Supplementary Material for: Adherence to Antithrombotic Treatment and Ischemic Stroke Recurrence in Egypt and Germany: A Comparative Analysis

<b><i>Background:</i></b> The burden of stroke weighs heavily in developing countries where recurrence rates clearly exceed that of developed countries. The impact of nonadherence to antithrombotic treatment within this context has been poorly investigated. <b><i>Objective:</i></b> The objective of this study was to evaluate patients with recurrent ischemic stroke in Egypt and Germany with focus on stroke subtype distribution and adherence to antithrombotic therapy. <b><i>Methods:</i></b> We conducted a comparative cross-sectional retrospective cohort study enrolling consecutive patients hospitalized for recurrent ischemic stroke in 2017 in 2 academic centers. Data were collected on demographics, risk factors, stroke subtypes, and medication adherence. Nonadherence to antithrombotic agents was analyzed at the time point of index stroke (recurrent stroke). Predictors of nonadherence were analyzed using logistic regression. <b><i>Results:</i></b> A total of 373 Egyptian and 468 German patients with ischemic stroke were included. The proportion of recurrent ischemic stroke among all patients was higher in the Egyptian cohort compared to the German cohort (33 vs. 10%, <i>p</i> &lt; 0.05). Small-vessel occlusion stroke was the most frequent subtype in Egyptians, with a significantly greater proportion than in Germans (45 vs. 26%, <i>p</i> &lt; 0.05). Nonadherence to antiplatelets at the time point of the recurrent stroke was higher in Egyptians than in Germans (82 vs. 19%, <i>p</i> &lt; 0.001). Low educational attainment among Egyptians (OR 0.14, 95% CI [0.00–0.19], <i>p</i> &lt; 0.01) and high comorbidity scores among Germans (OR 2.45, 95% CI [1.06–5.66], <i>p</i> &lt; 0.05) were found to be predictors of nonadherence to antithrombotic treatment. <b><i>Conclusions:</i></b> The large stroke recurrence burden in Egypt may be partly explained by differing adherence to secondary preventative antithrombotic pharmacotherapy. Predictors of medication nonadherence have to be addressed to reduce stroke recurrence disparities.

<b><i>背景：</i></b> 卒中负担在复发率显著高于发达国家的发展中国家尤为沉重。在此类环境下，抗血栓治疗（antithrombotic treatment）不依从的相关影响尚未得到充分研究。<b><i>目的：</i></b> 本研究旨在评估埃及与德国的复发性缺血性脑卒中（ischemic stroke）患者，重点关注卒中亚型分布及抗血栓治疗依从性情况。<b><i>方法：</i></b> 本研究为对比性回顾性横断面队列研究（cross-sectional retrospective cohort study），纳入2017年于两家学术医疗中心因复发性缺血性脑卒中住院的连续入组患者。收集人口统计学特征、危险因素、卒中亚型及药物治疗依从性相关数据。以索引卒中（index stroke，即复发卒中）时点为节点，对抗血栓药物（antithrombotic agents）不依从情况进行分析。采用逻辑回归（logistic regression）模型分析抗血栓治疗不依从的预测因素。<b><i>结果：</i></b> 本研究共纳入373例埃及患者与468例德国缺血性脑卒中患者。埃及队列的复发性缺血性脑卒中占比显著高于德国队列（33% vs. 10%，<i>p</i> < 0.05）。小血管闭塞性卒中为埃及患者最常见的卒中亚型，占比显著高于德国患者（45% vs. 26%，<i>p</i> < 0.05）。复发卒中时点的抗血小板药物（antiplatelets）不依从率，埃及患者亦显著高于德国患者（82% vs. 19%，<i>p</i> < 0.001）。分析显示，埃及人群中低文化程度（优势比（odds ratio, OR）=0.14，95%置信区间（confidence interval, CI）[0.00–0.19]，<i>p</i> < 0.01）与德国人群中高共病评分（comorbidity scores）（OR=2.45，95%CI[1.06–5.66]，<i>p</i> < 0.05）为抗血栓治疗不依从的预测因素。<b><i>结论：</i></b> 埃及地区较高的卒中复发负担，可部分归因于二级预防抗血栓药物治疗依从性的国别差异。需针对药物不依从的相关预测因素开展干预，以降低卒中复发的健康差距。