AUTHOR=Santos Emily dos , Wollmann Giulia M. , Nagel Vivian , Ponte Herminia M. S. , Furtado Luis E. T. A. , Martins-Filho Rui K. V. , Weiss Gustavo , Martins Sheila C. O. , Ferreira Leslie E. , França Paulo H. C. de , Cabral Norberto L. 

TITLE=Incidence, lethality, and post-stroke functional status in different Brazilian macro-regions: The SAMBA study (analysis of stroke in multiple Brazilian areas)

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.966785

DOI=10.3389/fneur.2022.966785

ISSN=1664-2295

ABSTRACT=Background: Stroke is the second leading cause of death in Brazil. The social and financial burden of stroke is remarkable, however, the epidemiological profile remains poorly understood. 
Objective: We aimed to report the incidence, lethality, and functional status, in 30 and 90 days post-stroke, in cities of different Brazilian macro-regions.
Methods: Observational, prospective, population-based study, led in Canoas (South), Joinville (South, reference center), Sertãozinho (Southeast), and Sobral (Northeast) in Brazil. It was developed according to the three steps criteria recommended by the World Health Organization to conduct population-based studies on stroke. Using different sources, all hospitalized and ambulatory patients with stroke were identified and the same criteria were kept in all cities. All first events were included, independently of sex, age, or type of stroke. Demographic and risk factors data were collected followed by biochemical, electrocardiographic, and radiological test results.  Functional status and lethality were obtained by the mRankin scale using a phone interview (validated Brazilian version). 
Results: In one year, 932 stroke cases were registered (784 ischemic stroke, 105 hemorrhagic stroke, and 43 subarachnoid hemorrhage). The incidence rates per 100,000 inhabitants, adjusted for the world population were 63 in Canoas, 106 in Joinville, 72 in Sertãozinho, and 96 in Sobral. Kaplan-Meier curves showed that 90-day survival was different among cities. Sobral, which has the lower socioeconomic indexes, revealed the worst results in terms of lethality and functional status.
Conclusion: This study expands the knowledge of stroke epidemiology in Brazil, a middle-income country with enormous socioeconomic and cultural diversity. The discrepancy observed regarding the impact of stroke in patients from Joinville and Sobral highlights the need to improve the strategic allocation of resources to meet the health priorities in each location.