual country | Nine Asian countries (Pakistan was not part of this study) | 2000 | Crude prevalence in India ranges from 90-222 per 100 000; Thailand and Taiwan had higher reported prevalence rates (690 and 1430) per 100 000 |
Jafar et al[4] | Self-reported history | Community survey and target sampling | Pakistan (n = 500) | 2001 | Crude prevalence was 4800 per 100 000 |
Venketa-subramanium et al[36] | Clinical diagnosis using WHO definition | Population-based, cross-sectional | Singapore (n = 15 606) | 2001-2003 | Crude as well as age-standardized rates were similar among ethnic groups (SA: 362, Malays: 332, Chinese: 376) per 100 000 population |
Department of Health Survey for England[37] | Clinical diagnosis using WHO definition | Population-based door-to-door health survey | Stratified proportionate sample from general population | 2005 | Crude prevalence in South Asians (Indian: 1100, Pakistani: 1800, Bangladeshi: 1800) were lower than European Whites (2400) per 100 000 population |
This Study - Kamal et al | Self-reported history based on SSQ followed by neurological examination | Community-based following census | Karachi, Pakistan (n = 545) | 2008-2009 | Crude prevalence was determined to be 19000 per 100,000. Women found to have a higher prevalence of stroke and at an earlier age than men. |