Survival of Stroke Patients According to Hypertension Status in Northern Ethiopia
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Date
2019
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Addis Ababa University
Abstract
Background: Globally, stroke appears as a major cause of preventable death and disability.
In Ethiopia, the intra-hospital mortality of stroke is significant and there is scarcity of
epidemiologic data whether there is a difference in the overall survival time between
hypertensive and non-hypertensive adult stroke patients admitted in specialized hospitals.
Objectives: To determine the survival of stroke patients according to their hypertension
status admitted in Ayder Comprehensive Specialized Hospital, Northern Ethiopia from
March 1, 2012 to February 28, 2019.
Methods: A facility-based retrospective cohort study conducted among all cohorts of
confirmed first-ever stroke patients admitted in Ayder Comprehensive Specialized Hospital,
Northern Ethiopia. Kaplan-Meier survival analysis applied to estimate the survival
probability of hypertensive and non-hypertensive first ever stroke patients. Cox proportional
hazards regression model used to determine the adjusted hazard ratio of death for each main
baseline predictor variable, with 95% CI and P-value <0.05 was used to declare statistical
significance. The assumptions of Cox proportional hazards regression model assessed by the
global test, Schoenfeld residuals.
Results: There were 503 (323 were hypertensive, 180 Non-hypertensive) confirmed first,
ever stroke patients, the overall median age of the patients was 65 years, IQR (53-75) years.
Seventy-five (14.91%) of them were dead, with median survival time of 48 days and 428
(85.09%) of them were censored. At any particular point in time the hazard of death among
hypertensive patients was two times higher than non-hypertensive patients but this was not
found to be a statistically significant (adjusted HR=2.13: 95% CI 0.66-6.81). Glasgow coma
scale 3-8 at admission (adjusted HR=10.12; 95% CI 2.58-40.68), presence of stroke
complications (adjusted HR=7.23; 95% CI 1.86-28.26) and borderline high total cholesterol
level (adjusted HR=3.57; 95% CI 1.15-11.1), were the only independent predictors of intra-
hospital patient mortality.
Conclusion and recommendations: There was a non-significant difference in the overall
survival time between hypertensive and non-hypertensive first-ever stroke patients. Early
identification and treatment of stroke complications, co-morbidities along with strict follow
up of comatose patients may improve intrahospital survival of stroke patients and we
recommend community based studies using large sample size.
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Keywords
Hypertension, Stroke, Cox regression, Predictors of survival, Ethiopia