World Stroke Day 2022: Brain strokes can cause immense economic burden on Indian households, experts | The Financial Express

World Stroke Day 2022: Brain strokes can cause immense economic burden on Indian households, experts

World Stroke Day 2022: According to a 2021 study published in Neurology India, the stroke burden in India is quite high, and ischemic stroke is the most common accounting for around 80% of total stroke cases in India.

World Stroke Day 2022: Brain strokes can cause immense economic burden on Indian households, experts
A known side effect of amyloid-lowering therapies is the development of amyloid-related imaging abnormalities (ARIAs), including ARIA related to underlying vasogenic edema (ARIA-E). (File)

World Stroke Day 29 October 2022: A stroke, also known as a brain attack, occurs when the blood supply to the brain gets blocked or a blood vessel in the brain bursts. According to doctors, strokes lead to damage or death of parts of the brain and this condition can cause lasting brain damage, long-term disability, or even death.

According to the Centre for Disease Control and Prevention (CDC), a stroke is a serious medical condition that requires emergency care. The CDC also stresses that when the flow of blood to the brain gets blocked, due to the absence of oxygen the brain cells start to die within minutes.

Generally, there are two types of strokes: Ischemic Stroke and Hemorrhagic Stroke. Studies have pointed out that stroke is the second leading cause of death and a major cause of disability worldwide. Moreover, cases of this critical condition are now more common in young people in low- and middle-income countries.

Global Burden of Stroke

Although a stroke is largely preventable, the number of cases is rising across the world. However, awareness about the critical brain condition is still low. According to the Stroke Forum, there are over 13.7 million new strokes of all types every year. Studies have also pointed out that every fourth person aged more than 25 years will suffer a stroke in their lifetime across the world. Additionally, nearly six million people die due to stroke every year.

Not just death stroke also contributes to serious and long-term disabilities. Stroke Forum data suggest over 116 million years of healthy life are lost due to stroke every year.

What are Ischemic Strokes?

According to the Centre for Disease Control and Prevention, ischemic stroke occurs when blood clots or other particles block the blood vessel to the brain. It is noteworthy that most strokes are ischemic strokes. According to the Stroke Forum data, of all strokes, about 88 percent are ischemic strokes and 12 percent are haemorrhagic strokes in nature. Moreover, over 2.7 million people die from ischemic stroke globally. According to a 2013 study published in Sage Journal, over the past years, incidence, prevalence, and mortality rates of ischaemic stroke changed substantially.

“Ischemic stroke occurs when the blood supply to part of the brain is interrupted or reduced. Brain cells begin to die in minutes. The estimated adjusted prevalence rate of stroke range, from 84-262/100,000 in rural and 334-424/100,000 in urban areas. The incidence rate is 119-145/100,000 based on recent population-based studies. Of patients with first-ever stroke, approximately 80 % are likely ischemic strokes,” Dr. Sanjay Pandey, Head, Department of Neurology, Amrita Hospital, Faridabad told Financial Express.com.

ALSO READ | Stroke Patient Care and Challenges

Ischemic Stroke in India

According to a 2021 study published in Neurology India, the stroke burden in India is quite high, and ischemic stroke is the most common accounting for around 80% of total stroke cases in India. The study also revealed that South Asians including Indians are disproportionately more susceptible to stroke due to the presence of cardio-metabolic risk factors.

Moreover, in India, the significant rise in the incidence of stroke in the last decade can be attributed to various socio-economic changes that resulted in altered lifestyle with restricted physical activity, excessive intake of processed food, and increased stress at the workplace leading to enhanced development of risk factors including type-2 diabetes, hypertension, obesity, and hyper-lipedema, the study revealed.

“The burden of brain stroke has alarmingly increased in India over the years. Between 1996 and 2019, there was a 100% increase in cases in India. Nearly 700,000 people in India died because of stroke in 2019, which was 7.4% of the total deaths in the country that year. However, a nationwide survey titled The State of Stroke: A Survey On Awareness About Stroke In Urban India conducted by Boehringer Ingelheim found that despite its common occurrence, less than one in four Indians were aware of the symptoms of brain stroke,” Dr. Shraddha Bhure, Medical Director, Boehringer Ingelheim India told Financial Express.com.

Causes and Symptoms

According to Dr. Pandey, blocked or narrowed blood vessels (mainly carotid or neck vessels) are caused by fatty deposits that build up in blood vessels or by blood clots or other debris that travel through the bloodstream, most often from the heart, and lodge in the blood vessels in the brain.

Symptoms:

  • Speech and language difficulty
  • Numbness or paralysis of the face, arm, or leg
  • Visual problem
  • Walking difficulty
  • ‘Mnemonic: BE-FAST’ (stands for balance loss, eyesight changes, face drooping, arm weakness, speech difficulties, and time to call an ambulance)

According to Dr. Bhure, Ischemic strokes are many a times a result of long-term lifestyle choices and decisions.

“Consumption of tobacco, lack of physical exercise, high stress levels, excessive intake of salt, and food rich in saturated fat can increase a person’s risk of a stroke significantly in the long run. Pre-existing health conditions such as diabetes, hypertension, and cardiovascular disease also contribute to increasing the risk of brain stroke. People over 50 years of age are more vulnerable to a brain stroke. However, there has been an increase in stroke cases even in those younger than the age of 45 years,” she told Financial Express.com.

What are India’s treatment and prevention strategies?

In India, around 10 percent to 15 percent of all strokes occur in the young affecting people below 40 years. In January 2008, the Government of India initiated the pilot phase of the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) with a focus on early diagnosis, management, public awareness, and infrastructure for major non-communicable diseases including stroke. According to experts, timely treatment is crucial in stroke as it kills about 2 million brain cells in under a minute.

It is noteworthy that even a blockage in a small blood vessel may lead to paralysis, speech issues, visual impairment, losing control of bladder and bowel movement, coma, or loss of life.

Until recently, all treatments were done by open surgery. With the advancement in medical technology, procedures like Mechanical Thrombectomy (MT), performed under guidance at catheterization labs (Cath labs), within 4.5 hours of a stroke incidence provide favorable clinical outcomes. However, accessibility to these procedures is still a challenge. Experts have also pointed out that with around 2,300 Neurologists and 1,800 Neurosurgeons, and only 1400 Cath labs, many patients find it hard to access appropriate healthcare in time.

According to Dr. Pandey, in order to diagnose a stroke, CT and MRI scans (including the angiography of neck and brain vessels) and doppler imaging are done on the patients. Meanwhile, blood tests to find out hyperglycaemia and hyperlipidaemia.

“Thrombolysis, mechanical thrombectomy, and drugs including antiplatelet, and anticoagulation are the mainstay of management. Control of modifiable risk factors such as hypertension, diabetes mellitus, and hyperlipidaemia is also extremely important,” he added.

India Hypertension Control Initiative (IHCI), launched in 2017, is a 5-year initiative involving the Ministry of Health & Family Welfare, the Indian Council of Medical Research, State Governments, and WHO-India.

ALSO READ | How 70 percent – 80 percent of stroke lead to disability and half of them causes death

In the first year, IHCI covered 26 districts across five states – Punjab, Kerala, Madhya Pradesh, Telangana, and Maharashtra. By December 2020, IHCI was expanded to 52 districts across ten states – Andhra Pradesh (1), Chhattisgarh (2), Karnataka (2), Kerala (4), Madhya Pradesh (6), Maharashtra (13), Punjab (5), Tamil Nadu (1), Telangana (13) and West Bengal (5).

Recently, India’s India Hypertension Control Initiative (IHCI) has won the ‘2022 UN Interagency Task Force, and WHO Special Programme on Primary Health Care Award’ at the UN General Assembly.

IHCI is being implemented in 138 districts of 23 states. More than 34 lakh people with hypertension are taking treatment in government health facilities.

“IHCI’s easily scalable strategies include a simple drug-dose-specific standard treatment protocol, ensuring adequate quantity of protocol medications, decentralization of care with follow-up and refills of medicines at Ayushman Bharat Health & Wellness Centres (AB-HWCs), task sharing involving all health staff, and a near real-time information system to track every patient for follow-up and blood pressure control. Around half of those who were treated under IHCI have blood pressure under control,” WHO had stated last month.

Meanwhile, health experts have pointed out that there are still numerous challenges.

“Lack of diagnostic facilities, stroke care centres, and trained manpower are the major challenges. There should be a stroke care center at every medical college, community health center, and primary health care center in the country,” Dr. Pandey told Financial Express.com.

What is the economic burden of Ischemic Strokes for India?

According to Dr. Pandey, the economic burden associated with ischemic stroke-related hospitalization and domiciliary care is substantial in India.

“It bears well to hold in mind that our nation is still a developing one and there is this huge disparity between the rich and the poor. Owing to the privatization of healthcare here, top-notch stroke care is, sadly, only available to the affluent. Poor people, who make the most of our population, can only seek a government-based setup during emergencies, and, unfortunately, these institutes have not been able to parallel their corporate counterparts due to lacking resources. So first of all, there ought to be a well-oiled stroke-care service system along with affordable transport facilities so that even a patient in a relatively remote area might need to seek acute medical care, which is all but the foundation of stroke management,” he said.

Dr. Pandey also emphasised that government institutions must be well-equipped to provide population-wide interventions right from the beginning to the rehabilitation of stroke patients.

“Because, in the end, it’s not really about how many patients receive elite care, but how many do receive any life-changing care at all. Cost-burdens of imaging can be slashed by ensuring just a simple CT-based thorough channel for accurate and time-saving diagnosis. There also needs to be a proper channel inclusive of a supervisor and well-trained staff who understand the roles assigned to them at all times. Finally, The publicly funded health insurance scheme should cover expenses on stroke-related medicines to reduce the expenditure of patients seeking treatment in public and private sector facilities,” he added.

According to Dr. Bhure, the effects of stroke can linger on for years. It is estimated that close to 60% of stroke cases in India lead to various disabilities.

“Many of these are lifelong. Apart from an increase in out-of-pocket expenditure, these also mean the loss of economic potential of individuals. Due to increased out-of-pocket expenditure, there is a large impact on the lifestyles of a family, and can shrink discretionary spending and quality of life,” she added.

She also highlighted that brain strokes can cause an immense economic burden on Indian households and families.

“The cost of hospitalization, medication, treatment, and even rehabilitation can be a significant drain on economic resources. Among youngsters, brain stroke can cause a loss of productivity. It can impact the ‘demographic dividend’ of the country and hamper economic growth. For the poorer sections of the society, stroke-related economic distress can be catastrophic, reducing their chances of earning a decent livelihood and dimming their economic prospects further,” she said.

ALSO READ | Less than one in four Indians aware of the symptoms of brain stroke: Brain Stroke Consumer Survey

Stroke awareness–A much-needed step

Much of stroke management, like most of the disorders of mankind, rests foremost on the awareness of how it can present in a day-to-day scenario.

“Raising that awareness is the most vital cog in the machine. Mnemonics such as ‘BE-FAST’, must be widely advertised via various modes of media for the public to be aware of how to recognize the disastrous symptoms at once. Social media platforms, that hold a lot of clout these days, must be employed for the same. Highly-influential people can be engaged to create ad campaigns that can depict the way a family loses so much when the breadwinner suffers from a stroke. There must be interventions to teach high-school children about the primary prevention of stroke & cardiovascular diseases. As I have already mentioned above, transportation plays a major role for a person living in a place that’s not well-connected to the major cities,” Dr. Pandey said.

He also stressed that 24-hour stroke care helplines need to be created.

“Essential drugs for thrombolysis should be free of cost and the provision of services such as medical thrombectomy must be heavily worked upon in government-based setups. Also, last but not the least, rehabilitation and physical training programs must be rigorously thought of and planned for all centres investing in stroke care,” he added.

Dr. Bhure also pointed out that despite being a leading cause of death in India, awareness around brain stroke remains low.

“Our survey found that only 25% of the respondents could recall the symptoms of stroke. Further, only 10% knew about the diagnostic procedures and treatment options for the condition. Low awareness around stroke prevents people from gaining access to quality medical care and takes a toll on public health. In addition to this, delayed diagnosis, absence of proper infrastructure, and lack of trained medical professionals are some common hurdles that prevent patients from getting access to quality stroke care,” she said.

ALSO READ | Severe headache with or without stroke symptoms could be a sign of a cerebral aneurysm: Doctors

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First published on: 29-10-2022 at 11:42:35 am
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