Are post-stroke complications pushing young stroke survivors towards lowered quality of life and disability?

Dr Ratna Devi, CEO, DakshamA Health and Tamanna Sachdeva, Project Officer Policy, DakshamA Health talks about post-stroke complications

Stroke-cerebrovascular accident (CVA) and a non-communicable disease is the second leading cause of death worldwide with an annual mortality rate of about 5.5 million. 1 in 4 over the age of 25 will experience a stroke in their lifetime. According to the World Stroke Organization global fact sheet over 80 million people are currently living who have experienced a stroke globally. In addition to this 116 million years of healthy life is lost each year due to stroke related death and disabilities¹. According to the Global Burden of Disease Study 2019, stroke was ranked as the second most common causes of health loss or Disability Adjusted Life Years (DALYs) in the 50–74-year and over 75-years age groups and posed a significant burden in the 25-49 years of age group².

Low and middle income countries show an increase in stroke incidence and stroke related mortality. Stroke incidence in India is higher (194-215 per 100,000 population) in rural areas when compared to the national average (119-145 per 100,000 population), which is almost a 100 per cent increase (till 2016)³.

In India, 10–15% of strokes occur in people below the age of 40 years. It is believed that the average age of patients with stroke in developing countries is 15 years younger than that in developed countries. Nearly one-fifth of patients with first ever strokes admitted to hospitals are aged <40 Years⁴. Risk factors like hypertension, diabetes mellitus, smoking and alcoholism are on the increase in younger populations with changes in life style, industrialisation and poor dietary habits.

The acute episode of stroke is often followed with various complications. Some of them includes paralysis, difficulty in swallowing, weakness, incontinence depression and the inability to live an independent life. Young adults suffering from stroke have a larger bearing on the functioning of their family, employment, society, and country as they are in their economically most productive period. The impact on the employment status following a stroke can affect more than their ability to pay for their bills, affecting their sense of purpose and confidence, causing difficulties at work, or even being at risk of losing their job, due to disabilities resulting from stroke. For many, the loss of income comes with huge financial burden on their family. A preliminary analysis of 100 acute stroke cases (CT confirmed), using WHO STEPwise Approach to Stroke Surveillance, Hastak, et al (2003) reported that at 28 days the overall case fatality rate was 9% and nearly 31% of survivors had severe neurologic disability/handicap whereas 13% had mild disability needing assistance. Only 47% of survivors were independent at the end of 28 days. Many stroke survivors get back to their work eventually, but some of them are not able to due to the disabilities that persist. Unfortunately, many of the survivors who has experienced stroke are the main breadwinners of their family making it difficult for them and their family to even manage their daily living, education, and cost of their long-term treatment or rehabilitation.

Financial burden along with the isolation following loss of employment, can severely affect a stroke survivor’s mental health. This develops various anxiety, depression and anger issues. Along with the survivors it becomes equally challenging for the caregivers to cope up with the burden of being financially weak. It is therefore incredibly important that stroke survivors are given access not only to treatments and therapies but also opportunities that will help them socialize and bring them back into the community. Apart from this, inclusion of the stroke as one of the disability under Rights of Persons with Disabilities Act, 2016 must be taken into consideration. This will help the survivors to better manage their employment and financial burden under the benefits being entitled under the act.

References:

1. World Stroke Organization. Purpose : Data Sources : https://www.world-stroke.org/assets/downloads/WSO_Global_Stroke_Fact_Sheet.pdf. Published online 2019:3.
2. Johnson CO, Nguyen M, Roth GA, et al. Global, regional, and national burden of stroke, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(5):439-458. doi:10.1016/S1474-4422(19)30034-1
3. Rise in stroke cases: experts call for integrated approach to treatment, rehabilitation. Accessed May 19, 2021. https://www.outlookindia.com/newsscroll/rise-in-stroke-cases-experts-call-for-integrated-approach-to-treatment-rehabilitation/1689949
4. Srinivas G, Muthalik M, Aashik YS. The study of the risk factor profile of stroke in young: a retrospective study. Int J Adv Med. 2020;8(1):57. doi:10.18203/2349-3933.ijam20205471