Ethnic differences in incidence of stroke: prospective study with stroke register |
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| Authors: | Stewart J A Dundas R Howard R S Rudd A G Wolfe C D |
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| Institution: | Department of Public Health Sciences, Guy's, King's College, and St Thomas's School of Medicine, 5th Floor, Capital House, London SE1 3QD. |
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| Abstract: | ObjectiveTo identify ethnic differences in the incidence of first ever stroke.DesignA prospective community stroke register (1995-6) with multiple notification sources. Pathological classification of stroke in all cases was based on brain imaging or necropsy data. Rates were standardised to European and world populations and adjusted for age, sex, and social class in multivariate analysis.SettingA multi-ethnic population of 234 533 in south London, of whom 21% are black.Results612 strokes were registered. The crude annual incidence rate was 1.3 strokes per 1000 population per year (95% confidence interval 1.20 to 1.41) and 1.25 per 1000 population per year (1.15 to 1.35) age adjusted to the standard European population. Incidence rates adjusted for age and sex were significantly higher in black compared with white people (P<0.0001), with an incidence rate ratio of 2.21 (1.77 to 2.76). In multivariable analysis increasing age (P<0.0001), male sex (P<0.003), black ethnic group (P<0.0001), and lower social class (P<0.0001) in people aged 35-64 were independently associated with an increased incidence of stroke.ConclusionsIncidence rates of stroke are higher in the black population; this is not explained by confounders such as social class, age, and sex. Ethnic differences in genetic, physiological, and behavioural risk factors for stroke require further elucidation to aid development of effective strategies for stroke prevention in multi-ethnic communities. Key messages- Incidence rates of first ever stroke adjusted for age and sex are twice as high in black people compared with white people
- This excess incidence cannot be accounted for by differences in social class in ages 35-64
- Black people tend to have their first stroke at a younger age than white people
- The excess incidence is found in all pathological types of stroke but is greatest for primary intracerebral haemorrhage
- There is no difference between ethnic groups in case fatality up to 6 months after stroke
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