1Jacob School of Medicine and Biomedical Sciences, University at Buffalo, New York.
2Vanderbilt University School of Medicine, Nashville, Tennessee.
J Neurosurg. 2023 Mar 31;139(4):1042-1051. doi: 10.3171/2023.2.JNS222807. Print 2023 Oct 1.
Strokes affect almost 13 million new people each year, and whereas the outcomes of stroke have improved over the past several decades in high-income countries, the same cannot be seen in low-income and lower-middle-income countries. This is the first study to identify the availability of diagnostic tools along with the rates of stroke mortality and other poststroke complications in low-income and lower-middle-income countries.
A review of the literature was completed with a search of the MEDLINE, Embase, and Scopus databases, with adherence to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were included if they reported any outcomes of stroke in low-income and lower-middle-income countries as designated by the World Bank classification. A meta-analysis calculating pooled prevalence rates of diagnostic characteristics and stroke outcomes was completed for all endpoint variables.
A total of 19 studies were included, of which 6 came from Ethiopia, 3 from Zambia, and 2 each from Tanzania and Iran. Single studies from Zimbabwe, Botswana, Senegal, Cameroon, Uganda, and Sierra Leone were included. A total of 5265 (61.7%) patients had an ischemic stroke, 2124 (24.9%) had hemorrhagic stroke, with the remaining 1146 (13.4%) having an unknown type. Among 6 studies the pooled percentage of patients presenting to hospital within 1 day was 48.37% (95% CI 38.59%-58.27%; I2 = 97.0%, p < 0.01). The pooled in-hospital mortality rate was 19.81% (95% CI 15.26%-25.31%; I2 = 91%, p < 0.01), but was higher in a hemorrhagic subgroup (27.07% [95% CI 22.52%-32.15%; I2 = 54%, p = 0.05]) when compared to an ischemic group (13.16% [95% CI 8.60%-19.62%; I2 = 87%, p < 0.01]). The 30-day pooled mortality rate was 23.24% (95% CI 14.17%-35.70%; I2 = 93%, p < 0.01). At 30 days, the functional independence (modified Rankin Scale score 0-2) pooled rate was 13.10% (95% CI 7.50%-21.89%; I2 = 82%, p < 0.01).
A severe healthcare disparity is present in low-income and lower-middle-income countries, where there is delayed diagnosis of strokes and increased rates of poor clinical outcomes for these patients.
中风每年影响近 1300 万人，尽管在过去几十年中，高收入国家的中风预后有所改善，但在低收入和中低收入国家却并非如此。这是第一项旨在确定低收入和中低收入国家诊断工具的可用性以及中风死亡率和其他中风后并发症发生率的研究。
对 MEDLINE、Embase 和 Scopus 数据库进行文献综述，并遵循 PRISMA（系统评价和荟萃分析的首选报告项目）指南。如果研究报告了世界银行分类指定的低收入和中低收入国家的任何中风结果，则将其纳入研究。对所有终点变量的诊断特征和中风结果的汇总患病率进行了荟萃分析。
共纳入 19 项研究，其中 6 项来自埃塞俄比亚，3 项来自赞比亚，2 项分别来自坦桑尼亚和伊朗。还有来自津巴布韦、博茨瓦纳、塞内加尔、喀麦隆、乌干达和塞拉利昂的单项研究。共有 5265 名（61.7%）患者患有缺血性中风，2124 名（24.9%）患有出血性中风，其余 1146 名（13.4%）中风类型未知。在 6 项研究中，有 48.37%（95%置信区间 38.59%-58.27%；I2 = 97.0%，p < 0.01）的患者在发病后 1 天内到医院就诊。住院死亡率为 19.81%（95%置信区间 15.26%-25.31%；I2 = 91%，p < 0.01），但在出血性亚组中更高（27.07% [95%置信区间 22.52%-32.15%；I2 = 54%，p = 0.05]），与缺血性组（13.16% [95%置信区间 8.60%-19.62%；I2 = 87%，p < 0.01]）相比。30 天死亡率的汇总率为 23.24%（95%置信区间 14.17%-35.70%；I2 = 93%，p < 0.01）。30 天时，功能独立性（改良 Rankin 量表评分 0-2）的汇总率为 13.10%（95%置信区间 7.50%-21.89%；I2 = 82%，p < 0.01）。
低收入和中低收入国家存在严重的医疗保健差距，这些国家中风的诊断延迟，患者的临床预后较差。
