1 in 7 Stroke Patients in India Under 45: ICMR Registry Reveals

A landmark analysis from India's largest hospital-based stroke registry has revealed a startling trend: approximately one in seven (13.8%) stroke patients in India are under the age of 45. This significant finding, equivalent to nearly 14% of cases, underscores a growing burden of stroke among younger adults in the country. The study, spearheaded by the Indian Council of Medical Research – National Centre for Disease Informatics and Research (ICMR-NCDIR) in Bengaluru, along with investigators of the National Stroke Registry Programme, collected data from 34,792 stroke cases across 30 hospitals between 2020 and 2022. Published in the 'International Journal of Stroke', these findings provide a comprehensive national snapshot of stroke patterns, existing treatment gaps, and patient outcomes in India. Hypertension emerged as the most dominant risk factor, present in a staggering 74.5% of all stroke patients. Other significant risk factors included smokeless tobacco use (28.5%), diabetes mellitus (27.3%), tobacco smoking (22.6%), and alcohol consumption (20.2%). These statistics highlight the critical need for robust public health interventions targeting these preventable conditions across all age groups. The registry data also shed light on notable demographic disparities. Approximately 63.4% of stroke patients were men, and a substantial 72.1% hailed from rural areas. This suggests inequalities in awareness, prevention strategies, and access to timely medical care, with rural populations and men facing a disproportionately higher burden. A major hurdle identified in acute stroke management is the significant delay in patients reaching the hospital. The study found that only about 20% of patients arrived within the crucial 4.5-hour window, which is vital for emergency stroke treatments like intravenous thrombolysis. Conversely, a concerning 37.8% of patients presented at the hospital more than 24 hours after the onset of symptoms. This delay severely limits the applicability of time-sensitive therapies; only 4.6% of ischemic stroke patients received thrombolysis, and a mere 0.7% underwent mechanical thrombectomy. Delayed arrival, along with imaging delays and medicine unavailability, were cited as key reasons for missing critical treatment opportunities. The outcomes for stroke patients in India are stark. In-hospital mortality was reported at 13.9%, which further rose to nearly 28% at the three-month follow-up, indicating a significant number of post-discharge deaths. Furthermore, nearly 30% of patients suffered significant disability, defined as a modified Rankin Scale score of 3-5, at three months. Women, in particular, were more likely to experience disability at follow-up, potentially pointing to gaps in rehabilitation and post-discharge care. Neurologists and public health experts have expressed alarm over these findings, which reinforce the need for immediate action. They emphasize the importance of public recognition of stroke symptoms and prompt emergency care, encapsulated by the phrase "Time is brain." Every minute lost means the irreversible loss of brain cells, leading to increased disability and long-term dependence. Compared to Western countries, where stroke incidence among younger adults is typically below 10%, India's figures are considerably higher, aligning with trends in other low- and middle-income countries (LMICs) where the stroke burden is increasing. Lifestyle factors, including early-onset diabetes, hypertension, smoking, air pollution, chronic stress, and erratic sleep schedules, are increasingly linked to this surge in younger stroke patients. The ICMR-NCDIR's National Stroke Registry Programme, which includes both population-based and hospital-based registries, is a crucial initiative for generating reliable data on stroke incidence and care patterns in India. The insights gleaned from this study are expected to inform the development of evidence-based comprehensive strategies for stroke prevention, effective management, and improved treatment outcomes across the nation. Proposed solutions include mandatory blood pressure screening at primary health centers, expanding stroke unit capacity in district hospitals, and targeted awareness campaigns, especially for young men and rural populations.

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