Survival of Stroke Patients According to Hypertension Status in Northern Ethiopia: Seven Years Retrospective Cohort Study

Abstract

Zenawi Hagos Gufue,1 Naod Firdu Gizaw,2 Wondimu Ayele,2 Yared Mamushet Yifru,3 Nigus Alemu Hailu,4 Embaba Tekelaye Welesemayat,5 Etsay Weldekidan Tsegay,6 Abadi Hailay Atsbaha,1 Hirut Teame Gebru1 1Department of Public Health, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia; 2Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 3Department of Neurology, Faculty of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 4Department of Biomedical Sciences, School of Medicine, College of Medicine and Health Sciences, Adigrat University, Adigrat, Ethiopia; 5Department of Epidemiology, School of Public Health, College of Health Sciences, Aksum University, Aksum, Ethiopia; 6Department of Pharmacy, College of Medicine and Health Sciences, Adigrat University, Adigrat, EthiopiaCorrespondence: Zenawi Hagos Gufue Email [email protected]: Globally, stroke appears as a major cause of preventable deaths and disabilities. In Ethiopia, the intra-hospital mortality of stroke is significant; however, epidemiologic data are scarce whether there is a difference in the overall survival time between hypertensive and non-hypertensive adult stroke patients admitted in specialized hospitals. This study was intended 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 and Findings: A hospital-based retrospective cohort study was conducted among all cohorts of confirmed first-ever stroke patients admitted in Ayder Comprehensive Specialized Hospital, Northern Ethiopia. Kaplan–Meier survival analysis was applied to estimate the survival probability of hypertensive and non-hypertensive first-ever stroke patients. Cox proportional hazards regression model was 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 the Cox proportional hazards regression model assessed by the global test, Schoenfeld residuals. There were 503 (323 were hypertensive, 180 Non-hypertensive) confirmed first, ever adult stroke patients, the overall median age of the patients was 65 years, IQR (53– 75) years. Seventy-five (14.9%) of them were dead, with a median survival time of 48 days and 428 (85.1%) 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: The overall survival time difference between hypertensive and non-hypertensive first-ever adult stroke patients was not statistically significant. Early identification and treatment of stroke complications, co-morbidities along strict follow-up of comatose patients may improve the intra-hospital survival of stroke patients, and we also recommend community-based studies using a large sample size.Keywords: hypertension, stroke, cox regression, predictors of survival, Ethiopia

Keywords

• hypertension
• stroke
• cox regression
• predictors of survival
• ethiopia.