Interdisciplinary Neurosurgery: Advanced Techniques and Case Management 32 (2023) 101746

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Interdisciplinary Neurosurgery: Advanced Techniques

and Case Management
journal homepage: www.elsevier.com/locate/inat

Prevalence of stroke in the elderly: A systematic review and meta-analysis

Fatemeh Rajati a, Mojgan Rajati b, Roumina Rasulehvandi c, Mohsen Kazeminia c, *
a
Research Center for Environmental Determinants of Health, Health institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
b
Obstetrics and Gynecology, Department of Obstetrics and Gynecology, School of Medicine, Motazedi Hospital Kermanshah University of Medical Sciences, Kermanshah,
Iran
c
Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran

A R T I C L E I N F O A B S T R A C T

Keywords: Background: Aging is a critical period of human life and paying attention to the needs and diseases of this period
Meta-analysis is considered as a social necessity. One of the most neurological debilitating diseases in the elderly is stroke.
Prevalence Considering that the previous studies have reported different prevalence rates of stroke in the elderly, the present
Stroke
study aimed at combining, summarizing, resolving inconsistencies in the results of conducted studies, examining
Systematic review
the impact of potential factors, and estimating the prevalence of stroke in the elderly using systematic review and
meta-analysis.
Methods: The present systematic review and meta-analysis study was performed during 1996–2022. All relevant
published studies were searched in SID, MagIran, PubMed, Embase, Scopus, Web of Science (WoS) databases and
Google Scholar motor engine using related MeSH/Emtree and Free Text words. Heterogeneity among studies was
assessed using I2 index.
Results: In the initial search, 13,583 studies were found. After excluding irrelevant studies, eventually, 36 eligible
studies were included in meta-analyses. The overall prevalence of stroke was estimated to be 7.4 % (95 % CI:
6.2–8.9 %) in the elderly, 7.0 % (95 % CI: 5.7–8.6 %) in male, and 6.4 % (95 % CI: 5.3–7.8 %) in female. The
prevalence of stroke enhanced with increasing the mean age of elderly and decreased with increasing the year of
publication (P < 0.001).
Conclusion: The results of the present study indicated that the prevalence of stroke is high in both male and
female and its rate increases with age. Therefore, it is recommended that health officials and policy makers pay
more attention to the prevention and control of stroke.

1. Introduction various physical, psychological, social, and economic problems for the
elderly [1]. The elderly population growth is associated with increased
Aging is a critical period of human life and paying attention to the prevalence of diseases and dependence in activities of daily living [2].
issues, needs, and diseases of this stage is a social necessity [1]. The One of the diseases that is considered as the main health problem in the
World Health Organization (WHO) defines elderly as people aged 65 and global elderly population is stroke [5].
over and a large percentage of elderly live in developing countries [2]. When blood flow to a part of the brain is disrupted or stopped, that
Nowadays, the global elderly population is increasing, due to the part of the brain cannot function normally, which is called stroke [6].
improvement of the health and treatment status, which is called the Stroke can be caused by the blockage or rupture of a cerebral artery
“demographic revolution” [3]. WHO had estimated that the global [6,7]. Stroke is considered as one of the most common neurological
elderly population would reach 727 million by 2020 and it is predicted debilitating diseases in middle age and elderly [8,9] and the third
that it will reach more than 1.5 billion by 2050 [4]. leading cause of death after cardiovascular disease and cancer world­
Although elderly is not a disease, it has been found that more than 80 wide [10,11].
% of the elderly suffer from one or more disorders or diseases that cause Stroke is recognized as one of the major causes of disability in the

Abbreviations: SID, Scientific Information Database; WoS, Web of Science; MeSH, Medical Subject Headings; PRISMA, Preferred Reporting Items for Systematic
Reviews and meta-Analysis; CI, Confidence Interval; JBI, Joanna Briggs Institute; WHO, World Health Organization.
* Corresponding author.
E-mail addresses: [email protected] (R. Rasulehvandi), [email protected] (M. Kazeminia).

https://doi.org/10.1016/j.inat.2023.101746
Received 10 December 2022; Accepted 11 February 2023
Available online 13 February 2023
2214-7519/© 2023 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-
nc-nd/4.0/).
F. Rajati et al. Interdisciplinary Neurosurgery: Advanced Techniques and Case Management 32 (2023) 101746

world with a sudden onset and its duration poses various challenges in 2.2. Inclusion criteria
the living conditions of survivors and their family members [12]. Stroke
survivors suffer from complications, such as brain injury, physical or The inclusion criteria were original articles, observational studies
cognitive impairment, and speech impairment [13]. About 30–50 % of (cross-sectional study, cohort study, etc.), access to the full text of the
stroke survivors live with severe disabilities that make them dependent article, and studies reported the rate or frequency of stroke in the
on others [14]. elderly.
Several primary studies have been recently performed on the prev­
alence of stroke in the elderly population in different parts of the world 2.3. Exclusion criteria
[15–19]. However, these studies examined the prevalence rate of stroke
in a limited geographical area with a small sample size. In addition, none The exclusion criteria included the irrelevant studies, interventional
of the studies investigated the effect of potential factors, such as year of studies (clinical trial study, field trial study, and social trial study),
publication, sample size, mean age, and gender of the elderly. Further, qualitative studies, case series, case reports, letter to editor, articles
given the changes in population structure in different parts of the world, presented at conferences, systematic review and meta-analysis studies,
the prevalence was not reported by different continents. There are also a dissertations, animal studies, lack of access to the full text of the article
large differences in the prevalence rate reported in their results. after sending email to the corresponding author for three times, dupli­
Therefore, it seems necessary to conduct systematic review and meta- cates, and studies with overlapping data.
analysis study to combine, summarize, and resolve inconsistencies in
the results of studies conducted to investigate the impact of potential 2.4. Selection process of studies
factors and estimate the overall prevalence rate of stroke in the elderly.
To the best of our knowledge, we did not find a systematic review and After identifying the search strategy for each database, all studies
meta-analysis in this regard. Thus, the present study aimed at estimating obtained from different databases were imported into EndNote X8
the prevalence of stroke in the elderly using systematic review and meta- software. Duplicates and studies with overlapping data were initially
analysis. excluded. Then, the name of authors, institutes, and journals of all ar­
ticles was deleted. The title and abstract of the studies were thoroughly
2. Methods screened to excluded the irrelevant studies. In the following, the full text
of remaining articles was carefully assessed to remove the studies unmet
The present systematic review and meta-analysis was performed the inclusion criteria. Ultimately, the quality assessment of all studies
based on the guidelines of PRISMA 2020 (https://www.prisma-stateme included in systematic review and meta-analysis was done.
nt.org/), including identification, screening, eligibility, and included
[20] from 1996 to April 2022. All steps of identification, selection, and 2.5. Quality assessment of the studies
quality assessment of studies, as well as data extraction were performed
by two researchers (M.K and R.R) independently to reduce publication The quality assessment of the studies was done using the Joanna
bias and error. In the event of any disagreement between the two re­ Briggs Institute (JBI) checklist, as a standard and well-known checklist
searchers, the third researcher (F.R) was consulted to reach a consensus. for quality assessment of studies reporting prevalence data [21]. This
checklist consists of 9 various items, including sample frame, partici­
2.1. Identification of studies pants, sample size, study subjects and setting described in detail, data
analysis, valid methods for identifying conditions, measure the situa­
A systematic literature review was conducted in the Persian data­ tion, statistical analysis, and response rate adequate. The responses of
bases of SID (https://www.sid.ir) and MagIran (https://www.magiran. “Yes” for pointed, “No” for not pointed, and “Not applicable” for not
com) and the English databases of PubMed, Embase, Scopus, and Web reported are applied for scoring. The total score range based on the
of Science (WoS) to identify relevant articles using related MeSH/ number of “Yes” is between 0 and 9.
Emtree and Free Text words. For example, the PubMed search strategy
was defined as follows: 2.6. Data extraction
(((((Epidemiology[Title/Abstract]) OR (Epidemiology[MeSH
Terms])) OR (Prevalence[MeSH Terms])) OR (Prevalen*[Title/Ab­ The data were manually extracted from all articles included in the
stract])) AND (((((((((((((((Stroke[MeSH Terms]) OR (Stroke*[Title/ systematic review and meta-analysis using a pre-prepared checklist. The
Abstract])) OR (“Cerebrovascular Accident”[Title/Abstract])) OR (“Ce­ items of this checklist included the name of first author, year of publi­
rebrovascular Accidents”[Title/Abstract])) OR (“CVA (Cerebrovascular cation, country and continent, sample size, age, study design, type of
Accident)”[Title/Abstract])) OR (“CVAs (Cerebrovascular Acci­ diagnostic tools, prevalence rate, and quality assessment score.
dent)”[Title/Abstract])) OR (“Vascular Accident, Brain”[Title/Ab­
stract])) OR (“Brain Vascular Accident”[Title/Abstract])) OR (“Brain 2.7. Statistical analysis
Vascular Accidents”[Title/Abstract])) OR (“Vascular Accidents,
Brain”[Title/Abstract])) OR (Apoplexy[Title/Abstract])) OR (“Cere­ The present study estimated the prevalence rate of stroke in the
brovascular Accident, Acute”[Title/Abstract])) OR (“Acute Cerebro­ elderly and the rate or relative frequency of stoke in each study was
vascular Accident”[Title/Abstract])) OR (“Acute Cerebrovascular employed to combine the results of different studies. Heterogeneity
Accidents”[Title/Abstract])) OR (“Cerebrovascular Accidents, Acute”[­ among studies was checked using I2 index and considering the high
Title/Abstract]))) AND (((((Elderly[Title/Abstract]) OR (Old*[Title/ heterogeneity between the results of the studies included in the meta-
Abstract])) OR (Geriat*[Title/Abstract])) OR (Elderlys[Title/Ab­ analysis (I2 ˃ 75 %), the random effects model was used, which calcu­
stract])) OR (Elderlies[Title/Abstract])) lates the parameter changes between studies. Therefore, the results of
No time and language limitation were considered for the search to random effects model in heterogeneous conditions are more generaliz­
retrieve as comprehensive as possible relevant studies. The Google able than those of fixed effect model. Funnel plot and Egger’s regression
Scholar motor engine and references of all eligible articles were manu­ intercept were used to assess the publication bias. Further, the meta-
ally reviewed to maximize the comprehensiveness of the search. regression was applied to examine the relationship between the preva­
lence rate of stroke in the elderly and sample size, year of publication,
and mean age of elderly. The subgroup analysis was performed based on
the different continents (Africa, America, Asia, and Europe) and gender

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F. Rajati et al. Interdisciplinary Neurosurgery: Advanced Techniques and Case Management 32 (2023) 101746

(Male and Female). The comprehensive meta-analysis software (version 3.3. Meta-analysis of the overall prevalence of stroke in elderly
2) was used for meta-analysis and P-value <0.05 was considered as
statistically significant. Considering that the result of I2 test for the overall prevalence of
stroke in the elderly demonstrated a significant heterogeneity among
3. Results studies (I2 = 99.65), the data were analyzed using a random effects
model (Table 2). The results of Egger’s regression intercept revealed no
3.1. The summary of how articles included in the meta-analysis publication bias in the studies at the level of 0.1 (P = 0.465) (Fig. 2).
After combining the results of studies included in the meta-analysis, the
The initial systematic literature search retrieved 13,562 articles and overall prevalence of stroke in the elderly was estimated to be 7.4 % (95
21 articles were identified through manual search. After excluding 5126 % CI: 6.2 %-8.9 %) based on the random effects model. The black square
duplicates and studies with overlapping data via EndNote, 8362 irrele­ illustrates the prevalence rate, the length of the line segment displays the
vant studies were eliminated by screening the title and abstract. Then, 95 % CI in each study, and the rhombus symbol indicates the overall
the full text of the remaining 95 studies were inspected carefully and 59 prevalence rate of stroke in the elderly (Fig. 3). The results of sensitivity
articles were eliminated, due to not fulfilling the eligibility criteria. analysis demonstrated that the pooled estimation did not change
Finally, 36 articles were included in the meta-analysis after quality significantly by eliminating each of the studies (Fig. 4).
assessment. Fig. 1 indicates the PRISMA 2020 flow diagram (Fig. 1).
4. The meta-regression of the prevalence rate of stroke in the
3.2. General characteristics of the studies elderly

The total sample size of all studies included in the meta-analysis was The correlation between the sample size (Fig. 5), year of the publi­
1,005,441 subjects. The maximum and minimum sample size were cation (Fig. 6), and mean age (Fig. 7) and the prevalence of stroke in the
related to the study of Cerasuolo et al. [22] with 654,460 subjects [22] elderly was evaluated using meta-regression. The results indicated a
and the study of Olindo et al. [23] with 95 subjects [23], respectively. significant correlation between these potential factors and the preva­
The oldest study was done in 1996 and the most recent study in 2021. A lence rate of stroke in the elderly (P < 0.001). The prevalence of stroke
large number of studies were conducted in the USA with eight articles. in the elderly decreased by increasing sample size and year of the pub­
Table 1 indicates the characteristics and data of studies included in the lication, and enhanced by increasing mean age (Figs. 5-7).
systematic review and meta-analysis (Table 1).

4.1. Subgroup analysis

Given the high heterogeneity among the studies (I2 = 99.65),

Fig. 1. PRISMA 2020 search flow diagram.

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Table 1
The characteristics and data of studies included in the systematic review and meta-analysis.
First Author, Year Country Sample size (n) Age Type of study Diagnostic tool Prevalence)%( Quality
(Reference) (Continent) Total Male Female (year) Total Male Female score

Díaz-Guzmán, 2008 Spain 5278 3251 2027 75.6 Population-based A 500-item screening 4.9 5.5 4.5 8
[24] (Europe) questionnaire
Hörnsten, 2016 Sweden 6098 3382 2716 70.3 ± Population-based A postal mail survey 7.0 7.2 6.6 8
[15] (Europe) 5.4
Mukhopadhyay, India (Asia) 1726 730 996 ≥ 65 Population-based WHO Screening 3.82 4.5 3.3 5
2012 [25] Questionnaire
Boix, 2006 [26] Spain 10,647 3983 6664 ≥ 70 Population-based Screening 6.4 7.3 5.6 6
(Europe) questionnaire
Xia, 2019 [18] China (Asia) 144,722 65,429 79,293 66.7 Population-based WHO Screening 4.94 5.67 4.25 7
Questionnaire
Orlandi, 2003 [27] Italy 2260 1004 1256 75.4 ± Cross-sectional Screening 6.4 8.2 5.1 5
(Europe) 7.2 study questionnaire
Ness-1, 1999 [28] USA 1802 474 1328 80 ± 9 Population-based Screening 13.0 – – 5
(America) questionnaire
Jin, 2006 [29] USA 2914 – – 72.0 Cross-sectional Physical examination 8.0 – – 5
(America) study
Viriyavejakul, 1998 Thailand 3036 – – ≥ 65 Cross-sectional Physical examination 1.12 – – 6
[30] (Asia) study
Zhang, 2014 [19] China (Asia) 4629 1917 2712 ≥ 70 Cross-sectional Screening 5.5 6.3 4.9 6
study questionnaire
Ness-2, 1999 [31] USA 1802 474 1328 79 ± 9 Cross-sectional Screening 19.5 24.5 17.7 5
(America) study questionnaire
Liu, 2005 [32] China (Asia) 2481 – – ≥ 65 Cross-sectional CT/MRI 12.9 – – 6
study
Dalal, 1997 [33] USA 4547 – – ≥ 65 Cross-sectional Physical examination 15.0 – – 5
(America) study
Saposnik, 2009 Canada 26,676 16,655 10,021 ≥ 70 Multicenter cohort Canadian Hospital 7.6 – – 7
[34] (America) study Morbidity database
(HMDB)
Press, 1996 [35] USA 618 278 340 68 ± 9 Cross-sectional Physical examination 18.77 28.77 10.58 5
(America) study
Costa, 2014 [36] Brazil 454 152 241 69.2 ± Cross-sectional Screening 8.1 – – 6
(America) 6.2 study questionnaire
Jin, 2010 [16] USA 1659 749 910 ≥ 65 Population-based Screening 38.0 – – 6
(America) questionnaire
Olindo, 2003 [23] France 95 – – 88.8 ± Cross-sectional Screening 8.4 – – 6
(Europe) 6.3 study questionnaire
Pereira, 2009 [37] Brazil 4207 2103 2104 ≥ 60 Cross-sectional Screening 2.9 3.2 2.7 8
(America) study questionnaire
Ness, 2000 [38] USA 1911 467 1444 79 ± 8 Retrospective Screening 6.6 – – 6
(America) questionnaire
Lubart, 2005 [39] Israel (Asia) 140 51 89 78 ± 8 Cross-sectional Physical examination 22.8 17.6 25.8 7
study
Navis, 2019 [40] Israel (Asia) 487 – – ≥ 80 Retrospective Screening 12.0 – – 7
questionnaire
Liu, 2021 [17] China (Asia) 18,724 9606 9118 68.98 Population-based Screening 10.82 10.88 10.73 9
± 9.12 questionnaire
Hornsten, 2012 Sweden 601 178 423 79.6 Population-based Screening 21.5 21.9 21.2 8
[41] (Europe) questionnaire
Looman, 1996 [42] USA 4982 1878 3104 ≥ 65 Population-based Screening 4.7 5.8 4.0 5
(America) prospective follow- questionnaire
up study
Bermejo, 1997 [43] Spain 1259 – – ≥ 65 Cross-sectional Screening 7.5 – – 5
(Europe) study questionnaire
Pengpid, 2021 [44] India (Asia) 31,477 16,371 15,106 ≥ 65 Cross-sectional Physical examination 2.7 – – 8
study
Liebetrau, 2003 Sweden 494 143 351 88.9 Cross-sectional Screening 18.8 16.8 19.7 6
[45] (Europe) study questionnaire
Sanuade, 2019 [46] Ghana 4279 2043 2236 ≥70 Cross-sectional WHO Screening 2.6 – – 8
(Africa) study Questionnaire
Cerasuolo, 2019 Canada 654,460 397,280 257,180 ≥80 Population-based Screening 4.5 4.2 5.1 6
[22] (America) questionnaire
Gan, 2017 [47] China (Asia) 765 – – ≥70 Community-based Screening 6.27 – – 7
cross-sectional questionnaire
The, 2018 [48] Singapore 2565 1118 1447 69.9 ± Cross-sectional Screening 7.6 8 7.3 8
(Asia) 7.8 study questionnaire
Zhang, 2017 [49] China (Asia) 20,525 8062 12,463 ≥65 Population-based Screening 1.37 1.06 1.87 8
questionnaire
Zhang, 2016 [50] China (Asia) 19,145 6732 12,413 ≥65 Cross-sectional Screening 3.3 4.8 2.5 7
study questionnaire
de Jesús, 2010 [51] Cuba 2944 1031 1913 ≥65 Population-based Screening 7.8 9.5 7.0 8
(America) questionnaire
Ferri-1, 2011 [52] India (Asia) 2004 1292 712 ≥65 1.9 – – 8
(continued on next page)

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Table 1 (continued )
First Author, Year Country Sample size (n) Age Type of study Diagnostic tool Prevalence)%( Quality
(Reference) (Continent) Total Male Female (year) Total Male Female score

Cross-sectional Screening
study questionnaire
Ferri-2, 2011 [52] China (Asia) 2162 945 1217 ≥65 Cross-sectional Screening 1.6 – – 8
study questionnaire
Ferri-3, 2011 [52] Latin 10,856 3882 6974 ≥65 Cross-sectional Screening 6.5 – – 8
America study questionnaire

Table 2
The report of the results of fixed and random effects model on meta-analysis.
Model Number Point Lower Upper Z-value P- Q-value df P- I2 (%) Tau Standard Variance Tau
studies estimate limit limit value (Q) value squared Error

Fixed 36 0.052 0.052 0.053 − 623.183 0.000 10689.89 35 0.000 99.654 0.379 0.275 0.076 0.616
Random 36 0.074 0.062 0.089 − 24.884 0.000

Fig. 2. The funnel plot of the results of the overall estimate of the prevalence rate of stroke in the elderly.

subgroup analysis was reported based on the different continents (Af­ most common type stroke. Second, hypertension can cause cerebral
rica, America, Asia, and Europe) and gender (male and female) arteries to rupture, blocking blood flow to the brain, and this type of
(Table 3). The results of the subgroup analysis illustrated that the stroke in the elderly is called hemorrhagic. Although hemorrhagic stroke
highest prevalence rate of stroke in the elderly was related to the USA occurs rarely, its damage is greater than ischemic stroke [6,53].
continent with 9.4 % (95 % CI: 6.5–13.4 %) and male with 7.0 % (95 % The prevalence of stroke was reported 4.6 % in the public population
CI: 5.7–8.6 %) (Table 3). in the late twentieth century [54], 4.42–5.59 % in India [55], and 3.17
% in Africa [56]. According to the systematic review and meta-analysis
5. Discussion studies, the prevalence rate of stroke in the elderly population is higher
than that in the public population. The difference in the prevalence rate
The present study aimed at estimating the prevalence of stroke in the of stroke in the aforementioned studies and the present study is attrib­
elderly using systematic review and meta-analysis. After combining the uted to some reasons, such as the differences in the structure of the study
data collected from 36 articles included in the meta-analysis with a population, comorbidities, sample size, number of studies included,
sample size of more than one million people, the overall prevalence of physiological changes occurring in the body with age, etc.
stroke in the elderly was estimated to be 7.4 %. The highest prevalence The meta-regression results of the present study demonstrated that
rate was related to the study of Gan et al. with 62.7 % [47] and the the prevalence of stroke enhances with age. The higher prevalence of
lowest was related to the study of Viriyavejakul with 1.12 % [30]. The stroke in the elderly is due to the overweight [57], smoking [58,59],
highest quality assessment score based on the JBI checklist was related stress [60], lack of mobility and activity [61], hypertension [62],
to the study of Liu et al. with a score of 9, which reported the prevalence excessive consumption of alcoholic beverages and coffee [63], insuffi­
of stroke in the elderly as 10.8 % [17]. cient sleep and sleep disorders [64], excessive use of salt in the diet [65],
The interruption of blood flow to the cerebral arteries can be caused low consumption of fruits and vegetables [66], high blood cholesterol
by two reasons: First, thickening and blockage of cerebral arteries by [8], and some diseases, such as diabetes [67] and kidney problems [68].
cholesterol, fat, and calcium can lead to blood clots due to the narrowing Therefore, it seems necessary for health officials and policy makers to
of the arteries. A blood clot that forms in the heart travels to the brain, take measures to lose weight, provide proper diet, increase physical
preventing blood supply to the brain. Ischemic stroke is known as the activities, and prevent diabetes and hypertension in the elderly.

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Fig. 3. The forest plot of the overall estimate of the prevalence rate of stroke in the elderly based on the random effects model.

Due to the changes in population structure, culture, race, diet, in developing vascular disease [69]. Other reasons for the difference in
mobility and physical activity, genetics, stress, anxiety, type of diag­ the prevalence of stroke in the population of male and female can be
nostic tools, etc. in different countries and geographical areas, a sub­ attributed to the differences in lifestyle [70], smoking [71,72], hyper­
group analysis was performed based on the different continents. The lipidemia [73], insulin resistance [74,75], obesity [76], diabetes [77],
highest prevalence of stroke was reported in the American elderly and hypertension [78,79], etc.
then in the European elderly. The high prevalence of stroke in the elderly population as well as its
Based on the results of subgroup analysis, the prevalence of stroke is increasing rate with the mean age (Fig. 7) in the present systematic re­
higher in male than in female. In general, vascular disease is more view and meta-analysis study indicated the need for further investiga­
common among male than female, and male is considered as a risk factor tion and follow-up of stroke. Stroke is considered as one of the most

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Fig. 4. The sensitivity analysis chart of the overall prevalence rate of stroke in the elderly.

important health problems for people and will lead to important health 6. Limitations
consequences, such as death, disability, and higher economic costs. The
need to adopt policies and strategies focused on reducing and control­ Although the process of systematic literature review and meta-
ling risk factors can reduce the health and economic burden of disease in analysis is regarded as a practical way to generate a more powerful es­
society in the long run. However, identifying more at-risk populations timate of true-effect size with less random error compared to the indi­
and providing effective, quality periodic medical care can slow the vidual studies, it does come with some limitations. One of the limitations
progression of the disease and reduce the complications and death of the present study was the small number of studies conducted in the
caused by stroke. continents of Africa and Australia. Thus, it is suggested to conduct
further studies with larger sample size in different countries of these

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Fig. 5. The meta-regression of the correlation between sample size and the prevalence of stroke in the elderly.

Fig. 6. The meta-regression of the correlation between the year of the publication and the prevalence of stroke in the elderly.

Fig. 7. The meta-regression of the correlation between the mean age and the global prevalence of stroke in the elderly.

continents to better clarify the prevalence rate of stroke in the elderly in keywords, the possibility of the lack of access to all articles and un­
these continents. Other limitations of the present study include inability published reports, lack of uniform reporting of articles, non-random
of Persian databases of SID and MagIran to search for a combination of selection of some samples, non-uniform study design, and lack of

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Table 3
The subgroup analysis of estimating the prevalence rate of stroke in the elderly by continents and gender.
Subgroups Number Point estimate Lower limit Upper limit Z-value P- P-value I2 (%) Tau Begg and Mazumdar
Studies value between

Continents Africa 1 0.026 0.022 0.031 − 37.700 0.000 0.000 0.000 0.000 –
America 14 0.094 0.065 0.134 − 11.171 0.000 99.75 0.755 0.356
Asia 15 0.057 0.038 0.085 − 12.925 0.000 99.71 0.831 0.287
Europe 8 0.089 0.065 0.121 − 13.191 0.000 97.70 0.480 0.456
Gender Male 20 0.070 0.057 0.086 − 22.840 0.000 0.004 99.18 0.483 0.495
Female 20 0.064 0.053 0.078 − 25.868 0.000 99.04 0.450 0.455

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(50001347). stroke history reliably reported by elderly with cognitive impairment? A
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Not applicable. influencing factors of stroke in elderly hypertensive patients: Based on the
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by the Student Research Committee of Kermanshah University of Med­ (1) (2019) 105–107.
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