Dr. Avnish Jolly, 11th May, 2009 : According to recent researchers the number of people suffering haemorrhagic strokes has rised around 20 percent in the last decade, probably because of an ageing population. The findings published in the journal Lancet also suggest that while more men and women are suffering these types of strokes, the death rate has not worsened over the past 10 years due in part to advances in care. Strokes, which occur when blood flow to the brain is interrupted, can kill brain tissue and are one of the world’s leading causes of death and permanent disability. According to report the incidence of strokes in Mumbai is as high as those registered in developed countries like Germany, Australia and England and, that too, within a much younger population. The community study, supported by World Health Organisation (WHO), was conducted by Lilavati Hospital in association with municipal hospitals, general practitioners and local clinics in Bandra (H Ward).
The two-year study, conducted in 2005-06, was aimed at establishing a record of stroke occurrence in Mumbai. It was observed that as many as 152 persons in a lakh aged between 25 and 85 suffered strokes. Of the 3.37 lakh residents of H ward, 1.56 lakh above the age of 25 were screened for the study, which found that the incidence rate, stroke subtypes and case fatality rate are similar to those found in developed countries. The results were first published in October last year in Lancet and were reviewed in the April 2009 issue of Lancet Neurology. The April review notes that the stroke incidence rate in Mumbai was comparable to those reported from populations in high-income countries (HICs), and the 28-day case fatality was high with a fatal outcome in one out of three stroke cases. A complete case ascertainment of both hospitalised and non-hospitalised stroke events was ensured by ongoing contact with 120 local medical practitioners, and additionally, with local hospitals, nursing homes, diagnostic and municipal health authorities.
Most strokes are ischaemic strokes, caused by a blockage. Intracerebral haemorrhage – which account for about two million of the 15 million strokes worldwide each year – are caused by a rupture of blood vessels in the brain. The major risk factor for this is high blood pressure that weakens the walls of blood vessels, which then may split under the pressure. In their review of published studies and data from clinical trials, the researchers determined that hospital admissions for haemorrahagic stroke increased 18 percent in the past decade.
A growing number of elderly people and the increasing use of blood-clotting drugs that can lead to uncontrolled bleeding help explain the rise, the researchers said. Early diagnosis, aggressive management of blood pressure and further study of techniques to remove blood clots can help reduce the number of people who die from stroke even further, the researchers added.
The report also observes that the mean age of stroke patients was 66 years, 10 years lower than those reported in stroke studies in HICs. The low mean age of stroke patients suggests that the social consequences could be more, as the patients could be core contributors to maintaining the family income, and survival with disability could reduce work opportunities and necessitate increased care.
Doctors working on the project identified hypertension (high blood pressure), diabetes (high blood sugar), smoking and raised blood lipids as major risk factors. Doctors said changing lifestyle, high stress levels and diet irregularities have resulted in cases being reported in age group of 45 years and under.
The WHO has observed a greater than 100% increase in stroke incidence in low and middle income countries. “Our aim is not to scare people but to create awareness so that non-communicable diseases like stroke can be understood and handled better. And also, so that people can lead better lives. With timely treatment 60 per cent of such patients can be saved.
KNOW THE KILLER
• Strokes kill more than six lac Indians every year
• Around 20 to 30 per cent of strokes happen to those under 45 in India
• A stroke occurs when a part of the brain gets damaged due to interruption in blood supply.
• This interruption may happen when a blood vessel is blocked by a clot or bursts, cutting off oxygen supply. It may be temporary, may impair language, vision or motor skills or may paralyse a person, crippling his or her mobility for life.
• It is the second largest cause of death in India, after cancer