Determinants of Mortality in First-Ever Stroke Patients in the Suburban Malaysia: A Retrospective Hospital-Based Study, 2005–2011

Stroke is defined as " rapidly developing clinical signs of focal (or global) disturbance of cerebral function, lasting more than 24 hours or leading to death with no apparent cause other than that of vascular origin " (1). Stroke is recognized as ten leading causes of mortality worldwide in 2011 with increasing trend of mortality over the past decade (2). Alarmingly, mortality due to stroke and heart disease has been projected to increase to almost 23.6 million in 2030 (3). In Malaysia, diseases of the circulatory system which include stroke ranked first in the list of principal causes of mortality (4). This imposes a significant burden on total health expenditure. Based on Health Expenditure Report 1997-2011, the total health expenditure for Malaysia increased from RM 8,188 million in year 1997 to RM 37,871 million in year 2011 for the total population of 29,062,000. For the same period, the health spending as a share of Gross Domestic Product (GDP) ranged from 2.9% to 4.3% of GDP. The per capita spending on health ranged from RM 636 (USD 233) to RM 1,303 (USD 426). The health spending of GDP in Malaysia is similar to the other countries in Asia such as Thailand, Bangladesh, Philippines, India, Sri Lanka and Indonesia (5). Establishing contemporary information on the determinants of mortality on first-ever, stroke patients in Malaysia would prove to be valuable for an improved and informed healthcare provision of stroke care and preventive measures especially for possible discrepancies between urban and rural areas in Ma-laysia. This study aimed to identify the significant determinants of mortality among first-ever stroke patients in suburban region in Malaysia. Medical records from 1 st January 2005 to 31 st De-cember 2011 of stroke patients admitted to Hospital Universiti Sains Malaysia, Kelantan, Malaysia were retrospectively reviewed. The inclusion criteria were clinically diagnosed first-ever stroke patients aged 18 and above. First-ever, stroke patient was defined as patient with no evidence of previous stroke and confirmed by computed tomogra-phy (CT) scan or magnetic resonance imaging (MRI) and neurological examination during admission. Recurrent stroke patients or patients with any neurological deficit due to epilepsy, tumor, infection or any traumatic causes were excluded.