Banandur Pradeep S, Sukumar Gautham Melur, Arvind Banavaram Anniappan, P R Srijithesh, V S Binu, Loganathan Santosh, Dalavaikodihalli Nanjaiah Nandakumar, Hegde Thimappa, Prasad Komal, Garady Lavanya, Akashanand Akashanand, Poddar Palak, Jayabalan Meenakshi, Madan Isha, Medhi Upashana, Arun Arpitha
Dept. of Epidemiology, NIMHANS, Bengaluru, Karnataka, India.
Department of Neurology, NIMHANS, Bengaluru, Karnataka, India.
PLoS One. 2024 Oct 2;19(10):e0310309. doi: 10.1371/journal.pone.0310309. eCollection 2024.
Stroke is a leading cause of death and disability worldwide. In India, it is the fourth leading cause of death and fifth leading cause of disability, posing a major public health concern. National surveys reveal an increasing trend in stroke risk factors such as tobacco use, physical activity, alcohol use, hypertension, and dyslipidemia. However, knowledge regarding the combined effect of these risk factors and their various combinations is limited. Understanding the individual, combined, and synergistic effects of known risk factors, along with new risk factors, is essential to address gaps in stroke epidemiology. This study aims to examine the effect of various risk factors of acute stroke and their association with stroke occurrence and its outcomes (survival, disability and quality of life).
This retrospective-prospective cohort will be conducted in one taluka of Kolara district and two urban wards of Bengaluru with a total population of ~400,000. All stroke-free individuals above 30 years of age ~200,000 individuals in the selected sites will be participants of stroke-free period and all first ever stroke patients in the community will be part of stroke and post-stroke period respectively. The study subjects will be recruited through a complete house-to-house survey at baseline and undergo annual follow-ups during the stroke-free period, with specific assessments at defined time points during the stroke and post-stroke period for a period of one year. Efforts are implemented to minimize loss to follow-up, including community engagement, a helpline number, and hospital-based surveillance.
This large population-based cohort study addressing stroke epidemiology in the country, is one -of-its-kind, attempting to fill certain critical gaps in the natural history, management, and outcomes of stroke in India. This research has the potential to provide important insights into the effect of novel risk factors of stroke and various combinations of risk factors of stroke. Furthermore, the development of a stroke risk predictability calculator will add value to the existing Indian National Programme for Prevention & Control of Non-Communicable Diseases (NP-NCD) and offers a model for similar countries once developed.
中风是全球死亡和残疾的主要原因。在印度，它是第四大死亡原因和第五大残疾原因，构成了重大的公共卫生问题。全国性调查显示，中风风险因素如吸烟、身体活动、饮酒、高血压和血脂异常呈上升趋势。然而，关于这些风险因素的综合影响及其各种组合的知识有限。了解已知风险因素以及新风险因素的个体、综合和协同作用，对于填补中风流行病学的空白至关重要。本研究旨在探讨急性中风的各种风险因素的影响及其与中风发生及其结局（生存、残疾和生活质量）的关联。
这项回顾性-前瞻性队列研究将在科拉纳区的一个 taluka 和班加罗尔的两个城市街区进行，总人口约为 40 万。选定地点所有 30 岁以上无中风的个体（约 20 万个体）将作为无中风期的参与者，社区中所有首次发生中风的患者将分别作为中风期和中风后期的一部分。研究对象将在基线时通过全面的逐户调查招募，并在无中风期进行年度随访，在中风期和中风后期的特定时间点进行为期一年的具体评估。采取措施尽量减少失访，包括社区参与、求助热线号码和基于医院的监测。
这项针对该国中风流行病学的大型基于人群的队列研究是同类研究中的首个，试图填补印度中风自然史、管理和结局方面的某些关键空白。这项研究有可能提供关于中风新风险因素的影响以及中风风险因素的各种组合的重要见解。此外，中风风险预测计算器的开发将为现有的印度国家非传染性疾病预防与控制计划（NP-NCD）增添价值，一旦开发成功，还可为类似国家提供一个模型。
