Stroke incidence, mortality, subtypes in rural and urban populations in five geographic areas of India (2018-2019): results from the National Stroke Registry Programme

Sukanya Rangamani; Deepadarshan Huliyappa; Vaitheeswaran Kulothungan; Sankaralingam Saravanan; P K Murugan; Radha Mahadevan; Chelladurai Rachel Packiaseeli; Esakki Bobby; Kandasamy Sunitha; Ashok Kumar Mallick; Soumya Darshan Nayak; Santosh Kumar Swain; Manoranjan Behera; Bhaskar Kanti Nath; Abhijit Swami; Amit Kumar Kalwar; Bijush Difoesa; Vijay Sardana; Dilip Maheshwari; Bharat Bhushan; Deepika Mittal; Rameshwar Nath Chaurasia; L P Meena; K S Vinay Urs; Rahul Rajendra Koli; Natesan Suresh Kumar; Prashant Mathur

doi:10.1016/j.lansea.2023.100308

Stroke incidence, mortality, subtypes in rural and urban populations in five geographic areas of India (2018-2019): results from the National Stroke Registry Programme

Lancet Reg Health Southeast Asia. 2023 Oct 28:23:100308. doi: 10.1016/j.lansea.2023.100308. eCollection 2024 Apr.

Authors

Sukanya Rangamani¹, Deepadarshan Huliyappa¹, Vaitheeswaran Kulothungan¹, Sankaralingam Saravanan², P K Murugan², Radha Mahadevan², Chelladurai Rachel Packiaseeli², Esakki Bobby², Kandasamy Sunitha², Ashok Kumar Mallick³, Soumya Darshan Nayak³, Santosh Kumar Swain³, Manoranjan Behera³, Bhaskar Kanti Nath⁴, Abhijit Swami⁴, Amit Kumar Kalwar⁴, Bijush Difoesa⁴, Vijay Sardana⁵, Dilip Maheshwari⁵, Bharat Bhushan⁵, Deepika Mittal⁵, Rameshwar Nath Chaurasia⁶, L P Meena⁷, K S Vinay Urs¹, Rahul Rajendra Koli¹, Natesan Suresh Kumar¹, Prashant Mathur¹

Affiliations

¹ ICMR-National Centre for Disease Informatics and Research, II Floor of Nirmal Bhawan, ICMR Complex Kannamangala Post, Bengaluru, 562 110, India.
² Tirunelveli Medical College, Tirunelveli, 627011, India.
³ SCB Medical College & Hospital, Cuttack, Behera Colony, Mangalabag, Cuttack, Odisha, 753001, India.
⁴ Silchar Medical College, Beside Indian Post, Ghungoor, Masimpur, Silchar, Assam, 788014, India.
⁵ Govt Medical College, MBS Hospital, Nayapura, Kota, Rajasthan, 324001, India.
⁶ Department of Neurology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, 221005, India.
⁷ Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, 221005, India.

Abstract

Background: Increasing stroke burden in India demands a long-term stroke surveillance framework. Earlier studies in India were urban-based, short term and provided limited data on stroke incidence and its outcomes. This gap is addressed by the establishment of five population-based stroke registries (PBSRs) of the National Stroke Registry Programme, India. This paper describes stroke incidence, mortality and age, sex, and subtypes distribution in the five PBSRs with urban and rural populations.

Methods: First-ever incident stroke patients in age group ≥18 years, resident for at least one year in the defined geographic area, identified from health facilities were registered. Death records with stroke as the cause of death from the Civil Registration System (CRS) were included. Transient ischemic attack (TIA) was excluded. Three PBSRs (Cuttack, Tirunelveli, Cachar) included urban and rural populations. PBSRs in Kota and Varanasi were urban areas. The crude and age-standardized incidence rate (ASR) by age, sex, and residence (urban and rural), rate ratios of ASR, case fatality proportions and rates at day 28 after onset of stroke were calculated for years 2018-2019.

Findings: A total of 13,820 registered first-ever stroke cases that included 985 death certificate-only cases (DCOs) were analysed. The pooled crude incidence rate was 138.1 per 100,000 population with an age-standardized incidence rate (ASR) of 103.4 (both sexes), 125.7 (males) and 80.8 (females). The risk of stroke among rural residents was one in seven (Cuttack), one in nine (Tirunelveli), and one in 15 (Cachar). Ischemic stroke was the most common type in all PBSRs. Age-standardized case fatality rates (ASCFR) per 100,000 population for pooled PBSRs was 30.0 (males) and 18.8 (females), and the rate ratio (M/F) ranged from 1.2 (Cuttack) to 2.0 (Cachar).

Interpretation: Population-based registries have provided a comprehensive stroke surveillance platform to measure stroke burden and outcomes by age, sex, residence and subtype across India. The rural-urban pattern of stroke incidence and mortality shall guide health policy and programme planning to strengthen stroke prevention and treatment measures in India.

Funding: The National Stroke Registry Programme is funded through the intramural funding of the Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, India.

Keywords: India; Mortality; Population-based stroke registry; Rural; Stroke incidence; Subtypes; Urban.