The Distribution of Lifestyle Risk Factors Among Patients with Stroke in the Indian Setting: Systematic Review and Meta-Analysis

Biji P Varkey; Jaison Joseph; Abin Varghese; Suresh K Sharma; Elezebeth Mathews; Manju Dhandapani; Venkata Lakshmi Narasimha; Radha Kuttan; Saleena Shah; Surekha Dabla; Sivashanmugam Dhandapani

doi:10.1177/09727531221115899

The Distribution of Lifestyle Risk Factors Among Patients with Stroke in the Indian Setting: Systematic Review and Meta-Analysis

Ann Neurosci. 2023 Jan;30(1):40-53. doi: 10.1177/09727531221115899. Epub 2022 Aug 8.

Authors

Affiliations

¹ Department of Neurology, Postgraduate Institute of Medical Sciences, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, Haryana, India.
² Department of Psychiatric Nursing, College of Nursing, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, Haryana, India.
³ College of Nursing, AIIMS, Nagpur, India.
⁴ College of Nursing, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India.
⁵ Department of Public Health and Community Medicine, Central University of Kerala, Kasaragod, Kerala, India.
⁶ National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Chandigarh, India.
⁷ Department of Psychiatry, All India Institute of Medical Sciences (AIIMS) Deoghar, Jharkhand, India.
⁸ College of Nursing, Bhopal Memorial Hospital and Research Centre, ICMR, Bhopal, Madhya Pradesh, India.
⁹ Government College of Nursing Thiruvananthapuram, Kerala, India.
¹⁰ Department of Neurology, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, Haryana, India.
¹¹ Department of Neurosurgery, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Chandigarh, India.

Abstract

Background: The burden of stroke is increasing in India, but there is limited understanding of the distribution of reported risk factors in the Indian setting. It is vital to generate robust data on these modifiable risk factors to scale up appropriate strategies for the prevention of cerebrovascular diseases in this setting.

Summary: The objective of this study is to estimate the overall proportion of life style risk factors of patients with stroke in the Indian setting. We searched PubMed and Google Scholar and relevant studies published till February 2022 were included. The risk of bias assessment was considered for the study selection criterion in the meta-analysis. The publication bias was evaluated by funnel plots and Egger's test. We identified 61 studies in the systematic review and after quality assessment, 36 studies were included for meta-analysis. Random effect model was used due to the significant inconsistency among the included studies (I2 > 97%). The mean age of the participants was 53.84±9.3 years and patients with stroke were predominantly males (64%). Hypertension (56.69%; 95% CI: - 48.45 - 64.58), obesity (36.61%; 95% CI: - 19.31 - 58.23), dyslipidemia (30.6%; 95% CI: - 22 - 40.81) and diabetes mellitus (23.8%; 95% CI: - 18.79 - 29.83) are the leading intermediate conditions associated with stroke. The Physical inactivity - 29.9% (95% CI: - 22.9 - 37.1), history of tobacco use (28.59 %; 95% CI: - 22.22 - 32.94) and alcohol use (28.15 %; 95% CI: - 20.49 - 37.33) were reported as the behavioral risk factors for stroke in this setting.

Key messages: The current meta-analysis provides robust estimates of the life style related risk-factor of stroke in India based on the observational studies conducted from 1994 to 2019. Estimating the pooled analysis of stroke risk factors is crucial to predict the imposed burden of the illness and ascertain the treatment and prevention strategies for controlling the modifiable risk factors in this setting.

Keywords: India; Lifestyle; Patients; Risk factors; Stroke.

Publication types

Review