Longitudinal trends in stroke risk factors and mortality over 20 years from a central stroke referral center in Pakistan using clinically digitized data
Document Type
Artefact
Department
Medicine; Neurology
Abstract
Background: Limited data exists on long-term stroke trends in low- and middle-income countries, including Pakistan, despite its growing burden. Understanding these trends is crucial for informing healthcare strategies and public health interventions. This study examines 20-year trends in stroke characteristics, risk factors, and mortality at a tertiary care center in Pakistan.
Methods: In this retrospective study, a secondary analysis was conducted using clinically digitized records from the Aga Khan University Hospital. Patients aged ≥18 years, admitted with stroke, and discharged between January 1, 1999, and December 31, 2018, were included. Stroke subtypes were classified using ICD-9 CM codes as ischemic stroke, intracerebral hemorrhage (ICH), or transient ischemic attack (TIA) and cross checked against discharge diagnosis and neuroimaging reports to validate case identification. The retrospective, single-center design and possible variability in coding accuracy should be considered limitations when interpreting results.
Results: The final cohort included 12,837 patients: 71.4 % ischemic stroke, 21.2 % ICH, and 7.4 % TIA. The median age was 62 years (IQR: 52-70). Stroke admissions rose over time (n = 1975 in 1999-2002 vs. n = 3829 in 2015-2018). Stroke prevalence increased among patients aged 18-40 (p = 0.005) and > 80 (p = 0.002). Risk factors including hypertension, diabetes, atrial fibrillation, smoking, and carotid artery stenosis rose significantly (all p < 0.001). The most frequent comorbidity cluster was hypertension and diabetes (26.3 %), followed by hypertension, diabetes, and dyslipidemia (5.6 %). Unadjusted in-hospital mortality was 9.1 %, declining from 10.4 % to 9.1 % (p = 0.022), primarily due to decreased ICH mortality (24.1 % to 16.4 %, p < 0.001). Mortality predictors included age > 80 (OR 1.70), ICH (OR 3.21), early admission years, complicated diabetes, atrial fibrillation, and multiple comorbidities.
Conclusion: Stroke patterns are shifting toward younger age and greater risk factor clustering, though in-hospital mortality has declined. Continued surveillance and targeted interventions are essential.
AKU Student
no
Publication (Name of Journal)
eNeurologicalSci
DOI
10.1016/j.ensci.2025.100598
Recommended Citation
Aziz, N.,
Saleem, S.,
Sattar, S.,
Khan, S.,
Wasay, M.,
Shafqat, S.,
Kanwar, D.,
Siddiqui, S. J.,
Hameed, S.,
Ali, M.,
Samad, Z.,
Kamal, A. K.
(2025). Longitudinal trends in stroke risk factors and mortality over 20 years from a central stroke referral center in Pakistan using clinically digitized data. eNeurologicalSci, 41(100598), 1-11.
Available at:
https://ecommons.aku.edu/pakistan_fhs_mc_med_neurol/280