Assessing tobacco-related ischemic stroke in Pakistan (1990-2019): Insights from the Global Burden of Disease Study

Shuai Hou; Meng Pang; Yifeng Zhang; Yulei Xia; Yanqiang Wang; Gang Wang

doi:10.18332/tid/185566

Assessing tobacco-related ischemic stroke in Pakistan (1990-2019): Insights from the Global Burden of Disease Study

Tob Induc Dis. 2024 Mar 28:22. doi: 10.18332/tid/185566. eCollection 2024.

Authors

Shuai Hou^{1

2}, Meng Pang³, Yifeng Zhang^{3

2}, Yulei Xia^{3

2}, Yanqiang Wang³, Gang Wang¹

Affiliations

¹ Emergency Department, Affiliated Hospital of Shandong Second Medical University, Weifang, People's Republic of China.
² School of Clinical Medicine, Shandong Second Medical University, Weifang, People's Republic of China.
³ Department II of Neurology, Affiliated Hospital of Shandong Second Medical University, Weifang, People's Republic of China.

Abstract

Introduction: This study analyzes the impact of active smoking and secondhand smoke on the ischemic stroke burden of Pakistan, 1990-2019.

Methods: We used data from the Global Burden of Disease (GBD) database to conduct a comprehensive evaluation of ischemic stroke-related indicators in Pakistan, including the number of deaths, mortality rates, disability-adjusted life years (DALYs), DALY rates, and the estimated annual percentage change (EAPC). Joinpoint analysis was applied to assess sex-specific temporal trends in the burden of active smoking and secondhand smoke in Pakistan and regions of Pakistan. These assessments incorporated the Socio-Demographic Index (SDI) and we have made comparative analyses of epidemiological differences between active smoking and secondhand smoke exposure.

Results: The burden of ischemic stroke related to tobacco use is presented in terms of the age-standardized mortality rate (ASMR) and the age-standardized disability-adjusted life year rate (ASDR) per 100000 population. The results (ASMR/ASDR) for Pakistan were 6.04/130.81, in the middle SDI region 7.69/176.54, and low-middle SDI region 5.64/124.22. Pakistan's ASMR is higher than the global average of 5.85, while ASDR is lower than the global average of 140.23. From 1990 to 2019, a downward trend in both ASMR and ASDR was observed, indicating progress in controlling tobacco-related stroke burdens. Individuals aged ≥70 years experienced the highest rates of stroke (ASMR: 66.31; ASDR: 1091.20). Gender disparities were evident: men were more affected by active smoking (ASMR: 3.08; ASDR: 78.47) than women (ASMR: 0.79; ASDR: 20.76), while women faced a higher burden from secondhand smoke (ASMR: 0.66; ASDR: 16.33) compared to men (ASMR: 0.79; ASDR: 9.93). Regional differences within Pakistan show fluctuating death and DALY rates. Notably, an increasing trend in female ASDR due to secondhand smoke in the Khyber Pakhtunkhwa Region (annual percentage change, APC=0.17 from 2010 to 2019) calls for focused health interventions.

Conclusions: The study finds ASMR for tobacco-related ischemic stroke in Pakistan exceeds global averages, with significant gender and age disparities in exposure to smoke, highlighting the need for targeted health interventions.

Keywords: Pakistan; active smoking; disease burden; ischemic stroke; secondhand smoke.

Grants and funding

FUNDING This work was supported by Shandong Province Medical and Health Science and Technology Development Plan (No 202103070864), Clinical Research Center of Affiliated Hospital of Shandong Second Medical University (No wyfy-2022-ky-148), Yuan Du Scholars and Weifang Key Laboratory.