Case-fatality and disability in the Tanzanian Stroke Incidence Project cohort

• Published in: Acta neurologica Scandinavica Vol. 133; no. 1; pp. 49 - 54
• Main Authors: Walker, R. W., Wakefield, K., Gray, W. K., Jusabani, A., Swai, M., Mugusi, F.
• Format: Journal Article
• Language: English
• Published: Denmark Blackwell Publishing Ltd 01.01.2016; Hindawi Limited; John Wiley and Sons Inc
• Subjects: Adult; Aged; case-fatality; Cohort Studies; disability; Disabled Persons; Female; Follow-Up Studies; Humans; Incidence; Male; Middle Aged; mortality; Original; Original articles; stroke; Stroke - diagnosis; Stroke - epidemiology; Stroke - mortality; sub-Saharan Africa; Survival Rate - trends; Tanzania; Tanzania - epidemiology; mortality; sub-Saharan Africa; stroke; disability; Tanzania; case-fatality
• ISSN: 0001-6314; 1600-0404
• DOI: 10.1111/ane.12422

Objectives The burden of stroke on healthcare services in sub‐Saharan Africa (SSA) is increasing. However, long‐term outcomes from stroke in SSA are not well described. We aimed to investigate case‐fatality and health outcomes for stroke survivors at 7‐ to 10‐year follow‐up. Materials and methods The Tanzanian Stroke Incidence Project (TSIP) recruited incidence stroke cases between 2003 and 2006. We followed up cases in 2013, recording date of death in those who had died. Results Of 130 stroke cases included in this study, case‐fatality and date of death data were available for 124 at 7–10 years post‐stroke. Of these, 102 (82.3%) had died by 7 years post‐stroke. Functional disability, as measured by the Barthel index immediately post‐stroke, was a significant predictor of case‐fatality at seven‐year follow‐up with those with severe disability having an almost four‐fold increase in the odds of death compared with those with no, mild or moderate disability. Conclusions Case‐fatality rates are higher than reported in high‐income countries, with post‐stroke disability a significant predictor of death. Sustainable interventions to reduce post‐stroke disability in this setting should be investigated.