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Int. J. Environ. Res. Public Health 2018, 15(5), 927; https://doi.org/10.3390/ijerph15050927

In Hospital Stroke Mortality: Rates and Determinants in Southwestern Saudi Arabia

1
Department of Internal Medicine, College of Medicine, King Khalid University, Abha 61421, Saudi Arabia
2
Department of Family and Community Medicine, College of Medicine, King Khalid University, P.O. Box 641, Abha 61421, Saudi Arabia
3
Department of Epidemiology, High Institute of Public Health, Alexandria University, Alexandria 21511, Egypt
4
Department of Community Medicine, College of Medicine Mansoura University, Mansoura 35516, Egypt
5
Department of Neurology Section, Aseer Central Hospital, Saudi Arabia, Abha 21411, Saudi Arabia
*
Author to whom correspondence should be addressed.
Received: 10 April 2018 / Revised: 3 May 2018 / Accepted: 5 May 2018 / Published: 7 May 2018
(This article belongs to the Section Global Health)
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Abstract

Objectives: The present study analyzed in-hospital first-time stroke mortality in southwestern Saudi Arabia over one-year to assess the in-hospital stroke case fatality rate, mortality rate and explore the factors associated with in-hospital stroke mortality. Study Design: Hospital based follow-up study. Methods: First-time stroke patients admitted to all hospitals in Asser region over one-year period (January through December 2016) were included in the study. Data about personal characteristics, pre-stroke history and clinical criteria, on admission clinical criteria, in-hospital complications and survival status were collected. The last reported Aseer region population was used to calculate age and sex stroke mortality rate per 100,000 population/year. Hazard ratios (HR) and concomitant 95% confidence intervals (95% CI) were computed using multivariate Cox regression survival analysis. Kaplan-Meier curve survival analysis for stroke patients were plotted. Results: A total of 121 in-hospital deaths out of 1249 first-time stroke patients giving an overall case fatality rate (CFR) of 9.7%. Non-significant difference with gender and age were observed in CFR. Overall, in-hospital stroke mortality rate was 5.58 per 100,000/year. Males and elders showed a significantly higher mortality rates. Multivariable Cox regression analyses revealed pre-stroke smoking (HR = 2.36), pre-stroke hypertension (HR = 1.77), post-stroke disturbed consciousness (HR = 6.86), poor mobility (HR = 2.60) and developing pulmonary embolism (HR = 2.63) as significant predictors of in-hospital stroke mortality. Conclusions: In Southwestern Saudi Arabia, the in-hospital stroke mortality rate is higher in men and increases with aging. The prognosis of acute stroke could be improved by smoking cessation, better control of hypertension and prevention of in hospital complication particularly pulmonary embolism. View Full-Text
Keywords: first-time stroke; in-hospital mortality; case fatality; determinants; Saudi Arabia first-time stroke; in-hospital mortality; case fatality; determinants; Saudi Arabia
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Alhazzani, A.A.; Mahfouz, A.A.; Abolyazid, A.Y.; Awadalla, N.J.; Katramiz, K.; Faraheen, A.; Khalil, S.N.; Aftab, R. In Hospital Stroke Mortality: Rates and Determinants in Southwestern Saudi Arabia. Int. J. Environ. Res. Public Health 2018, 15, 927.

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