The evaluation of the population health status has been based on simple estimators such as general mortality rates or by age groups, incidence rates, prevalence or lethality, these estimators present limitations to measure the health-disease phenomenon.
Stroke of both ischemic and hemorrhagic origin has many similar risk factors that are classified into two categories: modifiable and non-modifiable. Among the non-modifiable risk factors are age, sex, family history of stroke, having a previous episode, and black race. Multiple studies and clinical practice guidelines indicate that the risk of stroke increases significantly after 60 years of age. On the other hand, generally, up to the age of 60, there is a greater risk in men than in women, although mortality is always higher in women. After these ages, the risks are comparable. Strokes are the leading cause of serious long-term disability in several developed countries such as the United States. It is one of the 18 main diseases that causes loss of healthy life years and years of life lived with disability during 2010.
In Colombia, stroke was the third leading cause of death, after violence and coronary heart disease, during 2010; it is one of the main determinants of loss of healthy life years due to disability and premature death. Regarding the prevalence, differences have been found in reports according to the period and the place.
Local studies were found in various regions such as:
- The study by Girón, Santander, in 1984, showed a prevalence of 16 cases in 1,000 inhabitants.
- In Jamundí, department of Valle del Cauca, in 1984 a prevalence of 12 cases was reported in 1,000 inhabitants.
- In the Hato region, Santander, in 1985 we found reports of 8.2 cases in 1,000 inhabitants.
- The department of Antioquia has a study carried out in the region of Sabaneta in 1992, in which there are reports of 5.6 cases in 1,000 people.
- In Juan de Acosta in the Atlantic, in 1992 a prevalence of 1.42 cases was reported in 1,000 inhabitants.
- In Aratoca, Santander, in 2001 a prevalence of 4.7 cases was estimated in 1,000 population.
- A study in Piedecuesta, Santander, for the year 2002 reported 5.7 cases in 1,000 inhabitants.
- The EPINEURO National Epidemiological Study, published in 2003, shows figures of 6.8 cases in 1,000 inhabitants in the southwestern region, while for the eastern region was 17.2 cases in 1,000 inhabitants, with a national prevalence in over 50 years of 19.9 cases in 1,000 inhabitants.
These differences could be attributed to multiple factors such as lifestyles, ethnic factors, differences in eating habits, access to health care and lack of resources, among others. The study by Rosselli et al, published in 2014, which analyzes the behavior of mortality attributed to stroke, reports that the proportion of all deaths in the country has not varied as in other chronic diseases, remaining almost constant since 1960. During most of the rest of years are around 7%, predicting it to reach 8% for the year 2012.
The report from Sabaneta, Antioquia, shows an annual incidence adjusted for age and sex of 88.9 cases in 100,000 inhabitants, a figure that is low, compared to the incidence in other countries. The article authors refer that it may be associated with the impact of public health programs in terms of prevention, the low illiteracy rate in this region, the adequate control of risk factors, and appropriate diagnosis and treatment.
The behavior of stroke in Colombia, in terms of gender and age, reports a higher incidence in men, with estimates 118.7 cases in 100,000 inhabitants, while in women there are 61.8 cases in 100,000 inhabitants, numbers that are tripled after 60 years. According to DANE reports for 2010, the basic mortality cause rates show that stroke is the third cause of death with a mortality of 26.9%. Analyzing information by departments, it is among the main causes of death in 33 of them, when making adjustments for age. In Guainía it is the leading cause of death and is always among the top four causes of death by department.
In 2014, a total of 64,662 cases were presented, of which 33,037 were men and 31,625 women, a greater number of cases is observed in men than in women, although in the group over 80 there are more women than men with stroke, this may be due to the fact that women have a longer life expectancy and there is a greater population of women in this age group. In Colombia, information on direct and indirect costs of LCA is low; in the distribution by department, higher incidence rates for stroke are observed in departments such as Boyacá, Santander and Risaralda, and the lowest incidence rates are observed in the departments of Vaupés, Amazonas, Vichada and Guainía. This geographical distribution shows a wide range of incidence that goes from 0.16 to 1.43 which may because of the wide geographical, climatic, sociocultural, environmental, economic variation, access and health coverage and diverse distribution of risk factors within the country. In the incidence of stroke for Colombia in 2014, it is observed a significant increase from 50 years of age is greater in the group of men between 50 and 75 years than in women; in the age group of more than 80 years, women have a higher incidence rate of stroke. The CVD incidence rate for our country in 2014 was 1.31 cases per 1,000 inhabitants,1.33 in women and 1.30 in men.
There is a great similarity with other Colombian reports such as that of the National Health Institute (First ONS report) (incidence of 1.25), the study of Sabaneta, Antioquia, developed in 1996 reported a higher incidence rate in men (1.18) than in women (0.61) presenting differences with the data reported by the RIPS for 2014 (men 1.30 and women 1.33), additionally there is a lower incidence in both men and women in this Antioquia population.
The estimates of incidence, mortality, and prevalence of disability due to stroke, present a similar directionality to international publications and estimates, showing that stroke represents an important cause of disability and mortality for Colombia, which generates a high burden of disease, a high impact on the quality of life of affected people and their families, so it should be a priority in health and research in Colombia. These estimates support and sustain the creation of health policies, the identification of the most vulnerable groups (with a population over 60 years of age growing rapidly), in order to create prevention and promotion programs that benefit the Colombian population in risk.
Written by: Lórena Gomez.
References
- Furie KL, Kasner SE, Adams RJ, Albers GW BR, Fagan SC et al. Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack: A guideline for healthcare professionals from the American Heart Association/American stroke Association. Stroke. 2011;42 (1):227–76.
- Murray CJ, Ezzati M, Flaxman AD, Lim S LR, Michaud C et al. GBD 2010: Design, definitions, and metrics. Lancet. 2012;380(9859):2063–6.
