Key result
High altitude shows no association with stroke incidence compared to low altitude in Peru.
Why the study?
The association between altitude and stroke remains debated in high-altitude countries.
Does altitude gradient affect the incidence rate of stroke in adults in Peru?
Does altitude gradient affect the incidence rate of stroke in adults in Peru?
Stroke burden in Peru shows no significant differences across altitude gradients, suggesting that geographic heterogeneity is likely driven by disparities in healthcare access and vascular risk control rather than altitude alone.
No altitude gradient in Peruvian stroke incidence; hypothesis-generating for healthcare access as primary driver of disparities.
Background: The association between altitude and stroke remains debated in high-altitude countries. Peru’s diverse geography provides a natural setting to explore these patterns. Objective: To characterize stroke burden across altitude gradients in Peru (2020–2024). Methods: Nationwide ecological analysis of adults (≥18 years) with stroke (ICD-10 I60–I64) from SUSALUD. Departmental incidence rates per 100,000 inhabitants were calculated using INEI population data. Population-weighted average altitude was derived for each department. Rates were compared across altitude categories (<500, 500–2499, ≥2500 m) with Kruskal–Wallis tests, and associations with continuous altitude were explored via linear and Poisson regression. Geographic distribution by subtype and healthcare sector was mapped. Results: We identified 9,069 stroke cases. Most occurred in ≥65 years (63.9%) and in males (53.2%). Ischemic stroke was most common (24.6%), followed by hemorrhagic (22.1%), subarachnoid (18.4%), and unspecified (36.5%). The cumulative national rate was 5.7/100,000 (2020–2024). Mean rates: low altitude 8.3, medium 4.8, high 5.2 per 100,000. Differences across categories were not significant (χ 2 = 1.46, p = 0.48). Linear regression suggested a weak, non-significant negative association (β per 1000 m = –0.8, p = 0.15, R 2 = 0.05). Outliers included Callao, San Martín, and Lima. Government hospitals contributed 31.1% of cases, ESSALUD 26.2%, and MINSA 23.8%. Conclusions: Stroke burden in Peru shows no significant differences across altitude gradients. Geographic heterogeneity likely reflects disparities in healthcare access, diagnostic capacity, and vascular risk control rather than altitude alone.
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Váscones-Román et al. (2026) studied this question. Stroke burden in Peru shows no significant differences across altitude gradients, with a national incidence rate of 5.7 per 100,000 from 2020 to 2024.
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