A Multicentre Study Comparing Cerebrovascular Disease Profiles in Pacific Islander and Caucasian Populations Presenting with Stroke and Transient Ischaemic Attack

Abstract

<b><i>Introduction:</i></b> In a multicentre study, we contrasted cerebrovascular disease profiles in Pacific Island (PI)-born patients (Indigenous Polynesian [IP] or Indo-Fijian [IF]) presenting with transient ischaemic attack (TIA), ischaemic stroke (IS) or intracerebral haemorrhage (ICH) with those of Caucasians (CSs). <b><i>Methods:</i></b> Using a retrospective case-control design, we compared PI-born patients with age- and gender-matched CS controls. Consecutive patients were admitted to 3 centres in South Western Sydney (July 2013–June 2020). Demographic and clinical data studied included vascular risk factors, stroke subtypes, and imaging characteristics. <b><i>Results:</i></b> There were 340 CS, 183 (27%) IP, and 157 (23%) IF patients; mean age 65 years; and 302 (44.4%) female. Of these, 587 and patients presented with TIA/IS and 93 (13.6%) had ICH. Both IP and IF patients were significantly more likely to present >24 h from symptom onset (odds ratios [ORs] vs. CS 1.87 and 2.23). IP patients more commonly had body mass indexes >30 (OR 1.94). Current smoking and excess alcohol intake were higher in CS. Hypertension, diabetes, and chronic kidney disease were significantly higher in both IP and IF groups in comparison to CS. IP patients had higher rates of AF and those with known AF were more commonly undertreated than both IF and CS patients (OR 2.24, <i>p</i> = 0.007). ICH was more common in IP patients (OR 2.32, <i>p</i> = 0.005), while more IF patients had intracranial arterial disease (OR 5.10, <i>p</i> < 0.001). <b><i>Discussion/Conclusion:</i></b> Distinct cerebrovascular disease profiles are identifiable in PI-born patients who present with TIA or stroke symptoms in Australia. These may be used in the future to direct targeted approaches to stroke prevention and care in culturally and linguistically diverse populations.

Cerebrovascular Disease Profiles of Culturally and Linguistically Diverse Communities in South Western Sydney and New South Wales

“…SWS residents born overseas were also less likely to arrive at hospital by ambulance and had greater in-hospital mortality rates. These findings reflect those of previous Australian studies, showing that patients with TIA/stroke of CALD background experience delays in access to acute therapies [9] and receive suboptimal risk factor management [10,15].…”

“…Understanding differences in risk factors and patterns of disease among CALD communities offers the opportunity to address inequities through the implementation of targeted strategies for culturally appropriate care [6][7][8]. South Western Sydney (SWS) has a greater proportion of CALD communities compared to the rest of New South Wales (NSW) [9,10], and hospital presentations following TIA/stroke in many groups are often significantly delayed [9]. Of these communities, only Pacific Island ("Pasifika") peoples have been studied in detail, with recent work showing that they were more likely to have type 2 diabetes mellitus (T2DM), be undertreated for atrial fibrillation (AF), and more commonly suffer from types of stroke that carry greater morbidity than Caucasians [10].…”

“…South Western Sydney (SWS) has a greater proportion of CALD communities compared to the rest of New South Wales (NSW) [9, 10], and hospital presentations following TIA/stroke in many groups are often significantly delayed [9]. Of these communities, only Pacific Island (“Pasifika”) peoples have been studied in detail, with recent work showing that they were more likely to have type 2 diabetes mellitus (T2DM), be undertreated for atrial fibrillation (AF), and more commonly suffer from types of stroke that carry greater morbidity than Caucasians [10]. There are limited data on cerebrovascular disease patterns and vascular risk factors in other CALD communities living in SWS and in Australia.…”

Comparative Prevalence of Cerebrovascular Disease in Vietnamese Communities in South-Western Sydney

“…A recent SWS study compared stroke characteristics in Pacific Islander communities to an unselected Australian cohort, revealing that Pacific Islander patients had substantially higher rates of hypertension, atrial fibrillation (AF), diabetes, chronic kidney disease, obesity, smoking, and excess alcohol intake [9]. Certain stroke types were more common and, crucially, this preponderance of disease correlated with potentially modifiable risk factor exposure in a manner not seen in control participants.…”

“…For example, the rates of intracranial atherosclerotic disease (ICAD) in age-and sex-matched Indo-Fijian patients were more than double those seen in both Indigenous Fijians (geographically matched, ethnically nonmatched) and the controls (geographically and ethnically nonmatched). Furthermore, Indo-Fijian heritage was an independent predictor of ICAD that uniquely interacted with insulin-dependent diabetes, identifying this as a priority target for risk factor modification [9].…”