Stroke in the Philippines: What 15,230 Patients Reveal About the Gaps We Can No Longer Ignore

Stroke remains one of the Philippines’ most serious health challenges. It is the country’s third leading cause of death, accounting for approximately 60,000 deaths each year. Despite this enormous burden, reliable nationwide information on who develops stroke, how patients are treated, and what happens to them after reaching the hospital has remained limited.

A major study from the Philippine Neurological Association One Database-Stroke, or PNA1DB-Stroke, is helping provide a clearer picture. Published in Frontiers in Stroke in June 2026, the study examined 15,230 patients admitted for acute cerebrovascular disease across 11 tertiary hospitals in the Philippines. Beyond describing the characteristics of Filipino stroke patients, the study highlights substantial differences in access to diagnostics, treatment, and outcomes between public and private hospitals.

The PNA1DB-Stroke project prospectively collected information from five publicly funded and six privately funded tertiary hospitals with accredited neurology training programs. Adult patients admitted with transient ischemic attack, ischemic stroke, hemorrhagic stroke, or cerebral venous thrombosis were included from June 2021 through August 2024. The registry documented demographics, vascular risk factors, stroke characteristics, diagnostic procedures, treatments, and outcomes at hospital discharge.

The findings provide one of the most comprehensive real-world views of stroke care in the country.

A Heavy Burden of Hemorrhagic Stroke

Among the 15,230 cases, the average age was 58 years. Around 60% of cases were transient ischemic attacks or ischemic strokes, while 38.6% were hemorrhagic strokes. This proportion is considerably higher than figures commonly reported in high-income countries, where hemorrhagic strokes account for about 10% to 15% of cases.

Hypertension was the most common vascular risk factor, affecting 65.6% of patients. The study also showed that hypertension was the dominant mechanism associated with intracerebral hemorrhage. These findings strongly support the need for better blood pressure screening, treatment, and long-term control as part of a national stroke prevention strategy.

The relatively young age of affected patients is equally important. A stroke occurring around the sixth decade of life can affect people who are still actively working, supporting families, and contributing to the economy. The burden of stroke therefore extends beyond hospitals and rehabilitation centers. It can also result in major social and financial consequences for households.

Public and Private Hospitals Serve Different Populations

Nearly three-fourths of patients in the registry, 10,974 or 72.1%, were managed in public hospitals. Patients admitted to public institutions tended to be younger, had lower household incomes, were more frequently unemployed or migrants from other regions, and often presented with more severe neurological deficits. Smoking and heavy alcohol consumption were also more common in this group.

Interestingly, documented histories of hypertension, diabetes, and dyslipidemia were less common among public-hospital patients. The authors suggest that this may reflect underdiagnosis and limited access to regular preventive care rather than a genuinely lower prevalence of vascular disease.

This is an important point. Stroke prevention does not begin in the emergency room. It begins much earlier with routine blood pressure checks, diabetes screening, cholesterol management, smoking cessation, and access to primary care services.

Time Remains a Critical Problem

Effective stroke treatment depends greatly on how quickly patients reach an appropriate facility. The study found that among patients who presented directly to participating hospitals, the median time from stroke onset to hospital arrival was six hours. Only about one-quarter arrived within three hours, while almost another quarter arrived more than 24 hours after symptom onset.

Once patients reached the hospital, imaging could often be performed relatively quickly. The median time from hospital arrival to brain imaging was approximately 0.8 hour, and more than 60% underwent imaging within an hour. Public hospitals even achieved brain imaging within one hour more frequently than private hospitals, despite having fewer patients who arrived early after stroke onset.

This suggests that a major part of the delay occurs before patients reach a stroke-capable facility.

Reperfusion Therapy Remains Underused

One of the most important findings involved revascularization treatment.

Among 6,670 ischemic stroke patients who directly arrived at participating hospitals, only 620, or 9.3%, underwent attempted revascularization with intravenous thrombolysis and/or endovascular thrombectomy. The most common reason for not receiving these treatments was ineligibility, which included arrival beyond the therapeutic time window.

Access to endovascular thrombectomy was particularly limited. Among the 11 participating hospitals, only one of the five public hospitals and three of the six private hospitals were capable of performing EVT.

Intravenous thrombolysis, however, was used relatively more often in public hospitals. The study notes that government subsidy programs had made recombinant tissue plasminogen activator available free of charge in some public institutions, while patients in private hospitals may face significant out-of-pocket costs. This illustrates how treatment availability and treatment affordability are closely linked.

The study also found lower use of several diagnostic and therapeutic procedures in public hospitals. These included advanced imaging, echocardiography, vascular studies, endovascular treatment, antithrombotic therapy, and other interventions. Many of these differences remained significant even after adjusting for patient characteristics such as age, sex, stroke severity, income, and delay in hospital arrival. This suggests that differences in resources and infrastructure may continue to influence care.

The Human Cost of Unequal Access

The overall in-hospital mortality rate was 16.4%. Patients in public hospitals had higher mortality and initially appeared to have worse neurological outcomes at discharge. Some differences became less pronounced after adjustment for clinical severity, transfer status, arrival time, income, and other factors, showing that public hospitals often receive patients with more complicated presentations. However, in-hospital fatality remained higher in public hospitals for both ischemic and hemorrhagic stroke.

Another important finding was that approximately one-quarter of patients had been transferred from another institution. Transfers may be necessary when patients initially present to hospitals without appropriate stroke capabilities, but every transfer can introduce additional delay. In stroke, even short delays can affect eligibility for time-sensitive interventions.

The authors therefore emphasize the importance of stronger stroke networks, improved capacity in strategically located hospitals, clearer interfacility transfer pathways, and greater use of telemedicine where appropriate.

Turning Registry Data Into Action

The study has several limitations. It is hospital-based and therefore does not include people who developed stroke but never reached medical care. Participating institutions were tertiary centers with neurology training programs, which may also mean that urban patients and more severe referrals were overrepresented. Long-term outcomes after discharge were not included, and the observational design cannot prove that any single health-system factor directly caused the differences in outcomes.

Even with these limitations, the study provides a valuable picture of where Philippine stroke care stands and where improvement is most urgently needed.

The data point toward several priorities: stronger prevention programs, more aggressive control of hypertension and other vascular risk factors, better public recognition of stroke symptoms, faster access to stroke-ready hospitals, wider availability of stroke units, broader access to advanced diagnostics and thrombectomy, improved financing for reperfusion treatments, stronger rehabilitation services, and more efficient referral networks.

Perhaps the most important contribution of PNA1DB-Stroke is that it converts assumptions into measurable evidence. Without reliable data, disparities may remain anecdotal. With a national registry, gaps in access, treatment, and outcomes can be identified, tracked, and addressed.

The study therefore offers more than a description of stroke care in the Philippines. It provides a practical foundation for reform. Its findings support the need for data-driven, locally appropriate strategies that strengthen prevention, expand treatment capacity, improve financing, and connect hospitals into more effective stroke systems. If these gaps are addressed systematically, timely and equitable stroke care can move closer to becoming the standard for every Filipino, regardless of where they seek treatment.

Source:
Gan RN, Pascual V V JLR, Collantes MEV, Hiyadan JHB, Juangco DNA, Macrohon-Valdez MCZ, Escabillas CG, Co COC, Sarapuddin GB, Cañete MTA, Alvarez RM, Mesina-Nepomuceno BL, Lokin JK, Lukban MCS and Picar RE (2026) Acute cerebrovascular disease in the Philippine Neurological Association One Database (PNA1DB)—patient profiles and disparities between public and private hospitals. Front. Stroke 5:1835562. doi: 10.3389/fstro.2026.1835562