Trends in In-Hospital Mortality and Neurological Deficit Rates Following Ischemic Stroke in Low- and Middle-Income Countries

Introduction: Stroke is a leading cause of death and disability worldwide, but the impacts disproportionately affect low- and middle-income countries (LMIC), where an estimated 90% of the health burden occurs. There have been a limited number of publications on stroke in LMIC. This meta-analysis pools stroke data from 25 countries to compare changes in in-hospital mortality and neurological deficit rates from 1984 to 2022. This analysis will help elaborate on the current obstacles to care for stroke patients in LMIC.

Methods: A systematic search was completed using PubMed, Scopus, and Web of Knowledge for terms related to ischemic stroke and LMIC. Systematic reviews and meta-analyses were excluded but were used for citation matching. Outcomes of interest included in-hospital mortality and neurological deficit rate. A pooled proportional meta-analysis was performed for these outcomes using the inverse-variance method.

Results: Systematic screening yielded 153 unique articles, for a total of 65009 participants. Data was collected from 25 countries; studies were most commonly completed in India or Iran. There was a decrease in the in-hospital mortality rate but an increase in the neurological deficit rate of ischemic stroke patients in LMIC. Mortality declined 0.2% since 1990. The neurological deficit rate has increased by 1% overall, but has been stagnant for the last decade.

Conclusion : This meta-analysis demonstrates that in LMIC over the past 38 years there has been an overall decrease in the in-hospital mortality rate for patients with ischemic stroke. This outcome possibly reflects improvement in technology and treatment options in these locations. Future work should focus on comparing risk factors for poor inpatient outcomes to find areas to target to further improve patient care. There should also be further research into countries that are not represented by this data.