Epidemiological Burden, Modifiable Risk Factors, and Health System Challenges of Ischemic Stroke in Indonesia: A Systematic Review
DOI:
https://doi.org/10.69606/jps.v4i03.535Keywords:
ischemic stroke, epidemiology, modifiable risk factors, health system, INA-CBGs, IndonesiaAbstract
Background: Ischemic stroke is a major cause of mortality and disability in Indonesia. This immense burden reflects complex interactions between population-level risk factors, delayed prehospital care-seeking behavior, and structural health-system limitations under the national health insurance (JKN) scheme. Aims: To systematically review the epidemiological burden, primary modifiable risk factors, and health-system and financing challenges of ischemic stroke in Indonesia. Methods: Guided by the PRISMA 2020 framework, literature from major databases (PubMed, Scopus, Garuda, Google Scholar) and official health reports published through December 2025 was searched. Thirty eligible Indonesia-specific studies were narratively synthesized across three domains: epidemiological burden, risk factors, and health-system challenges; an additional 15 international and global studies were separately reviewed as comparator literature for the Discussion. Results: Nationally representative surveys show stroke prevalence rising from 7‰ (2013) to 10.9‰ (2018) and 8.3‰ (2023), with pronounced interprovincial disparity (4.9–14.7 per 100,000) and ischemic stroke accounting for the vast majority of cases; GBD modelling situates Indonesia’s age-standardized incidence (293.3/100,000) and mortality (193.3/100,000) among the highest in Southeast Asia. Major clinical risk factors include hypertension (62.6%–87.2%), diabetes mellitus (40.5%–51%), and dyslipidemia. Structurally, acute care access is severely hindered: only 2.4%–14.3% of patients arrive within the therapeutic window for intravenous thrombolysis. This access barrier is exacerbated by a severe geographic maldistribution of neurointerventional specialists (56.2% of the 105 national specialists practice in Java) and an estimated 27.7% deficit between INA-CBGs reimbursement tariffs and actual hospital costs. Conclusion: Indonesia’s ischemic stroke crisis is driven by an overwhelming epidemiological burden, uncontrolled cardiometabolic risk factors, and systemic barriers to acute treatment. Urgent interventions must prioritize community FAST education, primary care strengthening, the geographic redistribution of stroke-ready facilities, and JKN tariff revisions to sustainably fund acute reperfusion therapies.
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