Disparities in Stroke Incidence Over Time by Sex and Age in Latin America and the Caribbean Region 1997 to 2021: A Systematic Review and Meta-Analysis

Abstract

Background High-income country studies show unfavorable trends in stroke incidence (SI) in younger populations. We aimed to estimate temporal change in SI disaggregated by age and sex in Latin America and the Caribbean region. Methods and Results A search strategy was used in MEDLINE, WOS, and LILACS databases from 1997 to 2021, including prospective population-based observational studies with first-ever stroke incidence in Latin America. Reports without data broken down by age and sex were excluded. Risk of bias was assessed with The Joanna Briggs Institute's guide. The main outcomes were incidence rate ratio and relative temporal trend ratio of SI, comparing time periods before 2010 with after 2010. Pooled relative temporal trend ratios considering only studies with 2 periods in the same population were calculated by random-effects meta-analysis. Meta-regression analysis was used to evaluate incidence rate determinants. From 9242 records identified, 6 studies were selected including 4483 first-ever stroke in 4 101 084 individuals. Crude incidence rate ratio in younger subjects (<55 years) comparing before 2010:after 2010 periods showed an increase in SI in the past decade (incidence rate ratio, 1.37 [95% CI, 1.23-1.50]), in contrast to a decrease in older people during the same period (incidence rate ratio, 0.83 [95% CI, 0.76-0.89]). Overall relative temporal trend ratio (<55:≥55 years) was 1.65 (95 CI%, 1.50-1.80), with higher increase in young women (pooled relative temporal trend ratio, 3.08 [95% CI, 1.18-4.97]; P for heterogeneity <0.001). Conclusions An unfavorable change in SI in young people, especially in women, was detected in population-based studies in the past decade in Latin America and the Caribbean. Further investigation of the explanatory variables is required to ameliorate stroke prevention and inform local decision-makers. Registration URL: https://www.crd.york.ac.uk/prospero/ Identifier: CRD42022332563.

Keywords: epidemiology; intracranial hemorrhage; ischemic stroke; women, sex, and gender.

Figure 1. Incidence rate ratio by age and overall relative temporal trend ratios of stroke in Latin America and the Caribbean.

A, IRRs by age of stroke in LAC between 1997 to 2021 (n=6). B, Overall RTTR of stroke incidence in <55 vs ≥55 years age groups by sex, comparing ≥2010 time period vs<2010 in LAC (n=6). C, Overall RTTR of stroke incidence in <45 vs ≥45 years age groups by sex, comparing ≥2010 time period vs <2010 in LAC (n=6). IRR indicates incidence rate ratio; LAC, Latin America and the Caribbean; and RTTR, relative time trend ratio.

Figure 2. Pooled RTTR of stroke incidence by age groups.

A, Pooled RTTR of stroke incidence in <55 vs ≥55 years age groups by sex, comparing ≥2010 time period vs <2010 in LAC. B, Pooled RTTR of stroke incidence in <45 vs ≥45 years age groups by sex, comparing ≥2010 time period vs <2010, in LAC. LAC indicates Latin America and the Caribbean; and RTTR, relative time trend ratio.