Stroke Incidence and Survival in American Indians, Blacks, and Whites: The Strong Heart Study and Atherosclerosis Risk in Communities Study

Year: 2019

Type: article

Abstract: Background American Indians ( AIs ) have high stroke morbidity and mortality. We compared stroke incidence and mortality in AI s, blacks, and whites. Methods and Results Pooled data from 2 cardiovascular disease cohort studies included 3182 AI s from the SHS (Strong Heart Study), aged 45 to 74 years at baseline (1988-1990) and 3765 blacks and 10 413 whites from the ARIC (Atherosclerosis Risk in Communities) Study, aged 45 to 64 years at baseline (1987-1989). Stroke surveillance was based on self-report, hospital records, and death certificates. We estimated hazard ratios for incident stroke (ischemic and hemorrhagic combined) through 2008, stratified by sex and birth-year tertile, and relative risk for poststroke mortality. Incident strokes numbered 282 for AI s, 416 for blacks, and 613 for whites. For women and men, stroke incidence among AI s was similar to or lower than blacks and higher than whites. Covariate adjustment resulted in lower hazard ratios for most comparisons, but results for these models were not always statistically significant. After covariate adjustment, AI women and men had higher 30-day poststroke mortality than blacks (relative risk=2.1 [95% CI=1.0, 3.2] and 2.2 [95% CI=1.3, 3.1], respectively), and whites (relative risk=1.6 [95% CI=0.8, 2.5] and 1.7 [95% CI=1.1, 2.4]), and higher 1-year mortality (relative risk range=1.3-1.5 for all comparisons). Conclusions Stroke incidence in AI s was lower than for blacks and higher than for whites; differences were larger for blacks and smaller for whites after covariate adjustment. Poststroke mortality was higher in AI s than blacks and whites.

Source: Journal of the American Heart Association

DOI: 10.1161/jaha.118.010229

Authors: Clemma J. Muller, Alvaro Alonso, Jean Forster, David M. Vock, Ying Zhang, Rebecca F. Gottesman, Wayne Rosamond, W.T. Longstreth, Richard F. MacLehose

Institutions: Washington State University, Emory University, University of Minnesota, University of Oklahoma Health Sciences Center, Johns Hopkins University, University of North Carolina at Chapel Hill, University of Washington

Language: English

Topic: Acute Ischemic Stroke Management

Subfield: Epidemiology

Field: Medicine

Domain: Health Sciences

SDGs: Good health and well-being, Reduced inequalities

Open Access status: gold

Estimated APC paid: $2,750

Funders: University of Minnesota, Strong, National Institutes of Health, National Heart, Lung, and Blood Institute

OpenAlex ID: W2952008386