A new analysis from India’s largest hospital-based stroke registry reveals alarming trends: one in seven stroke patients in the country is younger than 45 years, and nearly two in five patients reach the hospital more than 24 hours after symptom onset. Furthermore, within three months, more than half either die or live with significant disability.
The study, published in the International Journal of Stroke, was led by Prashant Mathur of the ICMR–National Centre for Disease Informatics and Research (ICMR-NCDIR), Bengaluru, along with investigators from the National Stroke Registry Programme.
India’s Largest Hospital-Based Stroke Analysis
Researchers analysed 34,792 stroke cases recorded across 30 hospitals between 2020 and 2022. As a result, the study provides one of the most comprehensive national snapshots of stroke patterns, treatment gaps, and patient outcomes in India.
The mean age of patients was 59.4 years. However, 13.8% were younger than 45 years, highlighting the rising burden of stroke among young Indians. Additionally, 63.4% of patients were men, and 72.1% came from rural areas. These findings reflect disparities in awareness, prevention strategies, and timely access to care.
Hypertension Emerges as the Dominant Risk Factor
As reported by TOI, the analysis identified hypertension as the leading risk factor, affecting 74.5% of patients. In addition, diabetes was present in 27.3% of cases. Lifestyle-related risks were also significant: 28.5% reported smokeless tobacco use, 22.6% smoked tobacco, and 20.2% consumed alcohol.
Notably, the study observed gender differences. Women showed higher rates of hypertension and diabetes, whereas men reported greater tobacco and alcohol use. These distinctions underline the need for targeted prevention strategies.
Delayed Hospital Arrival: The Biggest Barrier
Time to treatment emerged as the most critical challenge. Only 20% of patients reached the hospital within the crucial 4.5-hour window for emergency stroke therapy. In contrast, 37.8% arrived after 24 hours, thereby missing the opportunity for life-saving interventions.
Consequently, only 4.6% of ischemic stroke patients received intravenous thrombolysis, and a mere 0.7% underwent mechanical thrombectomy. Delayed arrival, imaging delays, and the non-availability of medicines significantly contributed to missed treatment opportunities.
Stroke Types and Immediate Outcomes
Ischemic strokes accounted for 60% of cases, while intracerebral haemorrhage comprised 34.2%.
In-hospital mortality stood at 13.9%. However, by three months, nearly 28% of patients had died, indicating that many succumbed after discharge. Overall, more than half of the patients experienced poor outcomes, defined as death or significant disability.
Women were more likely than men to have disability at follow-up, suggesting possible gaps in rehabilitation services and post-discharge care. Additionally, 1.1% of patients suffered a recurrent stroke within three months.
“Time is Brain”: Experts Call for Urgent Action
Dr. Manjari Tripathi, Head of Neurology at All India Institute of Medical Sciences Delhi (AIIMS Delhi), emphasized the urgency of early intervention. She stated that patients must reach the hospital within three hours of symptom onset. Immediate brain imaging remains essential, and eligible patients should receive thrombolysis without delay.
“Time is brain,” she stressed, explaining that every minute lost results in irreversible neuron loss, leading to long-term disability and dependence. Therefore, public awareness about recognizing stroke symptoms and seeking emergency care is critical.
Strengthening Prevention and Acute Care
The authors concluded that India must intensify hypertension and diabetes control, promote tobacco cessation, and strengthen referral systems. Moreover, policymakers must expand access to acute stroke care, particularly in rural regions where the burden remains high.
Without stronger prevention strategies and faster emergency response systems, stroke will continue to affect younger individuals and leave families coping with preventable disability and loss.