title: Incidence, types, risk factors, and outcome of stroke in a developing country: the Trivandrum Stroke Registry.
abstract: OBJECTIVE
  Despite increasing burden of stroke in developing countries, population-based data are rare. Through the Trivandrum Stroke Registry, we intend to assess incidence, types, risk factors, and outcome of stroke among urban and rural dwellers of a South Indian community.
  
  
  METHODS
  We ascertained all first-ever strokes occurring among 741,000 urban and 185,000 rural inhabitants of Trivandrum, Kerala. In addition to Steps 1 and 2 of World Health Organization STEPS Stroke Manual, we used multiple supplementary methods to maximize ascertainment of nonfatal and nonhospitalized fatal stroke events in the community.
  
  
  RESULTS
  During a 6-month period, 541 strokes were registered, 431 in the urban and 110 in the rural communities. Stroke occurred at a median age of 67 years; only 3.8% of patients were aged <or=40 years. Adjusted annual incidence rates per 100,000 were 135 (95% confidence interval 123 to 146) for total, 135 (122-148) for urban, and 138 (112-164) for rural populations, and 74.8 (66.3 to 83.2), 10.1 (7.0 to 13.2), and 4.2 (2.2 to 6.1) for ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage, respectively. There was more stroke of undetermined type in the rural community. One or more modifiable risk factors were identified in 90% patients. More rural male patients smoked tobacco. The 28th day case fatality rate was 24.5% for urban and 37.1% for rural populations (P=0.011).
  
  
  CONCLUSIONS
  There are more similarities than differences between developing and developed countries in the epidemiology of stroke. Compared to urban stroke patients, rural ones are less likely to be optimally investigated and treated.
authors.affiliation: Department of Neurology, Achutha Menon Center for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
authors.forename: Sapna E
authors.initials: SE
authors.lastname: Sridharan
authors.forename: J P
authors.initials: JP
authors.lastname: Unnikrishnan
authors.forename: Sajith
authors.initials: S
authors.lastname: Sukumaran
authors.forename: P N
authors.initials: PN
authors.lastname: Sylaja
authors.forename: S Dinesh
authors.initials: SD
authors.lastname: Nayak
authors.forename: P Sankara
authors.initials: PS
authors.lastname: Sarma
authors.forename: Kurupath
authors.initials: K
authors.lastname: Radhakrishnan
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D002545:Brain Ischemia / Q000401:mortality; D002543:Cerebral Hemorrhage / Q000401:mortality; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005260:Female; D040362:Geographic Information Systems; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012042:Registries / Q000706:statistics & numerical data*; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D020521:Stroke / Q000401:mortality*; D013345:Subarachnoid Hemorrhage / Q000401:mortality; D014505:Urban Population / Q000706:statistics & numerical data*