<b>Prevalence and Risk Factors of First-Time Stroke in Swat, Pakistan: A Hospital-Based Observational Study</b>

Abstract Background: Stroke is a leading cause of mortality and disability in low- and middle-income countries (LMICs), with Pakistan facing a 100% increase in incidence since 1990. Community-specific risk factors in rural regions like Swat remain underexplored, hindering targeted prevention. Methods: This prospective observational study (January–December 2021) at King Hospital (private) and Saidu Sharif Hospital (public) in Swat, Pakistan, enrolled 150 patients with first-time stroke, confirmed by MRI or CT. Data on demographics, stroke types (ischemic [IS], intracerebral hemorrhage [ICH], subarachnoid hemorrhage [SAH]), Radiation risk factors were collected and analyzed using descriptive statistics and chi-square tests (p&lt;0.05) in SPSS v.22. Results: Of 150 patients (63.3% male, mean age 65.3±2.3 years), 81.3% had IS, 16.7% ICH, and 2.0% SAH. Hypertension (HTN) was the most prevalent risk factor (86.7%), followed by diabetes mellitus (DM, 64.7%), ischemic heart disease (IHD, 42.7%), atrial fibrillation (AF, 15.3%), and smoking (9.3%). No significant associations were found between stroke types and risk factors (p&gt;0.05). Conclusions: HTN, DM, and IHD are predominant risk factors for first-time stroke in Swat, with IS being the most common type. Community-based screening and prevention programs are urgently needed to address this burden. Keywords: Stroke, ischemic stroke, hemorrhagic stroke, risk factors, Pakistan, rural health