Rural Healthcare

Nearly one in seven stroke patients in India is under the age of 45, while delayed hospital arrival continues to undermine survival and recovery, according to findings from the country’s largest hospital-based stroke registry study published in the International Journal of Stroke. The analysis, led by Prashant Mathur of the ICMR–National Centre for Disease Informatics and Research (ICMR-NCDIR) along with investigators from the National Stroke Registry Programme, reviewed 34,792 stroke cases recorded across 30 hospitals between 2020 and 2022. The mean age of patients was 59.4 years, but 13.8 per cent were younger than 45, highlighting the rising burden of stroke among younger Indians. Men accounted for 63.4 per cent of cases, while 72.1 per cent of patients were from rural areas, underscoring disparities in awareness, prevention and access to timely care. Hypertension emerged as the most significant risk factor, present in 74.5 per cent of patients. Diabetes affected 27.3 per cent, smokeless tobacco use 28.5 per cent, tobacco smoking 22.6 per cent and alcohol consumption 20.2 per cent. The study observed gender differences, with women showing higher rates of hypertension and diabetes, while men reported greater tobacco and alcohol use. Timely treatment remains a major challenge. Only 20 per cent of patients reached hospital within the critical 4.5-hour window for emergency stroke therapy, while 37.8 per cent arrived after 24 hours. Consequently, just 4.6 per cent of ischemic stroke patients received intravenous thrombolysis and 0.7 per cent underwent mechanical thrombectomy. Delayed hospital arrival, imaging bottlenecks and limited availability of medicines were cited as key barriers. Ischemic strokes accounted for 60 per cent of cases, while intracerebral haemorrhage comprised 34.2 per cent. Dr Manjari Tripathi, Head of Neurology at the All India Institute of Medical Sciences (AIIMS Delhi), stressed the urgency of rapid response. She emphasised that patients should reach hospital within three hours, undergo immediate brain imaging and receive thrombolysis without delay if eligible, noting that every minute of delay leads to irreversible brain damage and long-term disability. Outcomes remain severe. In-hospital mortality stood at 13.9 per cent, rising to nearly 28 per cent at three months, suggesting many deaths occurred after discharge. Overall, more than half of patients experienced poor outcomes — defined as death or significant disability. Women were more likely than men to have disability at follow-up, indicating possible gaps in rehabilitation and post-discharge care. Recurrent stroke within three months was reported in 1.1 per cent of patients. Researchers called for stronger control of hypertension and diabetes, tobacco cessation efforts, faster referral systems and improved access to acute stroke care, particularly in rural India. Without stronger prevention and rapid treatment systems, they warned, stroke will continue to affect younger populations and leave families facing avoidable disability. Source: TNN