Transient ischemic attack (TIA) incidence with geographic information systems (GIS) mapping for stroke prevention interventions
Cynthia Felix1, Paramdeep Kaur2, Ivy A Sebastian3, Gagandeep Singh4, Monika Singla4, Shavinder Singh5, Clarence J Samuel5, Shweta J Verma3, Jeyaraj D Pandian3
1 University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA 15261, USA
2 Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Canada
3 Department of Neurology, Christian Medical College and Hospital, Ludhiana, Punjab, India
4 Department of Neurology, Dayanand Medical College, Ludhiana, Punjab, India
5 Department of Community Medicine, Christian Medical College and Hospital, Ludhiana, Punjab, India
Jeyaraj D Pandian,
Principal and Professor of Neurology, Christian Medical College, Ludhiana, Punjab, 141008; Vice-President, World Stroke Organisation Honorary Professor, The George Institute for Global Health, Sydney and School of Nursing, University of Central Lancashire, Preston Deputy Director, NIHR Global Health Research Group on Improving stroke Care in India.
Source of Support: None, Conflict of Interest: None
Objectives: GIS mapping as a public health tool has been increasingly applied to chronic disease control. While evaluating TIA incidence from an existing regional stroke registry in Ludhiana city, India, we aim to apply the innovative concept of regional TIA GIS mapping for planning targeted stroke prevention interventions. Methods: TIA patient data was obtained from hospitals, scan centers and general practitioners from March 2010 to March 2013 using WHO-Stroke STEPS based surveillance as part of establishing a population-based stroke registry in Ludhiana city. From this registry, patients with TIA (diagnosed by MRI image-based stroke rule-out, or clinically) were chosen and data analyzed. Results: A total of 138 TIA patients were included in the final analysis. The annual TIA incidence rate for Ludhiana city was 7.13/100,000 (95% confidence interval: 5.52 to 8.74) for 2012-2013. Mean age was 58.5 ± 13.9 years (range: 22-88 years) and 87 (63%) were men. Majority of the TIA cases had anterior circulation TIAs. Hypertension (87.4%) was the most common risk factor. Using Geographic Information System (GIS) mapping, high TIA incidence was seen in central, western, and southern parts and clustering of TIA cumulative incidence was seen in the central part of Ludhiana city. Conclusion: Incidence rate of TIA was lower than that expected from a low- and middle-income country (LMIC). TIA GIS mapping, looking at regional localization, can be a novel option for developing targeted, cost-effective stroke prevention programs.