Ethnic variation in acute cerebrovascular disease: Analysis from the Qatar stroke registry

Abstract

Objective: We analysed the Qatar stroke registry for ethnic variations in patients admitted with cerebrovascular disease at Hamad General Hospital, Qatar. Methods: Patients admitted with acute stroke from January 2014 to December 2015, enrolled in the registry were included in the study. We evaluated the clinical presentation, risk factors, and outcome at discharge and 90 days postdischarge in relation to the patient's ethnic background. Results: A total of 1727 patients were enrolled in the Hamad General Hospital stroke registry (Middle Eastern 594 (34.4%), South East Asian 924 (53.5%) and Far Eastern 209 (12.1%)). There were significant differences in risk factors, clinical presentation and prognosis. Compared to Middle Eastern patients, Far Eastern patients were younger (62.8 AE 13.7 vs. 48.9 AE 9.1 years; p < 0.001). Diabetes and hypertension were significantly more common in Middle Eastern patients (358 (60.3%), 458 (77.1%)) compared to South East Asian patients (420 (45.5%), 596 (64.5%)) and Far Eastern patients (57 (27.3%), 154 (73.7%)), respectively (p < 0.001). Stroke was more severe in the Far Eastern group (median (interquartile range)-5.0 (2-11.5)) compared to the Middle Eastern group (median (interquartile range)-4.0 (1-8)) and South East Asian (median (interquartile range)-4.0 (2-9)), p ¼ 0.011. Mortality at 90 days was highest in patients from the Far East (15/209 (8.2%)) compared to the Middle East (35/594 (6.5%)) and South East Asia (33/924 (4.0)), p ¼ 0.028. Patients from the Far East had significantly higher rates of intracranial hemorrhage compared to the Middle East and South East Asia (70/209 (33.5%), 77/594 (13.0%), and 169/924 (18.3%)), respectively (p < 0.001). Conclusion: The early age at presentation and the poor control of risk factors, especially in patients from South East Asia and the Far East requires attention.

Sex-Specific Differences in Short-Term and Long-Term Outcomes in Acute Stroke Patients from Qatar

“…Although baseline differences in age and premorbid disability may account for the poor outcome in women, other factors may be important contributors [25]. Diabetes, seen more frequently in female patients, leads to slower recovery and contributes to increased recurrence [19,20]. There are higher rates of poststroke depression and social isolation in women [25].…”

“…In men, MACEs occurred early: in the first year, the number of events was 87 (65.4%) and in the second year, 35 (26.3%) compared to 5 (3.7%) in the third, 3 (2.2%) in the fourth, and 3 (2.2%) in the fifth year. In women also, MACEs occurred predominantly in the first (63, 54.7%), second (28, 24.3%), and third (19,16.5%) years compared to the fourth (4, 3.4%) and fifth (1, 0.9%) years (Fig. 1).…”

“…All AS patients admitted to the Hamad General Hospital (HGH) from January 2014 to February 2019 were included in the study. Clinical information was entered prospectively in a database as previously published [18][19][20]. The hospital has a dedicated stroke ward, admits 98% of stroke patients in Qatar, and is the only center where AS treatment with intravenous thrombolysis and mechanical thrombectomy is offered.…”

“…Although a few studies from the Middle East have reported on the sexual differences in the risk factor profile [16], clinical presentation, and outcome of stroke [17], to our knowledge, there is no study reporting specifically on the effect of sexual difference in major adverse cardiovascular events (MACEs). We have previously reported on the risk factors, clinical presentation, and outcome following AS in a diverse group of patients in Qatar [18][19][20][21]. The purpose of the study was to evaluate the short-term prognosis and long-term outcome in MACEs in Qatari nationals admitted with acute stroke (AS).…”

Progression of stroke deficits in patients presenting with mild symptoms: The underlying etiology determines outcome

“…The study was approved by the Hamad Medical Corporation's Institutional Review Board. HGH annually admits approximately 1800 patients with AS and approximately 160 patients are treated with rt-PA yearly [22,23]. Stroke localization was made using the Trial of Org 10172 in AS Treatment (TOAST) criteria.…”