The Epidemiology and Spatial Analysis of Stroke in Trinidad and Tobago in the First Decade of the 21^st Century (2000-2009)

Abstract

Objective: To investigate the pattern and distribution of stroke in Trinidad and Tobago from 2000-2009. To identify the prevalence of co-morbid conditions among new stroke patients during the period under surveillance. Methods: Data were collected from May 2010 to July 2010 from the clinic of 728 new persons treated stroke at one of the main treatment centers. Variables measured included age, gender ethnicity, smoking status and co-morbid conditions. SPSS (Version 17) for Windows and ARC GIS version 9.3 were used to facilitate both descriptive and inferential data analysis. Results: Of the 728 new hospital admissions for the period January 2000-December 2009 for stroke, 369 (50.7%) were males and 359 (49.3%) were females. 59.8% were South-East Asian; 30.5% were African and 9.7% were mixed ethnicity. The predominant age group was 60 - 69 years (n = 215, 29.5%) while less than 1% were under 30. Ischemic stroke accounted for 352 (48.4%) of all new cases for the period; Hemorrhagic stroke accounted for 14.6% (n = 107), with 37% (n = 269) classified as other unspecified condition (including unknown). Of the 728 cases examined, 171 patients died before being discharged and 552 were treated and discharged. Information of 5 cases was not available. Using this data, the overall case fatality ratio was calculated as 23.5%, with the case fatality ratio for males being 23.2% and the equivalent ratio for females being 22.9%. Using a standard classification, the majority, (n = 389, 53.4%), of cases were classified as mild; 246 (33.8%) were deemed moderate, and 93 (12.8%) were severe cases. Hypertension was clinically diagnosed in 80.9% of the cases; 56.3% were diabetic, and 21.7% were classified as smokers having been either past or current smokers. Other lifestyle risk factors such as obesity and exercise were not examined due to the lack of the relevant data. The most frequent cardiovascular risk factor was chamber enlargement being present in 33.2%, while the second most frequent was left ventricular hypertrophy, 26.9%. The other cardiovascular risk factors examined included Ischemic heart disease, atrial fibrillation and previous myocardial infarction. All of which were present in less than 15% of the patients. Conclusion: The incidence of stroke in Trinidad and Tobago continues to be an important public health challenge as we complete the first decade of the 21 century. We provide important evidence on the changing epidemiological patterns of the disease, providing the first attempt to describe a possible stroke belt in the southern half of the island.