%A Ortiz-Prado,Esteban %A Espinosa,Patricio S. %A Borrero,Alfredo %A Cordovez,Simone P. %A Vasconez,Jorge E. %A Barreto-Grimales,Alejandra %A Coral-Almeida,Marco %A Henriquez-Trujillo,Aquiles R. %A Simbaña-Rivera,Katherine %A Gomez-Barreno,Lenin %A Viscor,Gines %A Roderick,Paul %D 2021 %J Frontiers in Physiology %C %F %G English %K Stroke,high-altitude,Mortality,Angiogenesis,adaptation,Ecuador %Q %R 10.3389/fphys.2021.733928 %W %L %M %P %7 %8 2021-September-30 %9 Original Research %# %! Stroke at high altitude %* %< %T Stroke-Related Mortality at Different Altitudes: A 17-Year Nationwide Population-Based Analysis From Ecuador %U https://www.frontiersin.org/articles/10.3389/fphys.2021.733928 %V 12 %0 JOURNAL ARTICLE %@ 1664-042X %X Introduction: Worldwide, more than 5.7% of the population reside above 1,500 m of elevation. It has been hypothesized that acute short-term hypoxia exposure could increase the risk of developing a stroke. Studies assessing the effect of altitude on stroke have provided conflicting results, some analyses suggest that long-term chronic exposure could be associated with reduced mortality and lower stroke incidence rates.Methods: An ecological analysis of all stroke hospital admissions, mortality rates, and disability-adjusted life years in Ecuador was performed from 2001 to 2017. The cases and population at risk were categorized in low (<1,500 m), moderate (1,500–2,500 m), high (2,500–3,500 m), and very high altitude (3,500–5,500 m) according to the place of residence. The derived crude and direct standardized age-sex adjusted mortality and hospital admission rates were calculated.Results: A total of 38,201 deaths and 75,893 stroke-related hospital admissions were reported. High altitude populations (HAP) had lower stroke mortality in men [OR: 0.91 (0.88–0.95)] and women [OR: 0.83 (0.79–0.86)]. In addition, HAP had a significant lower risk of getting admitted to the hospital when compared with the low altitude group in men [OR: 0.55 (CI 95% 0.54–0.56)] and women [OR: 0.65 (CI 95% 0.64–0.66)].Conclusion: This is the first epidemiological study that aims to elucidate the association between stroke and altitude using four different elevation ranges. Our findings suggest that living at higher elevations offers a reduction or the risk of dying due to stroke as well as a reduction in the probability of being admitted to the hospital. Nevertheless, this protective factor has a stronger effect between 2,000 and 3,500 m.