Risk factors for ischemic stroke in the elderly in Morocco – a case-control study
DOI:
https://doi.org/10.15584/ejcem.2025.2.19Keywords:
aged, schemic stroke, Morocco, risk factorsAbstract
Introduction and aim. Ischemic strokes occur most frequently in the elderly (more than 80%). This study aimed to determine the risk factors for ischemic stroke in elderly subjects in the Souss Massa region of southern Morocco.
Material and methods. Two hundred and thirteen cases and four hundred and thirty-two controls of the same age (76.51±2 years vs. 73.90±2 years) and sex were collected. Cases were selected from patients with ischemic stroke hospitalized in the neurology department of the regional hospital Souss Massa. All risk factors have been documented from interviews and review of patient medical records.
Results. Multivariate regression analysis showed that low-income families (odds ratios [OR]=4.19, 95% confidence intervals [95% CI] 2.886–6.09, p<0.001), residence area (urban OR=9.408, 95% CI 4.7133–18.778, p<0.001), high blood pressure (OR=62.984, 95% CI 26.7374–148.367, p<0.001), diabetes (OR=18.138, 95% CI 5.2320–62.880, p<0.001), are risk factors for ischemic stroke. On the contrary, health insurance (OR=0.295, 95% CI 0.1513–0.577, p<0.001) and marital status (in couple OR=0.448, 95% CI 0.284–0.708, p<0.001) are protective factors.
Conclusion. In addition to traditional risk factors of ischemic strokes such as high blood pressure and diabetes, low-income family as well as lack of health insurance and marital status (living with a partner) require particular attention. Integrating these new factors into public health strategies could significantly reduce the risk of stroke in the elderly.
Downloads
References
Johnson W, Onuma O, Owolabi M, Sachdev S. Stroke: a global response is needed. Bull World Health Organ. 2016;94(9):634. doi: 10.2471/BLT.16.181636
Chen RL, Balami JS, Esiri MM, Chen LK, Buchan AM. Ischemic stroke in the elderly: an overview of evidence. Nat Rev Neurol. 2010;6(5):256-265. doi: 10.1038/nrneurol.2010.36
Owolabi MO, Arulogun O, Melikam S, et al. The burden of stroke in Africa: a glance at the present and a glimpse into the future. Cardiovasc J Afr. 2015;26(2 H3Africa Sup-pl):S27. doi: 10.5830/CVJA-2015-038
Honjo K, Iso H, Ikeda A, et al. Marital transition and risk of stroke: how living arrangement and employment status modify associations. Stroke. 2016;47(4):991-998. doi: 10.1161/STROKEAHA.115.011926
Ranta A, Ozturk S, Wasay M, Giroud M, Béjot Y, Reis J. Environmental factors and stroke: Risk and prevention. J Neurol Sci. 2023:120860. doi: 10.1016/j.jns.2023.120860
Benamer HT, Grosset D. Stroke in Arab countries: a systematic literature review. J Neurol Sci. 2009;284(1-2):18-23. doi: 10.1016/j.jns.2009.04.029
Lin HC, Lin YJ, Liu TC, Chen CS, Chiu WT. Urbanization and stroke prevalence in Taiwan: analysis of a nationwide survey. J Urban Health. 2007;84:604-614. doi: 10.1007/s11524-007-9195-1
Beard JR, Officer AM, Cassels AK. The world report on ageing and health. The Gerontologist. 2016;56(2):S163-S166. doi: 10.1093/geront/gnw037
Simmatis LE, Scott SH, Jin AY. The impact of transient ischemic attack (TIA) on brain and behavior. Front Behav Neurosci. 2019;13:44. doi: 10.3389/fnbeh.2019.00044
Allen CL, Bayraktutan U. Risk factors for ischaemic stroke. Int J Stroke. 2008;3(2):105-116. doi: 10.1111/j.1747-4949.2008.00187.x
Estruch R, Ros E, Salas-Salvadó J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013;368(14):1279-1290. doi: 10.1056/NEJMoa1200303
Tsivgoulis G, Psaltopoulou T, Wadley VG, et al. Adherence to a Mediterranean diet and prediction of incident stroke. Stroke. 2015;46(3):780-785. doi: 10.1161/STROKEAHA.114.007894
Brosius III FC, Hostetter TH, Kelepouris E, et al. Detection of chronic kidney disease in patients with or at increased risk of cardiovascular disease: a science advisory from the American Heart Association Kidney And Cardiovascular Disease Council; the Councils on High Blood Pressure Research, Cardiovascular Disease in the Young, and Epidemiology and Prevention; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: developed in collaboration with the National Kidney Foundation. Circulation. 2006;114(10):1083-1087. doi: 10.1161/CIRCULATIONAHA.106.177321
Look AHEAD Research Group. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369(2):145-154. doi:10.1056/NEJMoa1212914
Mandić M, Rančić N. Risk factors for stroke. Med Pregl. 2011;64(11-12):600-605. doi: 10.2298/MPNS1112600M.
Allali F. Evolution of food practices in Morocco. Int J Med Surg. 2017;4:70-73. doi: 10.15342/ijms.v4is.145
Kharbach A, Obtel M, Lahlou L, Aasfara J, Mekaoui N, Razine R. Ischemic stroke in Morocco: a systematic review. BMC Neurol. 2019;19:1-15. doi: 10.1186/s12883-019-1558-1
Mensah GA. Epidemiology of stroke and high blood pressure in Africa. Heart. 2008;94(6):697-705. doi: 10.1136/hrt.2007.127753
El-Hajj M, Salameh P, Rachidi S, Hosseini H. The epidemiology of stroke in the Middle East. Eur Stroke J. 2016;1(3):180-198. doi: 10.1177/2396987316654338
Khan FY. Risk factors of young ischemic stroke in Qatar. Clin Neurol Neurosurg. 2007;109(9):770-773.
Mziwira M, Ahaji A, Naciri K, Belahsen R. Socio-economic characteristics, health status and access to health care in an elderly Moroccan community: study of the gender factor. Rocz Państw Zakładu Hig. 2022;73(3):341-349. doi: 10.32394/rpzh.2022.0224
Freyssenge J, Florent R, Schott AM, El Khoury C, Tazarourte K. Stroke: characterizing distribution inequalities in the Rhône Valley using geographic tools. Collège international des sciences territoriales (CIST). 2020:90-93.
Ljungman PL, Mittleman MA. Ambient air pollution and stroke. Stroke. 2014;45(12):3734-3741. doi: 10.1161/STROKEAHA.114.003130
Von Bornstädt D, Kunz A, Endres M. Impact of particulate matter exposition on the risk of ischemic stroke: epidemiologic evidence and putative mechanisms. J Cereb Blood Flow Metab. 2014;34(2):215-220. doi: 10.1038/jcbfm.2013.212
Everson-Rose SA, Roetker NS, Lutsey PL, et al. Chronic stress, depressive symptoms, anger, hostility, and risk of stroke and transient ischemic attack in the multi-ethnic study of atherosclerosis. Stroke. 2014;45(8):2318-2323. doi: 10.1161/STROKEAHA.114.004815
Henderson KM, Clark CJ, Lewis TT, et al. Psychosocial distress and stroke risk in older adults. Stroke. 2013;44(2):367-372. doi: 10.1161/STROKEAHA.112.679159
Kono Y, Terasawa Y, Sakai K, et al. Association between living conditions and the risk factors, etiology, and outcome of ischemic stroke in young adults. Intern Med. 2023;62(19):2813-2820. doi: 10.2169/internalmedicine.0912-22
Liu Q, Wang X, Wang Y, et al. Association between marriage and outcomes in patients with acute ischemic stroke. J Neurol. 2018;265:942-948. doi: 10.1007/s00415-018-8793-z
Ferrié JN, Omary Z, Serhan O. The Medical Assistance Scheme (RAMed) in Morocco: the misfortunes of voluntarism and opportunism. Rev Fr Aff Soc. 2018;(1):125-143.
Medford‐Davis LN, Fonarow GC, Bhatt DL, et al. Impact of insurance status on outcomes and use of Rehabilitation Services in acute ischemic stroke: findings from get with the guidelines‐stroke. J Am Heart Assoc. 2016;5(11):e004282. doi: 10.1161/JAHA.116.004282
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 European Journal of Clinical and Experimental Medicine

This work is licensed under a Creative Commons Attribution 4.0 International License.
Our open access policy is in accordance with the Budapest Open Access Initiative (BOAI) definition: this means that articles have free availability on the public Internet, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of these articles, crawl them for indexing, pass them as data to software, or use them for any other lawful purpose, without financial, legal, or technical barriers other than those inseparable from having access to the Internet itself.
All articles are published with free open access under the CC-BY Creative Commons attribution license (the current version is CC-BY, version 4.0). If you submit your paper for publication by the Eur J Clin Exp Med, you agree to have the CC-BY license applied to your work. Under this Open Access license, you, as the author, agree that anyone may download and read the paper for free. In addition, the article may be reused and quoted provided that the original published version is cited. This facilitates freedom in re-use and also ensures that Eur J Clin Exp Med content can be mined without barriers for the research needs.




