Supplementary Material for: Comparing Stroke Profiles and Outcomes between Urban and Rural India: A Secondary Analysis of the SPRINT INDIA Trial
dataset
posted on 2025-04-14, 09:55 authored by figshare admin kargerfigshare admin karger, Verma S.J., Devi K.S., Arora D., Dhasan A., Sylaja P.N., Khurana D., Vijaya P., Ray B.K., Nambiar V., Aaron S., Mittal G.K., Pai A.R., Kumaravelu S., Reddy Y.M., Narayan S., Borah N.C., Das R., Kulkarni G.B., Huded V., Mathew T., Srivastava P., Bhatia R., Ojha P.K., Roy J., Abraham S.M., Vaishnav A., Sharma A., Pathak A., Bhoi S.K., Sharma S., Sulena S., Saroja A.O., Ramrakhiani N., Kempegowda M.B., Gorthi S.P., Kate M.P., George T., Sebastian I.A., Sharma M., Dhaliwal R., Huilgol R., Pandian J.D.Introduction:
Stroke causes significant death and disability, with urban-rural disparities in healthcare, and limited studies in India, despite its rural majority of 70%. The post-hoc study aimed to explore differences in stroke profiles, risk factors, and outcomes between urban and rural participants using data from the SPRINT INDIA trial.
Methods:
The SPRINT INDIA trial was a multi-centre Randomised clinical trial RCT across 31 Indian sites. Data was collected between April 28, 2018, and Nov 30, 2021. Index stroke patients, aged 18 and older, presenting within two days to three months of symptom onset, were randomized using a centralized web-based system into intervention or control groups. The intervention included SMS, videos, and an interactive educational workbook for secondary stroke prevention in 11 Indian languages. Baseline data captured in Case report form (CRF) included participants' urban or rural location. Primary outcome was a composite endpoint that included recurrent stroke, high-risk transient ischemic attack (TIA), acute coronary syndrome (ACS), and all-cause mortality within one year after randomization. The trial is registered by Clinicaltrials.gov, NCT03228979 and Clinical Trials Registry-India CTRI/2017/09/009600).
Results:
The trial enrolled 4,298 sub-acute stroke patients, out of which 3038 (70.68%) were followed-up of which 1620 (53.32%) were urban and 1418 (46.68%) were rural. Primary composite outcome (recurrent stroke, high-risk TIA, ACS, and mortality) was higher in urban areas compared to rural areas 61 (3.8%) vs 34 (2.4%); p=0.018 at one year follow-up. All cases of high-risk TIA occurred in urban participants (p<0.001).
Urban participants were more educated 795 (49.1%) vs rural 394 (27.8%); p<0.001), with higher rates of dyslipidemia 335 (20.7%) vs 247 (17.4%); p=0.023, and higher BMI 25.17±4.31 vs. 24.76±4.23; p=0.008. Behavioural risk factors of alcohol intake and smoking tobacco were higher in rural patients compared to urban patients 65 (4.6%) vs. 73 (4.5%); p<0.001 and 59 (4.2%) vs. 65 (4.0%); p<0.001 respectively.
Conclusion:
Urban patients show higher stroke recurrence and lifestyle-related conditions, while rural patients face more behavioural risks like smoking and alcohol use. To address these disparities, requires targeted interventions; urban patients would benefit from lifestyle-focused programs, such as dietary improvements and stress management. For rural patients, programs should focus on reducing behavioural risks like smoking and alcohol use through community-based education and accessible cessation support services.
