Smoking prevalence among stroke patients in Saudi Arabia: A systematic review and meta-analysis

Background: Stroke represents a significant global health issue, consistently identified as one of the leading causes of disability and mortality worldwide. Smoking constitutes a major risk factor for stroke development. Objectives: This study evaluated the prevalence of smoking among stroke patients in Saudi Arabia. Methods: Embase, Medline, and SCOPUS were systematically searched from inception to December 2024. Data was screened and synthesized following the PRISMA guidelines. Stratified meta-analysis was performed to pool the prevalence of smokers among stroke patients across various provinces of Saudi Arabia. Results: There were 19,499 stroke patients in 42 included studies; 2695 (14 %) were smokers, and 14,701 were male. The overall pooled prevalence of smoking among stroke patients in Saudi Arabia is 18 % (95 % CI, 14–22 %). The Western and Northern provinces demonstrate the highest percentages of smokers among stroke patients, at 33 % (95 % CI, 21–47 %) and 23 % (95 % CI, 19–27 %), respectively. The sensitivity analysis using leave-one-out methodologies shows that the pooled percentage estimate is robust, with no one research substantially influencing the conclusions. The meta-regression shows no link between smoking prevalence in stroke patients and age (p-value = 0.17). The results of Egger's test (t = 0.74, bias estimate = 0.7109, p-value = 0.4645) indicate no publication bias in this meta-analysis. Conclusion: Smoking is prevalently high among stroke patients in Saudi Arabia, with significant regional variations. To reduce the impact of smoking on stroke incidence and outcomes, it is essential to implement targeted preventive programs that include integrating smoking cessation into stroke treatment plans and launching public health campaigns.