Spatial Analysis of Cerebrovascular Disease Mortality before and during the COVID-19 Pandemic in Peru, 2017-2022

Abstract

Cerebrovascular disease (CVD) is a significant global health concern, ranking as the second leading cause of death and disability worldwide, with 7.3 million deaths in 2021. The COVID-19 pandemic exacerbated existing healthcare challenges, particularly for non-communicable diseases like stroke. Peru, one of the hardest-hit countries in Latin America, faced severe strain on its healthcare system. This study analyzed the geographic distribution of CVD mortality in Peru before and during the COVID-19 pandemic. We employed a secondary analysis of stroke-related deaths from 2017 to 2022, sourced from the National Informatic System of Deaths (SINADEF), and population estimates from the National Registry of Identification and Civil Status (RENIEC). We estimated age- and sex-adjusted standardized mortality ratios (SMR) of stroke. The spatial analysis utilized a Poisson-Lognormal model implemented in R, using the INLA and sf packages for small area estimation. We identified areas with higher-than-expected stroke SMRs, and areas with lower ratios than the national average. Pre-COVID years showed consistent spatial patterns with higher SMRs than the national average in northern, central, and southern departments. During the COVID-19 pandemic, these patterns mostly persisted and intensified, with continued high SMRs in the same regions. An overall increase in stroke mortality was observed during the pandemic, particularly in 2020 and 2021. The findings highlight persistent geographical disparities in stroke mortality in Peru. Limitations include potential inaccuracies in the SINADEF registry, insufficient differentiation between stroke types, and underreporting in rural areas. Despite these limitations, the study provides valuable insights for targeted healthcare interventions and resource allocation. Regions in the Northwest and South of Peru consistently showed higher stroke SMR than the national average. While the SMR increased, patterns also remained stable across the years. These findings emphasize the need for improved resource allocation and healthcare infrastructure resilience to address both immediate and long-term public health challenges. Lastly, enhanced coverage and accuracy of national registries are crucial for effective public health planning and intervention strategies.