The epidemiology and management of stroke in French Guiana

Dévi Rita Rochemont, Emmanuelle Mimeau, Caroline Misslin-Tritsch, Martine Papaix-Puech, Emmanuel Delmas, Yannick Bejot, Bertrand DeToffol, Isabelle Fournel, Mathieu Nacher, Dévi Rita Rochemont, Emmanuelle Mimeau, Caroline Misslin-Tritsch, Martine Papaix-Puech, Emmanuel Delmas, Yannick Bejot, Bertrand DeToffol, Isabelle Fournel, Mathieu Nacher

Abstract

Background: French Guiana has the highest incidence of ischemic and hemorrhagic stroke of all French territories. However, there is no further information on the epidemiology and management of stroke in French Guiana. Our goal was to describe the characteristics of patients in French Guiana in order to generate hypotheses regarding the determinants explaining the magnitude of this public health problem.

Methods: We used the data of the French multicentre INDIA prospective cohort study which included consecutive patients aged > 18 years with a first-ever stroke from June 2011 to October 2014. For the present study, only patients with ischemic or hemorrhagic stroke admitted in one of the 3 participating hospitals were analyzed.

Results: Among the 298 patients (mean age 62.2 ± 14.5 years, 63.7% man) included in French Guiana, 52% were born abroad. Most strokes were ischemic strokes (79%), 14% of which were thrombolyzed. Hypertension (70.2%), history of smoking (22%) and diabetes (25%) were the most common risk factors and 28.4% of patients had known but untreated hypertension. Overall 89 (38%) patients with ischemic stroke were admitted less than 4.5 h after the first symptoms. In-hospital mortality was greater for intracerebral hemorrhage (18.7%) than for ischemic stroke (4.2%). Overall, 84.5% had health insurance coverage and among these, 41.9% had CMU, the universal health insurance for the poor.

Conclusions: The present study is the first epidemiologic description of stroke in French Guiana. The comparisons of these results show that stroke patients in French Guiana are epidemiologically atypical because they are younger, and more likely to be males than patients in mainland France. Stroke risk factors and delay between stroke and hospital admission were comparable with what is observed in France, suggesting that efforts should focus on primary care and social inequalities of health to alleviate the main determinants of stroke in French Guiana.

Keywords: Emergency care; Epidemiology; France; French Guiana; Stroke.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Sociodemographic characteristics of strokes in French Guiana

References

    1. Bejot Y, Caillier M, Rouaud O, Benatru I, Maugras C, Osseby G-V, et al. Épidémiologie des accidents vasculaires cérébraux. Datarevues0755498200361-C2117. 2008.
    1. Rothwell PM. The high cost of not funding stroke research: a comparison with heart disease and cancer. Lancet Lond Engl. 2001;357(9268):1612–1616. doi: 10.1016/S0140-6736(00)04730-9.
    1. Jean-Louis MAS. Epidemiologie des accidents vasculaires cérébraux. 1992. pp. 243–255.
    1. Feigin VL, Krishnamurthi RV, Parmar P, Norrving B, Mensah GA, Bennett DA, et al. Update on the global burden of ischemic and hemorrhagic stroke in 1990-2013: the GBD 2013 study. Neuroepidemiology. 2015;45(3):161–176. doi: 10.1159/000441085.
    1. Townsend N, Nichols M, Scarborough P, Rayner M. Cardiovascular disease in Europe — epidemiological update 2015. Eur Heart J. 2015;36(40):2696–2705. doi: 10.1093/eurheartj/ehv428.
    1. Béjot Y, Touzé E, Agnès J, Giroud M, Jean-Louis M. Épidémiologie des accidents vasculaires cérébraux | médecine/sciences. 2009.
    1. Feigin VL, Roth GA, Naghavi M, Parmar P, Krishnamurthi R, Chugh S, et al. Global burden of stroke and risk factors in 188 countries, during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet Neurol. 2016;15(9):913–924. doi: 10.1016/S1474-4422(16)30073-4.
    1. Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, et al. Global and regional burden of stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet Lond Engl. 2014;383(9913):245–254. doi: 10.1016/S0140-6736(13)61953-4.
    1. Njuieyon F, Buende Eyenga RS, Elenga N. Incidence du diabète chez les enfants de moins de 15 ans en Guyane française: 2011–2013. Ann Endocrinol. 2014;75(5):374. doi: 10.1016/j.ando.2014.07.346.
    1. Conan C, Garnier S. Les patients diabétiques traités en Guyane. AntianEchos Rev Économique Soc Antill Guyane Insee. 2008;70:30–31.
    1. Carrère P, Halbert N, Lamy S, Inamo J, Atallah A, Lang T. Changes in prevalence, awareness, treatment and control of hypertension in disadvantaged French Caribbean populations, 2003 to 2014. J Hum Hypertens. 2017;31(9):596–601. doi: 10.1038/jhh.2017.24.
    1. Inamo J, Atallah A, Ozier-Lafontaine N, Inamo A, Larabi L, Gaudemaris R. Existe-t-il des spécificités dans la prévalence et la prise en charge de l’hypertension artérielle aux Antilles-Guyane par rapport à la France métropolitaine? Bull Épidémiologique Hebd. 2008;49–50:489–492.
    1. Rochemont DR, Meddeb M, Roura R, Couchoud C, Nacher M, Basurko C. End stage renal disease in French Guiana (data from R.E.I.N registry): South American or French? BMC Nephrol. 2017:18 Disponible sur: . Cité 25 juill 2017.
    1. Rochemont DR. End stage renal disease as a symptom of health inequalities in French Guiana. J Health Inequa. 2018;4:31–5.
    1. Baromètre santé DOM 2014 - Présentation. Disponible sur: . Cité 8 nov 2018.
    1. Cepidc . Mortality data in French Guiana. Cepidc Inserm. 2014.
    1. Béjot Y, Guilloteau A, Joux J, Lannuzel A, Mimeau E, Mislin-Tritsch C, et al. Social deprivation and stroke severity on admission: a French cohort study in Burgundy and the West Indies - Guyana region. Eur J Neurol. 2017;24(5):694–702. doi: 10.1111/ene.13271.
    1. O’Donnell MJ, Chin SL, Rangarajan S, Xavier D, Liu L, Zhang H, et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet Lond Engl. 2016;388(10046):761–775. doi: 10.1016/S0140-6736(16)30506-2.
    1. Barker DJ. Maternal nutrition, fetal nutrition, and disease in later life. Nutr Burbank Los Angel Cty Calif. 1997;13(9):807–813. doi: 10.1016/S0899-9007(97)00193-7.
    1. Rimbaud D, Restrepo M, Louison A, Boukhari R, Ardillon V, Carles G, et al. Blood lead levels and risk factors for lead exposure among pregnant women in western French Guiana: the role of manioc consumption. J Toxicol Environ Health A. 2017;80(6):382–393. doi: 10.1080/15287394.2017.1331490.
    1. Navas-Acien A, Guallar E, Silbergeld EK, Rothenberg SJ. Lead exposure and cardiovascular disease--a systematic review. Environ Health Perspect. 2007;115(3):472–482. doi: 10.1289/ehp.9785.
    1. Marie Claude-Valentin, Rallu Jean-Louis. Les tendances démographiques et migratoires dans les régions ultrapériphériques : quel impact sur leur cohésion économique, sociale et territoriale ? Rapport de synthèse. INED institut national d’étude démographiques; Disponible sur: .
    1. Carde E. Le système de soins français à l’épreuve de l’outre-mer. Des inégalités en Guyane. Espace Popul Sociétés Space Popul Soc. 2009;2009/1:175–189. doi: 10.4000/eps.3638.
    1. En 2015, les prix dans les DOM restent plus élevés qu’en métropole - Insee Première - 1589. Disponible sur: . Cité 17 avr 2019.
    1. Bejot Y, Rouaud O, Benatru I, Fromont A, Couvreur G, Caillier M, et al. Les apports du registre dijonnais des accidents vasculaires cérébraux en 20 ans d’activité. Rev Neurol (Paris) 2008;164(2):138–147. doi: 10.1016/j.neurol.2007.06.003.
    1. Yannick B, Aurélie C, Marie C, Olivier R, Jerome D, Christine M, et al. Trends in Incidence, Risk Factors, and Survival in Symptomatic Lacunar Stroke in Dijon, France, From 1989 to 2006. Stroke. 2008;39(7):1945–1951. doi: 10.1161/STROKEAHA.107.510933.
    1. Béjot Y. Les accidents vasculaires cérébraux de la personne jeune : une pathologie émergente chez la femme comme chez l’homme. Apports du Registre dijonnais des AVC (1985–2011) 2016. pp. 7–8.
    1. Lecoffre C. L’accident vasculaire cérébral en France : patients hospitalisés pour AVC en 2014 et évolutions 2008–2014. BEH. 2017;5–21:84–92.
    1. de Carvalho JJF, Alves MB, Viana GÁA, Machado CB, dos Santos BFC, Kanamura AH, et al. Stroke epidemiology, patterns of management, and outcomes in Fortaleza, Brazil: a hospital-based multicenter prospective study. Stroke. 2011;42(12):3341–3346. doi: 10.1161/STROKEAHA.111.626523.
    1. Alexis S. Impact du plan AVC sur le aprise en charge des accidents vasculaires cérébraux ischémiques constitués: évolution 2011–2016 des indicateurs d’évaluation de la haute autorité de santé. BEH. 2018;5–6:78–84.
    1. Lahr MMH, Luijckx G-J, Vroomen PCAJ, van der Zee D-J, Buskens E. Proportion of patients treated with thrombolysis in a centralized versus a decentralized acute stroke care setting. Stroke. 2012;43(5):1336–1340. doi: 10.1161/STROKEAHA.111.641795.
    1. Katzan IL, Hammer MD, Hixson ED, Furlan AJ, Abou-Chebl A, Nadzam DM. Utilization of Intravenous Tissue Plasminogen Activator for Acute Ischemic Stroke. Arch Neurol. 2004;61(3):346–350. doi: 10.1001/archneur.61.3.346.
    1. Conforto AB, de Paulo RB, Patroclo CB, Pereira SL d A, Miyahara H d S, da Fonseca CB, et al. Stroke management in a university hospital in the largest South American city. Arq Neuropsiquiatr. 2008;66(2B):308–311. doi: 10.1590/S0004-282X2008000300004.
    1. Hadi A, Bendriss L, Khatouri A. L’apport des explorations cardiovasculaires réalisées de manière systématique lors du bilan étiologique d’un AVC ischémique constitué (À propos de 230 cas) Ann Cardiol Angéiologie. 2018;67(4):256–259. doi: 10.1016/j.ancard.2018.04.002.
    1. Guillon B, Planchon B, Woimant F, Magne C, Barrier J. Prise en charge des accidents vasculaires cérébraux en service de médecine interne générale. Résultats d’une enquête de pratiques. Rev Médecine Interne. 2001;22(9):830–844. doi: 10.1016/S0248-8663(01)00434-9.
    1. Marion H. Prise en charge initiale du syndrome coronarien aigu ST+ en milieu isolé : L’exemple de la Guyane française. 2018.
    1. Hart JT. Commentary: Can health outputs of routine practice approach those of clinical trials? Int J Epidemiol. 2001;30(6):1263–1267. doi: 10.1093/ije/30.6.1263.
    1. Lecoffre C, de Peretti C, Gabet A, Grimaud O, Woimant F, Giroud M, et al. National Trends in patients hospitalized for stroke and stroke mortality in France, 2008 to 2014. Stroke. 2017;48(11):2939–2945. doi: 10.1161/STROKEAHA.117.017640.

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