Stroke Characteristics in a Cohort of Hmong American Patients

Abstract

Background Prior studies have indicated high rates of vascular risk factors, but little is known about stroke in Hmong. Methods and Results The institutional Get With The Guidelines (GWTG) database was used to identify patients discharged with acute ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage between 2010 and 2019. Hmong patients were identified using clan names and primary language. Univariate analysis was used to compare Hmong and White patients. A subarachnoid hemorrhage comparison was not conducted because of the small sample size. We identified 128 Hmong patients and 3084 White patients. Hmong patients had more prevalent hemorrhagic stroke (31% versus 15%; P <0.0016). In the acute ischemic stroke cohort, compared with White patients, Hmong patients were younger (60±13 versus 71±15 years; P <0.0001), presented to the emergency department almost 4 hours later; and had a lower thrombolysis usage rate (6% versus 14%; P =0.03496), worse lipid profile, higher hemoglobin A 1C , similar stroke severity, and less frequent discharge to rehabilitation facilities. The most common ischemic stroke mechanism for Hmong patients was small‐vessel disease. In the intracerebral hemorrhage cohort, Hmong patients were younger (55±13 versus 70±15 years; P <0.0001), had higher blood pressure, and had a lower rate of independent ambulation on discharge (9% versus 30%; P =0.0041). Conclusions Hmong patients with stroke were younger and had poorer risk factor control compared with White patients. There was a significant delay in emergency department arrival and low use of acute therapies among the Hmong acute ischemic stroke cohort. Larger studies are needed to confirm these observations, but action is urgently needed to close gaps in primary care and stroke health literacy.

Racial Impact on Inpatient Stroke Quality of Care in Two Community Hospitals

“…Non-white patients with ICH had the youngest median age compared to non-white patients of other stroke subtypes. We also observed that the proportion of ICH was higher in the non-white group, which is consistent with findings in Hmong Americans [20], other Asian ethnicities, such as Japanese [21] and Chinese [22], and Asian Americans in general [23,24]. This means that a larger proportion of younger nonwhite patients suffer from ICH, which is a disease with higher morbidity and mortality [25] and, unlike AIS, has no effective therapeutic intervention [26].…”

“…We observed that the median age of non-white patients was 11 years younger than that of the white patients, which is the same difference observed between Hmong Americans and white patients [20]. Non-white patients with ICH had the youngest median age compared to non-white patients of other stroke subtypes.…”

“…Similarly, the time from LKW to ED arrival was not statistically different between white and non-white ICH patients, although the median was numerically higher in the non-white group (about 4 h longer). These findings resemble those of stroke in Hmong Americans except that the EMS utilization was actually significantly higher, and the disease severity, as measured by NIHSS and GCS, was significantly higher in the Hmong-American patients compared to white patients [20].…”

“…The low rate of EMS utilization in non-white patients with AIS and TIA and the significant delay in arrival is similar to the observed delay in Hmong Americans [20] and racial minorities in general [31,32]. We recently conducted a stroke health literacy survey within the Hmong community and found that while 95% of respondents could name at least one correct stroke symptom, only 78% indicated that the first action they would take in the case of a stroke would be to call 911, while other respondents indicated that they would call an elder, call their doctor, drink water, take an aspirin, call 911 only if symptoms are severe, and other behaviors that are not helpful in the case of a stroke emergency [33].…”

“…The relatively high Asian population is due to the high concentration of the Hmong population in the catchment area of the study hospitals, especially in the city of St. Paul, where 19% of the population is Asian [19]. Stroke in Hmong Americans was first characterized in a recent retrospective study [20]. There are multiple similarities between this current analysis and stroke in Hmong Americans, which we will highlight in the relevant sections of this discussion.…”