A new survey has found that low-income countries and those with lower healthcare spending have higher rates of hemorrhagic stroke, higher 30-day mortality, and an increased rate of younger-age stroke.

Researchers at the Institute of Cognitive Neurology (INECO) Foundation (Buenos Aires, Argentina) and the University of Toronto (Canada) conducted a systematic review of population-based studies reporting incident stroke risk and/or 30-day case-fatality according to pre-specified criteria. The researchers used three macro socioeconomic status indicators that are consistently defined by international agencies: per capita gross domestic product (GDP) adjusted for purchasing power parity (PPP), total health expenditures per capita at purchasing power parity, and unemployment rate. They then examined the correlation of each status indicator with incident risk of stroke, 30-day case-fatality, the proportion of hemorrhagic strokes, and age at stroke onset. In all, 23 studies met the criteria, reflecting standards of living concerns in 30 regions of the world.

The results showed that the age-adjusted incident risk of stroke using the standardized World Health Organization (WHO; Geneva, Switzerland) world population measures was 32% greater in countries with lower per-capita GDP, while countries with low government and private spending on health have a 26% higher rate of stroke. Thirty-day case-fatality rates and proportion of hemorrhagic strokes also reflected a 43% greater risk when related to lower per capita GDP, adjusted for PPP and total health expenditures per capita at PPP. Moreover, stroke occurred at a younger age in populations with low per capita GDP adjusted for PPP and total health expenditures per capita at PPP. There was no correlation between unemployment rates and outcome measures. The study was published ahead of print on October 27, 2011, in Stroke.

“A significant correlation was seen between the average annual per-capita gross domestic product and the proportion spent on healthcare, suggesting that the investment on health among less-developed countries was lower both in absolute and relative terms,” concluded study authors Luciano Sposato, MD, of the vascular research institute at INECO, and Gustavo Saposnik, MD, of the Stroke Outcomes Research Center at the University of Toronto. “As a result, these macro socioeconomic status indicators may be used as proxy measures of quality of primary prevention and acute care and considered as important factors for developing strategies aimed at improving worldwide stroke care.”

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