Early-onset stroke among people with disabilities: a national database study in South Korea from 2008 to 2017

Elsevier, The Lancet Regional Health - Western Pacific, Volume 38, September 2023
Yang H.S., Kim S.Y., Jo M.J., Kim Y.Y., Park J.H.

Background: This study investigated 10-year trend in the incidence and prevalence of ischemic, hemorrhagic, and overall strokes according to the severity and type of disability between people with and without disabilities. Methods: This serial cross-sectional analysis was conducted using national health information data during a 10-year period from 2008 to 2017. Age-standardized incidence and prevalence were analyzed for each year, according to the presence, severity, and type of disability. The odds ratio (OR) of stroke was examined using multivariable logistic regression after adjusting for socio-demographic and clinical variables collected in 2017. Findings: In total, 413,398,084 people were enrolled between 2008 and 2017. In 2017, 43,552,192 people aged 19 or older were included and 5.8% was disabled. For 10 years, age-standardized incidence of ischemic and hemorrhagic stroke decreased significantly regardless of the presence of disability. However, age-standardized incidence of stroke in disabled were almost 2.5 times higher than the non-disabled in 2017. Stroke occurs 20 years earlier in people with disabilities than in those without disabilities. In 2017, people with disabilities had higher odds of stroke compared to those without disability (OR = 4.11, 95% confidence interval [CI]: 4.06–4.16), particularly among those with severe disabilities (OR = 4.75, 95% CI: 4.67–4.84). People with major internal organ impairment showed the highest incidence of stroke (OR = 5.95, 95% CI: 5.73–6.17). The main risk factors for stroke presented in this study were disability factors, chronic diseases, and advanced age. Interpretation: People with disabilities are at a greater risk of developing stroke incidence. Developing a public health policy and identifying the risk factors for stroke in people with disabilities would be beneficial. Funding: This work was supported by a National Research Foundation of Korea (NRF) grant funded by the Ministry of Education (No. 2022R1I1A3070074).