Mortality rates and long-term disability after cerebrovascular events: A prospective cohort study in general Villegas, Buenos Aires, Argentina. The EstEPA population study

Abstract

Background: Stroke is a major cause of death and disability worldwide, with a disproportionate burden in low- and middle-income countries. However, long-term, population-based outcome data are scarce in Latin America. We aimed to estimate mortality and disability after cerebrovascular events in a community-based cohort from Argentina.

Methods: We conducted a prospective, population-based cohort study in General Villegas, Buenos Aires, including all incident cerebrovascular events (ischemic stroke, hemorrhagic stroke, subarachnoid hemorrhage, and transient ischemic attack) from June 1, 2017 to May 31, 2020. Patients were followed for up to five years, with annual assessment of mortality and disability. Mortality rates were calculated and age-standardized to national and WHO populations. Exploratory Cox regression identified baseline predictors of mortality.

Results: The five-year cumulative mortality was 50.5 %, with 38 % of deaths occurring within the first year. The crude mortality rate was 131.3 per 100,000 person-years, and 109.4 per 100,000 when standardized to the Argentine population. Older age and higher baseline disability were independently associated with increased mortality. Among survivors, 70.5 % (n = 72) had good functional outcomes (mRS ≤2) at one year, and 70.6 % (n = 24) at five years. A sensitivity analysis excluding transient ischemic attacks (n = 19) yielded similar mortality estimates.

Conclusions: Long-term mortality after cerebrovascular events in this Argentine population was high, highlighting gaps in stroke care and follow-up. Nonetheless, most survivors maintained functional independence over time. These findings underscore the need for integrated stroke systems and long-term monitoring strategies, especially in underserved settings.