Spatial Analysis of Cerebrovascular Disease Mortality Before and During the COVID-19 Pandemic in Peru, 2017-2022
Arantxa Sanchez Boluarte1, Dayanne Ataucury Arones3, Cesar Carcamo3, Joseph Zunt4, Laura Lindgren-Dwyer2
1Department of Global Health, 2Institute for Health Metrics and Evaluation, University of Washington, 3Universidad Peruana Cayetano Heredia, 4Harborview Medical Center
Objective:
We analyzed the geographic distribution of stroke mortality in Peru before and during the COVID-19 pandemic.
Background:
Cerebrovascular disease (CVD) is a major global health issue, ranking second among causes of death and disability. The COVID-19 pandemic exacerbated healthcare challenges, particularly for non-communicable diseases like stroke. Peru, one of the hardest-hit countries, faced severe strain on its healthcare system due to COVID-19.
Design/Methods:
We conducted a secondary analysis of stroke-related deaths (2017-2022), sourced from the National Informatic System of Deaths, and population estimates from the National Registry of Identification and Civil Status. We estimated age- and sex-adjusted standardized mortality ratios (SMR) at department, province, and district levels. The spatial analysis utilized a Poisson-Lognormal model with spatially-autocorrelated random effects.
Results:
Stroke mortality varied annually across regions (p<0.001), mainly affecting the Northern and Southern jungle and highlands, with persistent high mortality throughout the study period. Between 2017-2019, there were 17,155 stroke-related deaths, increasing to 26,671 in 2020-2022. The highest SMR was observed in San Martin, peaking at 1.90 (95% UI [1.71-2.12]) in 2020. Pre-pandemic, provinces within San Martin, like Lamas and Picota, had SMRs above 2.00, while Marañon (SMR 2.19, 95% UI [1.44-3.36]) and Rioja (SMR 2.51, 95% UI [1.98-3.19]) showed high mortality during the pandemic. In Lima (coastal department), the SMR was 0.41 (95% UI [0.38-0.43]) in 2017, rising to 1.07 (95% UI [1.03-1.11]) by 2020. SMRs increased in most regions in 2020-2021, with a slight decrease in 2022.
Conclusions:
The findings highlight persistent geographical disparities in stroke mortality in Peru, with the Northwest and Southern regions consistently showing higher SMRs than the national average. The pandemic amplified these inequities, emphasizing the need for equitable resource allocation and resilient healthcare infrastructure to mitigate future pandemic impacts on stroke outcomes. Improved coverage and accuracy of national registries are crucial for effective public health planning and interventions.
Disclaimer: Abstracts were not reviewed by Neurology® and do not reflect the views of Neurology® editors or staff.