Poorer countries, those spending less on health care have more strokes, deaths

Poorer countries and those that spend proportionately less money on health care have more stroke and stroke deaths than wealthier nations and those that allocate more to health care, according to new research in Stroke: Journal of the American Heart Association.

Poorer countries also had a greater incidence of hemorrhagic stroke - caused by a burst blood vessel bleeding in or near the brain - and had more frequent onset at younger ages.

Regardless of overall wealth, countries that spend less money proportionately on health care also had higher incidences of all four outcomes.

"Not only is the economic wellness of a country important, but also significant is what proportion of their gross domestic product is expended on health," said Luciano A. Sposato, M.D., M.B.A., study lead author and director of the neurology department at the Vascular Research Institute at INECO Foundation in Buenos Aires, Argentina. "This is very important for developing healthcare strategies to prevent stroke and other cardiovascular diseases."

In the large-scale literature review, researchers took a unique approach to identify stroke risk by correlating it to nationwide socioeconomic status.

Previous research tended to focus on the link between stroke and individual or family financial standing, said Sposato, also director of the Stroke Center at the Institute of Neurosciences, University Hospital Favaloro Foundation.

The terms intracerebral hemorrhage (ICH) and hemorrhagic stroke are used interchangeably in this discussion and are regarded as separate entities from hemorrhagic transformation of ischemic stroke. Intracerebral hemorrhage accounts for 10-15% of all strokes and is associated with higher mortality rates than cerebral infarctions.

Acute ischemic stroke refers to stroke caused by thrombosis or embolism and is more common than hemorrhagic stroke. Previous literature indicates that only 8-18% of strokes were hemorrhagic.

Although a 2010 retrospective review from a stroke center found that 40.9% of 757 strokes were hemorrhagic, nonetheless, the authors stated that the increased percentage of hemorrhagic stroke may be due to improvement of computed tomography (CT) scanning availability and implementation, unmasking a previous underestimation of the actual percentage, or it may be due to an increase in therapeutic use of antiplatelet agents and warfarin causing an increase in the incidence of hemorrhage.

Patients with hemorrhagic stroke present with similar focal neurologic deficits but tend to be more ill than patients with ischemic stroke. Patients with intracerebral bleeds are more likely to have headache, altered mental status, seizures, nausea and vomiting, and/or marked hypertension; however, none of these findings reliably distinguishes between hemorrhagic stroke and ischemic stroke. Though stroke is less common in children, the clinical presentation is similar.