THE

SOCIOECONOMIC DEEPIKA VASUDEVAN

IMPACT OF D. VASUDEVAN

STROKE – A
SURVEY IN RURAL/ DEPT. of NEUROLOGY

SEMIURBAN
SAVEETHA MEDICAL COLLEGE

SIMATS, INDIA

TAMIL NADU
Introduction

India is silently witnessing a stroke epidemic. Stroke is a

major health concern not only because it is the third major
cause of death but also because it leaves patients with several
residual disabilities like physical dependence, cognitive
decline, dementia, depression, and seizures. The costs
involved in caring for these patients are enormous and have
adverse social implications.
AIM

This study aims to evaluate the burden of

disease on the financial aspects of the
patient’s life as well as the quality of life
after stroke has occurred.
 Objectives

• To determine the financial burden on the

patient and his/her family
• To assess the effect of stroke on various
aspects of a patient’s life
 METHODS

– This is a cross sectional study with a sample size of 51 stroke

patients along with their families.
– This study was done using non probability convenience sampling
method.
– The data was collected using a pre tested semi structured
questionnaire.
– Administered in the native language by interview method when
the patient was unable to fill the questionnaire.
– The data was entered in Microsoft excel and was analysed
Certain stroke facts

– Indian population is relatively young compared to

developed countries.
– Indian population > 60 yrs : 8.5% (2016), USA(16),
China(17.3), Japan(33), Europe(26)
– However stroke has reached epidemic proportions
– In 1969-70 it was 13 per 100000
– In 2003 – 05 it was 145 per 100000 and increasing
– This is a double whammy !!
Stroke facts

More number of strokes

Younger populations are more affected
Economic impact is all the more devastating.
Stroke is the third major cause of death in India.
Stroke mortality is 22 times that of Malaria
1.4 times that of TB.
Stroke facts

– There are national eradication programs for Malaria and

for TB.
– None for stroke
Results
 Results
Economic status
• Middle income – 7.8% ( >6 < 8 Lacs )
• Lower income – 64% ( 3 to 6 lacs p.a. )
• Uncertain or Poor – 27 %. They are mostly daily
wage labourers with uncertain monthly income.
Probably less than 90000 p.a.

Family income before and after stroke

Around 37 % (sole provider) lost more than 80%

of their income.
In case of contributors (35%) , they lost around
30-50 % of the family income
In 28% (dependents) there was no change in
family income as they were already dependent.
Results

29.4% of patients were dependent on others

financially at the onset of stroke
 Results

72% patients experienced role reversal from provider to dependent. The remainder were
already dependent.
 Results

None of the stroke patients went back to productive work, leading to significant
Financial loss for the family ( in rupees ).
 Results

Due to strong family bonding, none of the patients faced issues in relationships.
Rather, these provided emotional support to the patients.
 Results

29.4% of families did not experience disconcerting financial changes despite the
Stroke victim being a contributor because of other earning members.
 Results

Rehabilitation procedures were worst affected. Food, clothing and school fees of
children were compromised.
 Results

Systematic assistance from organizations was conspicuously lacking.

Individual support from relatives played a greater role.
 Discussion

– Impact on patient, family, society

– Patients became dependent on the family
– Spill over effect on family was more in cases where
patient was the sole provider
– Longer duration of disease had a more severe toll on
the family financially
– Rehabilitation was usually the first compromise in the
financial crunch
– On a positive note, no patients were abandoned by the
family members
Conclusion

Stroke has a profound impact on the

individual, family and society
Targeted measures by healthcare sector
with support from NGOs and other
governmental bodies in identification and
treatment of risk factors, preventing
stroke and early rehabilitation will go a
long way in alleviating burden.
 References

• Mishra NK, Khadilkar SV. Stroke program for India. Annals

of Indian Academy of Neurology. 2010 Jan;13(1):28.
• Mapulanga M, Nzala S, Mweemba C. The Socio-economic
Impact of Stroke on Households in Livingstone District, Zambia:
A Cross-sectional Study. Annals of medical and health sciences
research. 2014;4(8):123-7.
• Sacco RL, Kasner SE, Broderick JP, Caplan LR, Culebras A,
Elkind MS, George MG, Hamdan AD, Higashida RT, Hoh BL,
Janis LS. An updated definition of stroke for the 21st century.
Stroke. 2013 Jul 1;44(7):2064-89.
• Kuruvilla T, Bharucha NE. Epidemiology of stroke in India.
Neurol J Southeast Asia. 1998;3:5-8.