CommunityBased Study of Risk Factors for Stroke in Da Nang, Viet Nam

To assess the situation of stroke and its risk factors in Da Nang • To enhance the capacity of health staff in stroke care, treatment, and research. Designed and conducted a household survey to evaluate risk factors of stroke: approx. 900 households – 1621 participants 35 yrs and older • Develop a stroke registry patients hospitalized in Da Nang Hospital (using WHO STEPS questionnaire) 497 cases were collected from Mar – Nov. 2010. Lists of stroke patients from other hospitals will also be collected to evaluate the burden of the disease.

Da Nang Department of Health Community-Based Study of Risk Factors for Stroke in Da Nang, Viet Nam Annette L Fitzpatrick, PhD Dept of Epidemiology, Adjunct Global Health University of Washington Quang Van Ngo, MD, MPH Da Nang Department of Health Da Nang, Vietnam Acknowledgments Da Nang Department of Health Kiet A Ly, MD, MPH, Northwest Center To Reduce Oral Health Disparities Thanh G N Ton, PhD, Department of Neurology David L Tirschwell, MD, Department of Neurology W.T Longstreth, MD, MPH, Department of Neurology Tung T Vo, MD, Department of Health, Da Nang Chien H Pham, Director, Department of Health, Da Nang Contents of Presentation • Need to Study CVD in Developing Nations • Burden of Stroke • Introduction to our Project in Da Nang • Community Survey Methodology • Community Survey Preliminary Results Why Study CVD in Developing Countries? • Life expectancy is increasing in absolute and relative terms worldwide • Majority of CVD mortality and morbidity occurs in older adults • CVD may differ in risk factors, presentation, and course across gender, age, ethnicity, geography • CVD = primary cause of death worldwide • Neurological diseases = highest burden of disease as measured by DALYs CVD = Global Issue Source: WHO Estimated Global Deaths by Cause All Ages 2005 Deaths (m illions) 20000 18000 16000 14000 12000 10000 8000 6000 4000 2000 HIV/AIDS Tuberculosis Malaria Cardiovascular Cancer Chronic Diabetes Disease Respiratory Disease Not Just an Issue in High Income Countries Projected Global Distribution of Chronic Disease Deaths By World Bank Income Group, 2005 High Income Low Income Countries Countries 20% 35% Upper Middle Income Countries 8% Lower Middle Income Countries 37% Impact of Stroke Globally •1:3 persons will experience a stroke, dementia or both (Hashchinski, Stroke 2006) •Stroke will kill about 10% of the world’s population of 6.5 billion people and leave millions of others disabled (Lancet 2007) •Cerebrovascular diseases = highest in number of DALY’s in the developing world (WHO 2006) • Stroke is a costly disease: – Large numbers of premature deaths, – Ongoing disability in many survivors, – Impact on families or caregivers – Impact on health services (WHO Stroke STEPS) Stroke in Vietnam • Health Transition from Infectious to Chronic Disease • Stroke = #1 Cause of Death (20-27%) (Minh 2003, Scand J Pub Health; Hoang 2006, Prev Chron Dis) • Prevalence of Key Risk Factors High – Smoking – Hypertension Stroke in Vietnam Results for adults aged Both Sexes Males Females 25-64 years (incl 95% CI) 1.7(± 0.3) 1.6(± 0.3) Step Tobacco Use 29.7(± 1.1) 60.0(± 1.8) 7.0(± 1.3) 28.4(± 1.1) 57.3(± 1.9) Percentage who currently 11.1(± 0.4) smoke tobacco 11.2(0.4) Percentage who currently smoke tobacco daily Mean number of manufactured cigarettes smoked per day Results for adults aged 25-64 years Both Sexes Males Females Stroke in Vietnam (incl 95% CI) Step Physical Measurement Percentage with raised BP (SBP ≥140 19.2(± 0.9) 23.1(± 1.6) 15.4(± 1.0) and/or DBP ≥90 mmHg or currently on 11.9(± 0.8) 12.4(± 1.2) 11.5(± 0.9) medication for raised BP) Percentage with raised BP (SBP ≥160 and/or DBP ≥100 mmHg or currently on medication for raised BP) • What are characteristics of stroke in Da Nang ?