The major risk factor of stroke across Indonesia; a nationwide geospatial analysis of universal health coverage program.

BACKGROUND

Stroke is the leading cause of mortality in Indonesia, with hypertension and diabetes mellitus (DM) recognized as well-established risk factors. Moreover, recent epidemiological studies have documented rising incidence, morbidity and mortality of these conditions. Understanding their spatial distribution and interrelationships is crucial for developing targeted public health interventions. This study aims to analyze the geographic distribution of stroke, DM, and hypertension across Indonesia's provinces, evaluate their spatial correlations, and explore their interconnections using advanced spatial modeling techniques.

METHODS

The data were collected from the Social Health Insurance Administration Body, which manages Indonesia's universal health coverage, between 2017 and 2022. Crude incidence rates for the diseases were calculated and spatial distribution patterns were analyzed using Global and local Moran analysis. A spatial autoregressive (SAR) model was employed to assess the spatial dependence and interrelationships between these diseases.

RESULTS

The crude incidence rates of stroke, hypertension, and DM were 158.47, 2716.34, and 1503.06 per 100,000 population, respectively. Significant spatial heterogeneity was observed, with certain provinces consistently appearing as high-risk areas across all three diseases. Through SAR analysis, our study identified a significant positive spatial association between DM and stroke incidence, indicating that provinces with higher DM rates also tend to experience elevated stroke burden.

CONCLUSION

This study mapped the geographical and spatial distribution of stroke, DM, and hypertension across Indonesia and found the pivotal role of DM in driving stroke incidence. By prioritizing high-incidence regions and addressing specific risk factors, targeted interventions can significantly reduce stroke cases and enhance public health outcomes in Indonesia.