Abstract 2783: Disparities in Ischemic Stroke Presentation and Outcomes Based on Human Development Index of a Nation: A Secondary Analysis of International Stroke Trial
Background and Purpose: Human Development Index (HDI), a comparative composite measure of health, education and standard of living of nations worldwide, is published annually by United Nations Development Programme (UNDP). Our aim was to study the disparities in presentation and outcomes of acute ischemic stroke based on HDIs of nations.
Methods: We used the International Stroke Trial (IST) database which was recently made available for public use for novel secondary analyses by independent researchers. IST, one of the largest prospective randomized controlled trials of acute stroke, was conducted in 467 hospitals of 36 countries in years 1991-1996 and included 19435 patients to study the effect of early treatment with aspirin and heparin in acute ischemic stroke. The trial had 99% complete six month follow-up data. We used the internet tool available on UNDP website to find HDIs of participating nations for the year 1995. We calculated National Institute of Health Stroke Scale equivalent stroke severity scale from the clinical findings present on admission. We only included the cases with final diagnosis of acute ischemic stroke and with known HDI (n=17262) in our analysis. We used χ2and one-way ANOVA to compare demographic and clinical characteristics between HDI groups. Multivariate logistic regression was used to study numeric HDI value multiplied by 100 as an independent predictor of various outcomes in stroke.
Results: There was a significant difference in all the studied stroke characteristics between different HDI groups (Table 1). With each unit increment in HDI by 0.01, odds of in-hospital mortality, complete functional recovery at six months and all-cause mortality at six months decreased by 2.3%, 3.6% and 2.8% respectively and odds of in-hospital recurrent ischemic stroke and functional dependence at six months increased by 4.8% and 2.7% respectively. HDI value could not predict intracranial hemorrhage or major non-cerebral bleeding significantly (Table 2).
Conclusions: We identified significant disparities in ischemic stroke presentation and outcomes between countries with different levels of national development. The disparities may have important implications in international health policy making and planning of multinational clinical trials involving acute ischemic stroke.
- © 2012 by American Heart Association, Inc.