Epidemiologic Depiction of Main Risk Factors of Brain Stroke in East Azerbaijan Province (The Northwest of Iran): A Hospital-Based Study

Extended Abstract

Background

Brain stroke is the second cause of death and the third cause of disability-adjusted life years (DALYs) in Iran. Every year, brain stroke kills thousands of Iranians and more than five and a half million people around the world, and the majority of global deaths are in developing countries. Brain stroke is the second most common cause of death and the first cause of disability in the world. Given that the adoption of health, prevention, and treatment policies in any city or country is based on the importance and extent of the problem and priority cases, and considering that studies related to brain stroke risk factors in Iran are insufficient and are mostly performed with a low sample size, this study investigated the epidemiology of the main risk factors for brain stroke in East Azerbaijan province.

Methods

This cross-sectional study was conducted using data gathered from 5430 patients with a definite diagnosis of brain stroke registered in the Tabriz Stroke Registration System (TSR) between February 2015 and June 2021 in the referral hospitals of East Azerbaijan. From the total of 5543 patients registered for the mentioned period, all the patients who entered the hospital with an mRS (Modified Rankin Scale) score equal to 6 were excluded from the study (110 cases). This score was equivalent to the death of the patient, which meant that the patient died at the time of entering the hospital. In very few cases (three cases), the patients' information was incomplete, and they were not able to enter the study. Finally, 5,430 patients were selected and included in the study. It should be noted that no duplicate cases were registered in the TSR system. Analyses were performed using STATA software (version 17). Descriptive statistics were calculated, and a chi-square test was run. It is worth mentioning that any P<0.05 was considered statistically significant.

Results

The results indicated that the highest frequency of brain stroke cases was in the age range of over 80 years, and the lowest frequency was in the age range of 61-70 years. The lowest recorded age for the patients was 11, and the highest recorded age was 110 years. About half of the patients (2770) were from the city of Tabriz, and the other half were from other cities in East Azerbaijan province. About 93% of the patients were at home when the brain stroke occurred, and most of them (in 87% of cases) were awake. In 14% of cases, the people reported weakness in the left upper limb, and in 34% of cases, weakness in the right upper limb. In 33% of cases, the patients also stated that there was weakness in the left lower limb as well as the right lower limb. The patients reported weakness in the left side of the face in 14% of cases and weakness in the right side of the face in 13% of cases. The patients experienced speech disorder in 22% of cases, loss of consciousness in 31% of cases, falling or tripping in 11% of cases, dizziness in 11% of cases, headaches in 23% of cases, vomiting in 24% of cases, and difficulty with swallowing in 21% of cases. The evaluation of the brain stroke scale score indicated that most of the patients had moderate brain stroke (40% of cases) and severe brain stroke (30% of cases). Also, the consciousness score of the patients indicated that most of them (67% of cases) had mild brain damage, and 15% had severe brain damage. The epidemiological profile of the main risk factors was presented in the framework of clinical trials and findings, clinical risk factors, and behavioral risk factors associated with brain stroke. The mean age of the patients was 69.52±15.72 years; 47.15% were female and 52.85% were male. The most common risk factors included: having high blood pressure (67.81%), snoring (32.06%), diabetes mellitus (22.23%), familial history of stroke (18.78%), ischemic heart disease (17.55%), aspiration pneumonia (15.32%), smoking (13.65%), atrial fibrillation (10.15%), and hyperlipidemia (8.42%). Ischemic brain stroke (68.20%) was more common than hemorrhagic brain stroke (31.80%). Smoking was significantly higher in men than women (P<0.001). The prevalence of hypertension (P<0.001), atrial fibrillation (P=0.001), and hyperlipidemia (P<0.001) was significantly higher in women than men. There was a direct and significant relationship between atrial fibrillation and age (P<0.001) and female gender (P=0.001).

Conclusion

The most common risk factors for brain stroke in this study include high blood pressure, snoring, diabetes mellitus, familial history of stroke, ischemic heart disease, aspiration pneumonia, smoking, atrial fibrillation, and hyperlipidemia, respectively. Hypertension is the most common risk factor among patients, so screening for asymptomatic cases is recommended. Educating people about common clinical manifestations can help expedite their early referral and treatment. Having an epidemiological profile of the main risk factors for brain stroke in Iran depends on the availability of sufficient information and epidemiological studies. Prevention and intervention to control brain stroke risk factors with prioritization based on the findings of this study are recommended.