Neal S. Parikh, MD

Chang T, Gajasinghe S, and Arambepola C. Prevalence of Stroke and Its Risk Factors in Urban Sri Lanka: Population-Based Study. Stroke. 2015

In this issue of Stroke, researchers seek to establish the prevalence of stroke in Colombo, Sri Lanka. Though the aim may appear narrow at first glance, the results are striking and deserve the attention of those interested in global health and health disparities.

The researchers conducted a cross-sectional, survey-based study of the adult inhabitants of densely-populated Colombo, Sri Lanka. The survey they used is a validated tool and depends on patient report of clinical symptoms consistent with stroke. Their methodology was designed to comprehensively sample the diversity of Colombo. A remarkable 96.9% response rate yielded 2,313 people in 782 households. 

The prevalence was 10.4 strokes per 1000 adults. Stroke occurred in a 2:1 ratio favoring men and at a young mean age of 58.2 years. Two-thirds of stroke survivors experienced changes or cessation of employment. It is noteworthy that 62.5% of these patients had hypertension, 33.3% had diabetes and 45.8% were smokers.

If we are to extrapolate from this data and other data from India and China cited by the authors, young men and women in the urbanizing developing world are subject to high rates of stroke at young age and often face unemployment subsequently. In parts of the world with limited acute stroke treatment due to resource and infrastructure limitations, the importance of addressing readily modifiable risk factors such as hypertension and smoking cannot be overstated.