Stroke in Trinidad and Tobago: burden of illness and risk factors

This study describes the burden of stroke on hospital services in a Caribbean community. The settings are the two main acute general hospitals in Trinidad observed over a 12-month period. All subjects were admitted with a clinical diagnosis of acute stroke. The measures were hospital admission rates, length of hospital stay, case-fatality rates, disability at discharge, and risk factors for stroke. There were 1 105 hospital admissions with a diagnosis of stroke. The median length of stay was 4 days, with an interquartile range of 2 to 9, and stroke accounted for approximately 9 478 bed days per annum. The hospital admission fatality rate was 29 percent. Among surviving patients, 437 (56 percent) were severely disabled at discharge. Age-standardized admission rates for first strokes in persons aged 35-64 years were 114 (95 percent CI: 83 to 145) per 100 000 in Afro-Trinidadian men and 144 (109 to 179) in Indo-Trinidadian men. The equivalent rates for women were 115 (84 to 146) and 152 (118 10186). Among patients with first strokes, 348/531 (66 percent) reported physician-diagnosed hypertension, but only 226 (65 percent) of these reported being on antihypertensives at admission. Stroke in Trinidad and Tobago is associated with a high case-fatality rate and severe disability in survivors. Modifiable risk factors were reported in a majority of stroke cases, and there is a need to develop effective preventive strategies (AU)

Stroke in Trinidad and Tobago: burden of illness and risk factors

This study describes the burden of stroke on hospital services in a Caribbean community. The settings are the two main acute general hospitals in Trinidad observed over a 12 month period. All subjects were admitted with a clinical diagnosis of acute stroke. The measures were hospital admission rates, length of hospital stay, case-fatality rates, disability at discharge, and risk factors for stroke. There were 1.105 hospital admissions with a diagnosis of stroke. The median length of stay was 4 days, with an interquartile range of 2 to 9, and stroke accounted for approximately 9.478 bed days per annum. The hospital admission fatality rate was 29 por cien. Among surviving patients, 437 (56 percentage) were severely disabled at discharge. Age-standardized admission rates for first strokes in persons aged 35-64 years were 114 (95 percentage CI: 83 to 145) per 100.000 in Afro-Trinidadian men and 144 (109 to 179) in Indo-Trinidadian men. The equivalent rates for women were 115 (84 to 146) and 152 (118 to 186). Among patients with first strokes, 348/531 (66 percentage) reported physician-diagnosed hypertension, but only 226 (65 percentage) of these reported being on antihypertensives at admission. Stroke in Trinidad and Tobago is associated with a high case-fatality rate and severe disability in survivors. Modifiable risk factors were reported in a majority of stroke cases, and there is a need to develop effective preventive strategies

Stroke in Trinidad and Tobago: Burden of illness and risk factors

This study describes the burden of stroke on hospital services in a Caribbean community. The settings are the two main acute general hospitals in Trinidad observed over a 12-month period. All subjects are admitted with a clinical diagnosis of acute stroke. The measures were hospital admission rates, length of hospital stay, case-fatality rates, disability at discharge, and risk factors for stroke. There were 1,105 hospital admissions with a diagnosis of stroke. The median length of stay was 4 days, with an interquartile range of 2 to 9, and stroke accounted for approximately 9,478 bed days per annum. The hospital admission fatality rate was 29 percent. Among surviving patients, 437 (56 percent) were severely disabled at discharge. Age-standardized admission rates for first strokes in persons aged 35-64 years were 114 (95 percent CI: 83 to 145) per 100,000 in Afro-Trinidadian men and 144 (109 to 179) in Indo-Trinidadian men. The equivalent rates for women were 115 (84 to 146) and 152 (118 to 186). Among patients with first strokes, 348/531 (66 percent) reported physician-diagnosed hypertension, but only 226 (65 percent) of these reported being on antihypertensives at admission. Stroke in Trinidad and Tobago is associated with a high case-fatality rate and severe disability in survivors. Modifable risk factors were reported in a majority of stroke cases, and there is a need to develop effective preventive strategies.(AU)

Stroke in Trinidad and Tobago: burden of illness and risk factors

This study describes the burden of stroke on hospital services in a Caribbean community. The settings are the two main acute general hospitals in Trinidad observed over a 12 month period. All subjects were admitted with a clinical diagnosis of acute stroke. The measures were hospital admission rates, length of hospital stay, case-fatality rates, disability at discharge, and risk factors for stroke. There were 1.105 hospital admissions with a diagnosis of stroke. The median length of stay was 4 days, with an interquartile range of 2 to 9, and stroke accounted for approximately 9.478 bed days per annum. The hospital admission fatality rate was 29 por cien. Among surviving patients, 437 (56 percentage) were severely disabled at discharge. Age-standardized admission rates for first strokes in persons aged 35-64 years were 114 (95 percentage CI: 83 to 145) per 100.000 in Afro-Trinidadian men and 144 (109 to 179) in Indo-Trinidadian men. The equivalent rates for women were 115 (84 to 146) and 152 (118 to 186). Among patients with first strokes, 348/531 (66 percentage) reported physician-diagnosed hypertension, but only 226 (65 percentage) of these reported being on antihypertensives at admission. Stroke in Trinidad and Tobago is associated with a high case-fatality rate and severe disability in survivors. Modifiable risk factors were reported in a majority of stroke cases, and there is a need to develop effective preventive strategies

Social environment, morbidity and use of health care among people with diabetes mellitus in Trinidad

BACKGROUND: This study aimed to identify social characteristics associated with higher levels of morbidity from diabetes and their relationship to health care utilization. METHODS: During a 6-month period 1149/1447 (79 percent) subjects admitted to Port of Spain Hospital, Trinidad with diabetes responded to a structured interview. Data collection included social factors, diabetes-related morbidity and health care utilization. Analyses were adjusted for age, sex, ethnic group and self-reported diabetes duration. RESULTS: Of 12 indicators of morbidity, nine were more frequently in subjects with no schooling compared with those with secondary education. At ages 15-59 years, nine morbidity indicators were less frequently among subjects in full-time jobs compared with those not in employment. The association of educational attainment was explained by confounding with age, sex, ethnic group and diabetes duration but five morbidity indicators were associated with employment status after adjusting for confounding. The type of water supply in the home was generally not associated with morbidity. Each of the indicators of lower socioeconomic status was associated with less use of private doctors and with more use of government health centres. CONCLUSIONS: Morbidity from diabetes was greater in groups with lower socioeconomic status. While morbidity associated with lower educational attainment was mostly explained by older age; the results suggested the possibility that diabetes may contribute to unemployment of those in the labour force. Private care was less accessible to social groups with higher levels of morbidity and the availabiltiy of government funded health services was important for reducing inequalities in health care utilization.(AU)

Counting the cost of hospital admissions with stroke in the Port-of-Spain and San Fernando, Trinidad

Cerebrovascular disease is one of the leading causes of death in Caribbean countries, but few studies have examined the use of hospital services by people suffering from stroke. We studied all patients admitted to Port-of-Spain and San Fernando hospitals in Trinidad over a twelve-month period. There were 643 admissions at Port-of-Spain Hospital and 462 at San Fernando. There were 823 (74 percent) admissions with first time strokes and 282 (26 percent) admissions with recurrent stroke; 321 (29 percent) were aged 65-74 years and 324 (29 percent) were 75 years of age. Five hundred and nine (46 percent) were Afro-Trinidadian and 418 (38 percent) Indo-Trinidadian but ethnic distribution differed at the two hospitals. There were clinical diagnoses of hypertension in 693 (63 percent) and diabetes mellitus in 355 (32 percent). There were 322 deaths giving a hospital admission fatality rate of 29 percent (95 percent CI, 26-32 percent). Mortality was associated with level of consciousness and degree of impairment of speech, swallowing and continence at the time of first assessment. Hospital mortality was not associated with age, gender, ethnic group or hospital of treatment. Among surviving patients 444 (57 percent) were severely disabled at the time of discharge. The median length of stay was 4 days (interquartile range 2-8 days) at Port-of-Spain and 5(3-9) days at San Fernando. At the two hospitals admissions with stroke accounted for 9088 bed-days annually with a conservatively estimated hospital cost in excess of TT $3.6 million (US$ 0.63). We conclude that stroke imposes a significant burden on hospital services, the hospital mortality rate is high and survivors have significant disability. The high prevalence of hypertension in stroke sufferers points to a strategy for control of stroke (AU)

Counting the cost of diabetic hospital admissions from a multi-ethnic population in Trinidad

Many middle-income countries are experiencing an increase in diabetes mellitus but patterns of morbidity and resource use from diabetes in developing countries have not been well described. We evaluated hospital admission with diabetes among different ethnic groups in Trinidad. We compiled a register of all patients with diabetes admitted to adult medical, general surgical, and ophthalmology wards at Port of Spain Hospital, Trinidad. During 26 weeks, 1447 patients with diabetes had 1722 admissions. Annual admission rates, standardized to the world population, for the catchment population aged 30-64 years were 1031 (95 percent CI 928 to 1134) per 100,000 in men and 1354 (1240 to 1468) per 100,000 in women. Compared with the total population, admission rates were 33 percent higher in the Indian origin population and 47 percent lower in those of mixed ethnicity. The age-standardized rate of amputation with diabetes in the general population aged 30-60 years was 54 (37 to 71) per 100,000. The hospital admission fatality rate was 8.9 percent (95 percent CI 7.6 percent to 10.2 percent). Mortality was associated with increasing age, admission with hyperglycaemia, elevated serum creatinine, cardiac failure or stroke and with lower-limb amputation during admission. Diabetes accounted for 13.6 percent of hospital admissions and 23 percent of hospital bed occupancy. Admissions associated with disorders of blood glucose control or foot problems accounted for 52 percent of diabetic hospital bed occupancy. The annual cost of admissions with diabetes was conservatively estimated at TT10.66 million (UK 1.24 million pounds). In this community diabetes admission rates were high and varied according to the prevalence of diabetes. Admissions, fatalities and resource use were associated with acute and chronic complications of diabetes. Investing in better quality preventive clinical care for diabetes might provide an economically advantageous policy for countries like Trinidad and Tobago. (AU)

Quality of blood pressure monitoring and control in primary care in Trinidad and Tobago - abstract

This study evaluated the quality of blood pressure (BP) monitoring and control among primary care attenders, aged o30 years, and not diabetic or currently pregnant, in Trinidad and Tobago. Data were collected from 1616 clinic records (92 percent retrieval rate for eligible cases): 1041 attended eighteen government health centres and 575 attended eight private general practitioner (GP) offices. Overall, 1469 (91 percent) patients had BP recorded at some time and 1217 (75 percent) within the previous 12 months. The proportion with no BP measurement was higher for GP patients (19 percent) than for health centre patients (4 percent). Only 73 (5 percent) of patients had BPo160/100 mm Hg and were not treated with drugs, but 164 (10 percent) had BPo140/90 and < 160/100 mm Hg and were not treated with drugs. Patients aged o 65 [Odds Ratio (OR) 3.29 (95 percent Confidence Interval (CI) 1.54 to 7.07)] and patients attending GPs [(OR 2.31 (CI 1.20 to 4.43)] were more likely to have untreated BPo160/100 mm Hg. Among 784 patients treated for hypertension only 143 (18 percent) had BP < 140/90 mm Hg. Advice on non-drug treatment was recorded for only 164 (10 percent) of all patients. Health centres mainly prescribed methyldopa and Brinerdin while GPs prescribed ACE inhibitors and calciun antagonists as well as thiazides and Brinerdin. Most primary care attenders had BP measurements recorded and most patients with hypertension received treatment but control of hypertension in those treated was unsatisfactory, more so for those attending GPs than for those attending health centres (AU)

Counting the cost of diabetic hospital admissions in North Trinidad - abstract

A register was compiled of all patients with diabetes mellitus who were admitted to medical, general surgical or opthalmology wards at the Port-of-Spain General Hospital over a 26-week period form October, 1993 to April, 1994. Admission rates declined with increasing distance from the hospital, but increased with age, were higher in women than in men, and higher in Indo-Trinidadians than in Afro-Trinidadians. There were 1722 diabetic admissions of whom 1334 (77 percent) were medical, 302 (18 percent) surgical and 86 (5 percent) opthalmology. Frequent diagnoses on admission were: hyperglycaemia, 19 percent; hypoglycaemia, 12 percent; stroke and myocardial infarction, 8 percent each. The median length of stay was 4 days (interquartile range, 2 to 9 days). Diabetic inpatients occupied an estimated 26,659 hospital bed days per year, with an estimated hospital cost > TT$10.6 million (US$1.8 million). Patients admitted with disorders of glycaemic control or foot problems occupied an estimated 13,913 bed days per year with an approximate annual cost of TT$5.5 million (US$0.96 million). The mean cost of one diabetic admission was approximately TT$3,096 (US$538). This sum would cover the cost of one year's treatment in a government primary care setting for up to 9 persons with diabetes mellitus. Many admissions might be avoided with improved preventive management in primary health care settings. Improving the quality of primary care for diabetes mellitus might free considerable hospital resources for alternative use (AU)

Social inequalities in health status and care practices among patients admitted to hospital with diabetes mellitus in Trinidad - abstract

Of 1149/1447 (79 percent) patients admitted to the General Hospital, Port-of-Spain, with diabetes mellitus in a 6-month period, 138 (12 percent) had no schooling (NS), 782 (68 percent) had only primary education (PE), 119 (17 percent) had secondary education or higher (SE), 30 (3 percent) were not classified. Compared with patients with SE, those with NS were older, were more likely to be women, or of East Indian descent and to have effort chest pain, a history of `stroke' or `heart attack' (Odds Ratio (OR) 3.51 (95 percent CI 1.97 to 6.24)), neuropathic symptoms (OR 1.72 (1.11 to 2.68)) and vision defects (OR 2.97 (1.28 to 6.87)). Variations in the prevalence of these conditions were mostly explained by confounding with increasing age, female sex and East Indian ethnicity. Patients with NS were more likely to attend a health centre than a private doctor as their usual source of care (OR 4.51 (2.76 to 7.35)), were less likely to have attended a dietitian (OR 0.53 (0.34 to 0.83)), and were less likely to test for blood glucose at home (OR 0.14 (0.03 to 0.61)). Adjusting for age, gender and ethnic group did not explain social inequalities in the usual source of care, attendance at a dietitian or use of home blood glucose monitoring. Our data are consistent with the `inverse care law': those most affected by diabetic complications had more limited access to health care (AU)