Background

India is a large country with geographically diverse populations and varying risk factors. Identification of regional differences can improve healthcare policy decisions.

Aim

To study regional differences in stroke between North and South India.

Methods

We analyzed data from the Indo-US Collaborative Stroke Project, a National Institute of Health-funded multicentre prospective study conducted in five academic centers in India with a US-based coordinating center. Risk factors, severity, mechanisms, management, complications, and outcomes among ischemic stroke patients were compared between North and South Indian centers.

Results

Of the 2066 patients enrolled from North (n = 1060) and South India (n = 1006), North Indian patients were significantly older with fewer men and had lower rates of diabetes (32.8% vs. 38.7%, p < 0.01), dyslipidemia (3.5% vs. 25.7%, p < 0.01), tobacco use (27% vs. 38%, p < 0.001), and alcohol use (30.1% vs. 38.6%, p < 0.01). North Indian patients had higher median National Institute of Health stroke scale scores (10 vs. 9, p < 0.01), more frequent large-artery atherosclerosis mechanism (34% vs. 25.6%, p < 0.001), intravenous thrombolysis (14.0% vs. 6.1%, p < 0.001), and lower rates of pneumonia (10.5% vs. 15.1%, p = 0.02). The three-month outcome (modified Rankin Scale score 0–2, 45.8% vs. 50.3%, p = 0.08) did not differ; however, North Indian patients had higher 90-day mortality (23.5% vs. 13.5%, p < 0.0001).

Conclusions

The substantial regional differences in stroke risk factors and mechanisms may be partly explained by factors such as differing dietary habits and lifestyle, which can be addressed at a national level. Differences in acute and inpatient stroke care suggest a need for better adoption of national stroke management guidelines.

中文翻译：

---

印度缺血性卒中的区域差异（北部与南部）

背景

印度是一个人口大国，危险因素各异的大国。识别区域差异可以改善医疗保健政策的决策。

目的

研究印度北部和南部之间的卒中区域差异。

方法

我们分析了印美合作中风项目的数据，该项目是由美国国立卫生研究院资助的多中心前瞻性研究，研究在印度的五个学术中心和美国的一个协调中心进行。在北印度和南印度中心之间比较了缺血性中风患者的危险因素，严重性，机制，管理，并发症和结局。

结果

在北 印度（n = 1060）和南印度（n  = 1006）招募的2066名患者中，北印度患者的年龄明显偏大，男性较少，糖尿病发生率较低（32.8％vs. 38.7％，p  <0.01），血脂异常（3.5％vs. 25.7％，p  <0.01），烟草使用（27％vs. 38％，p  <0.001）和酒精使用（30.1％vs. 38.6％，p  <0.01）。北印度患者的美国国立卫生研究院卒中量表评分中位数较高（10比9，p  <0.01），大动脉粥样硬化机制发生率更高（34％比25.6％，p  <0.001），静脉溶栓（14.0％vs 。6.1％，p <0.001）和较低的肺炎发生率（10.5％对15.1％，p  = 0.02）。三个月的结果（改良Rankin量表评分0–2，分别为45.8％和50.3％，p  = 0.08）；但是，北印度患者的90天死亡率较高（23.5％比13.5％，p  <0.0001）。

结论

中风危险因素和机制的区域性差异可能部分由饮食习惯和生活方式不同等因素引起，这些因素可以在国家一级解决。急性和住院中风护理的差异表明需要更好地采用国家中风管理指南。