Age and Ethnic Disparities in Incidence of Stroke Over Time

Abstract

Background and Purpose-Data on continuous monitoring of stroke risk among different age and ethnic groups are lacking.We aimed to investigate age and ethnic disparities in stroke incidence over time from an inner-city population-based stroke register. Methods-Trends in stroke incidence and before-stroke risk factors were investigated with the South London StrokeRegister, a population-based register covering a multiethnic population of 357 308 inhabitants. Age-, ethnicity-, and sexspecific incidence rates with 95% confidence intervals were calculated, assuming a Poisson distribution and their trends over time tested by the Cochran-Armitage test. Results-Four thousand two hundred forty-five patients with first-ever stroke were registered between 1995 and 2010. Total stroke incidence reduced by 39.5% during the 16-year period from 247 to 149.5 per 100 000 population (P<0.0001). Similar declines in stroke incidence were observed in men, women, white groups, and those aged >45 years, but not in those aged 15 to 44 years (12.6-10.1; P=0.2034) and black groups (310.1-267.5; P=0.3633). The mean age at stroke decreased significantly from 71.7 to 69.6 years (P=0.0001). The reduction in prevalence of before-stroke risk factors was mostly seen in white patients aged >55 years, whereas an increase in diabetes mellitus was observed in younger black patients aged 15 to 54 years. Conclusions-Total stroke incidence decreased during the 16-year time period. However, this was not seen in younger age groups and black groups. The advances in risk factor reduction observed in white groups aged >55 years failed to be transferred to younger age groups and black groups. (Stroke. 2013;44:3298-3304.)

Trends in Stroke Incidence and 28-Day Case Fatality in a Nationwide Stroke Registry of a Multiethnic Asian Population

“…For instance, data from the United States have shown that stroke incidences have declined in the White but not in the Black population. 9,15 Similar findings were reported by the South London Stroke registry, 14 and a recent systematic review of studies from 19 countries and 5 continents found that stroke is more common in men but more severe, with high 1-month case-fatality rate, in women. 16 In addition to remaining widespread disparities and inequalities in stroke morbidity and mortality, rapidly aging populations are expected to further increase the absolute disease burden of stroke in the future.…”

“…Although these findings are consistent with research from other, mostly Western countries, our study uncovers these differences for the first time in a large mixedethnicity Asian population. 14,29 We also identified adverse trends in the younger population, particularly with regards to stroke incidence rates. Similar observations have been made in some western countries and have also been reported from the Global Burden of Disease Study.…”

“…11 Studies from the United States and United Kingdom have provided some evidence to support these concerns and reported increasing incidence rates in the younger population. [12][13][14] Apart from age-related differences in stroke trends, studies from Western countries have also identified considerable differences in the trends between men and women, as well as in different ethnic groups. For instance, data from the United States have shown that stroke incidences have declined in the White but not in the Black population.…”

An evidence-based approach to the use of telehealth in long-term health conditions: development of an intervention and evaluation through pragmatic randomised controlled trials in patients with depression or raised cardiovascular risk

“…The incidence of a first ever stroke was taken from the study by Wang et al, 345 using the incidence rates in the white ethnicity group (approximately 99% of participants randomised to the CVD risk trial in the Healthlines study were of white ethnicity). Incidence rates were split into male and female rates using data from the same study.…”

Trends in Incidence and Early Outcomes in a Black Afro-Caribbean Population From 1999 to 2012

“…Previous studies on blacks have been conducted in multiethnic population 9,10 and have shown that overtime, stroke incidence reduced in white group but not in black group. In these multiracial populations, socioeconomic status discrepancy 12 and sustained inequalities in risk 11 may partly account for the observed ethnic differences.…”