Ethnic Disparities in Ischemic Stroke, Intracerebral Hemorrhage, and Subarachnoid Hemorrhage Incidence in The Netherlands

TY - JOUR

T1 - Ethnic Disparities in Ischemic Stroke, Intracerebral Hemorrhage, and Subarachnoid Hemorrhage Incidence in The Netherlands

AU - Agyemang, Charles

AU - van Oeffelen, Aloysia A M

AU - Nørredam, Marie Louise

AU - Kappelle, L Jaap

AU - Klijn, Catharina J M

AU - Bots, Michiel L

AU - Stronks, Karien

AU - Vaartjes, Ilonca

N1 - © 2014 American Heart Association, Inc.

PY - 2014/11

Y1 - 2014/11

N2 - BACKGROUND AND PURPOSE: Data on the incidence of stroke subtypes among ethnic minority groups are limited. We assessed ethnic differences in the incidence of stroke subtypes in the Netherlands.METHODS: A Dutch nationwide register-based cohort study (n=7 423 174) was conducted between 1998 and 2010. We studied the following stroke subtypes: ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Cox proportional hazard models were used to estimate incidence differences between first-generation ethnic minorities and the Dutch majority population (ethnic Dutch).RESULTS: Compared with ethnic Dutch, Surinamese men and women had higher incidence rates of all stroke subtypes combined (adjusted hazard ratios, 1.43; 95% confidence interval, 1.35-1.50 and 1.34; 1.28-1.41), ischemic stroke (1.68; 1.57-1.81 and 1.57; 1.46-1.68), intracerebral hemorrhage (2.08; 1.82-2.39 and 1.74; 1.50-2.00), and subarachnoid hemorrhage (1.25; 0.92-1.69 and 1.26; 1.04-1.54). By contrast, Moroccan men and women had lower incidence rates of all stroke subtypes combined (0.42; 0.36-0.48 and 0.37; 0.30-0.46), ischemic stroke (0.35; 0.27-0.45 and 0.34; 0.24-0.49), intracerebral hemorrhage (0.61; 0.41-0.92 and 0.32; 0.16-0.72), and subarachnoid hemorrhage (0.42; 0.20-0.88 and 0.34; 0.17-0.68) compared with ethnic Dutch counterparts. The results varied by stroke subtype and sex for the other minority groups. For example, Turkish women had a reduced incidence of subarachnoid hemorrhage, whereas Turkish men had an increased incidence of ischemic stroke and intracerebral hemorrhage compared with ethnic Dutch.CONCLUSIONS: Our findings suggest that Surinamese have an increased risk, whereas Moroccans have a reduced risk for all the various stroke subtypes. Among other ethnic minorities, the risk seems to depend on the stroke subtype and sex. These findings underscore the need to identify the root causes of these ethnic differences to assist primary and secondary prevention efforts.

AB - BACKGROUND AND PURPOSE: Data on the incidence of stroke subtypes among ethnic minority groups are limited. We assessed ethnic differences in the incidence of stroke subtypes in the Netherlands.METHODS: A Dutch nationwide register-based cohort study (n=7 423 174) was conducted between 1998 and 2010. We studied the following stroke subtypes: ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Cox proportional hazard models were used to estimate incidence differences between first-generation ethnic minorities and the Dutch majority population (ethnic Dutch).RESULTS: Compared with ethnic Dutch, Surinamese men and women had higher incidence rates of all stroke subtypes combined (adjusted hazard ratios, 1.43; 95% confidence interval, 1.35-1.50 and 1.34; 1.28-1.41), ischemic stroke (1.68; 1.57-1.81 and 1.57; 1.46-1.68), intracerebral hemorrhage (2.08; 1.82-2.39 and 1.74; 1.50-2.00), and subarachnoid hemorrhage (1.25; 0.92-1.69 and 1.26; 1.04-1.54). By contrast, Moroccan men and women had lower incidence rates of all stroke subtypes combined (0.42; 0.36-0.48 and 0.37; 0.30-0.46), ischemic stroke (0.35; 0.27-0.45 and 0.34; 0.24-0.49), intracerebral hemorrhage (0.61; 0.41-0.92 and 0.32; 0.16-0.72), and subarachnoid hemorrhage (0.42; 0.20-0.88 and 0.34; 0.17-0.68) compared with ethnic Dutch counterparts. The results varied by stroke subtype and sex for the other minority groups. For example, Turkish women had a reduced incidence of subarachnoid hemorrhage, whereas Turkish men had an increased incidence of ischemic stroke and intracerebral hemorrhage compared with ethnic Dutch.CONCLUSIONS: Our findings suggest that Surinamese have an increased risk, whereas Moroccans have a reduced risk for all the various stroke subtypes. Among other ethnic minorities, the risk seems to depend on the stroke subtype and sex. These findings underscore the need to identify the root causes of these ethnic differences to assist primary and secondary prevention efforts.

KW - Adult

KW - Aged

KW - Brain Ischemia

KW - Cohort Studies

KW - Ethnic Groups

KW - Female

KW - Follow-Up Studies

KW - Health Status Disparities

KW - Humans

KW - Incidence

KW - Male

KW - Middle Aged

KW - Netherlands

KW - Registries

KW - Stroke

KW - Subarachnoid Hemorrhage

U2 - 10.1161/strokeaha.114.006462

DO - 10.1161/strokeaha.114.006462

M3 - Journal article

C2 - 25270628

SN - 0039-2499

VL - 45

SP - 3236

EP - 3242

JO - Stroke

JF - Stroke

ER -