Integrated analysis of the prevalence and influencing factors of poststroke dysphagia

Objectives: Poststroke dysphagia (PSD) is a common complication after stroke but there is limited information on its global prevalence and influencing factors, such as spatial, temporal, demographic characteristics, and stroke-related factors. Our study seeks to fill this knowledge gap by exploring the overall prevalence of PSD and its influencing factors.

Methods: A search of English-language literature from database inception from 2005 until May 2022 was performed using PubMed, Embase, Web of Science, Cochrane Library, and Scopus. We used the Joanna Briggs Institute Critical Appraisal Instrument to estimate study quality and calculated the pooled prevalence of PSD with a 95% confidence interval (CI) using an inverse-variance weighted random-effects meta-analysis. A subgroup analysis was performed to identify sources of heterogeneity, and the relationship between PSD and various clinical features was examined using binary logistic regression.

Results: Among 95 studies of 1,059,969 patients, the overall pooled estimated prevalence of PSD was 38.57% (95% CI 35.45-41.69%). Subgroup analysis reveals that South America has the highest prevalence of PSD at 52.30% (95% CI 41.15-63.46%). In rehabilitation units, this rate is 42.42% (95% CI 34.20-50.64%). Women are notably affected, with a prevalence of 41.17% (95% CI 36.97-45.36%) and a higher risk (OR: 1.376, 95% CI 1.315-1.439) than men. Individuals over 65 years exhibit a higher prevalence of 40.26% (95% CI 35.68-44.84%). Fiberoptic endoscopic evaluation of swallowing test shows a striking prevalence of 64.27% (95% CI 55.72-72.81%), and Video fluoroscopic Swallowing Study is 46.93% (95% CI 41.99-51.87%). The the Speech Language Physiotherapist group accounts for 41.36% (95% CI 36.61-46.11%), and a positive correlation between the prevalence of PSD and the NIHSS score. The prevalence of PSD is higher in non-acute strokes, the hemorrhagic strokes, right hemisphere strokes, as well as in the cardioembolism group and the total anterior circulation syndrome (TACS) group. Hemorrhagic strokes [OR: 2.111 (95% CI 1.781-2.503)], the CARDIOEMBOLISM GROUP [OR: 1.531 (95% CI 1.381-1.698)], and TACS group [OR: 2.895 (95% CI 1.495-5.607)] were associated with higher risk of PSD.

Conclusions: We found that various factors, including spatial, temporal, demographic characteristics, and stroke-related factors, all influence the prevalence of PSD. More high-quality epidemiological research is needed to explore the links between PSD, demographic characteristics, and stroke-related factors. Caution is advised when interpreting our study results due to the included studies' heterogeneity.