Abstract
BackgroundStroke has emerged as a significant and escalating health problem for Asian populations. We compared risk factors, quality of care and risk of death or recurrent stroke in South Asian, East Asian and White patients with acute ischemic and hemorrhagic stroke.MethodsRetrospective analysis was performed on consecutive patients with ischemic stroke or intracerebral hemorrhage admitted to 12 stroke centers in Ontario, Canada (July 2003-March 2008) and included in the Registry of the Canadian Stroke Network database. The database was linked to population-based administrative databases to determine one-year risk of death or recurrent stroke.ResultsThe study included 253 South Asian, 513 East Asian and 8231 White patients. East Asian patients were more likely to present with intracerebral hemorrhage (30%) compared to South Asian (17%) or White patients (15%) (p<0.001). Time from stroke to hospital arrival was similarly poor with delays >2 hours for more than two thirds of patients in all ethnic groups. Processes of stroke care, including thrombolysis, diagnostic imaging, antithrombotic medications, and rehabilitation services were similar among ethnic groups. Risk of death or recurrent stroke at one year after ischemic stroke was similar for patients who were White (27.6%), East Asian (24.7%, aHR 0.97, 95% CI 0.78-1.21 vs. White), or South Asian (21.9%, aHR 0.91, 95% CI 0.67-1.24 vs. White). Although risk of death or recurrent stroke at one year after intracerebral hemorrhage was higher in East Asian (35.5%) and White patients (47.9%) compared to South Asian patients (30.2%) (p=0.002), these differences disappeared after adjustment for age, sex, stroke severity and comorbid conditions (aHR 0.89 [0.67-1.19] for East Asian vs White and 0.99 [0.54-1.81] for South Asian vs. White).ConclusionAfter stratification by stroke type, stroke care and outcomes are similar across ethnic groups in Ontario. Enhanced health promotion is needed to reduce delays to hospital for all ethnic groups.
Highlights
Stroke has emerged as a significant and escalating health problem for Asian populations
Ischemic stroke was more common than intracerebral hemorrhage (ICH) for all ethnic groups, occurring in 70% of East Asian, 83% of South Asian and 85% of White patients
Risk factors and stroke characteristics In the cohort with ICH, South Asian patients were younger and more likely to be male, to reside in a low income neighborhood and to have hyperlipidemia compared to White or East Asian patients, while White patients were more likely to smoke cigarettes, consume more than two alcoholic drinks per day and have a Charlson comorbidity index score of greater than two (Table 1)
Summary
Stroke has emerged as a significant and escalating health problem for Asian populations. Quality of care and risk of death or recurrent stroke in South Asian, East Asian and White patients with acute ischemic and hemorrhagic stroke. There is an emerging epidemic of acute stroke in Asian populations, with recent data suggesting that the prevalence of stroke has increased 3 to 5 fold in the last 40 years in South Asian patients [1] whereas stroke rates have plateaued or declined in general North American populations [2]. The aim of this study was to compare stroke characteristics, delivery of acute stroke care and risk of death or hospitalization for recurrent stroke in South Asian (those originating from India, or Pakistan), East Asian (originating from China, Japan, Korea, Vietnam, Thailand or Laos) and White patients with acute ischemic or intracerebral hemorrhagic stroke, using a large clinical database of patients from in 12 stroke centers in Ontario, Canada
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