Advertisement

Ethnic Disparities in Stroke

  • Charles Agyemang
  • Pietro Amedeo ModestiEmail author
Chapter
  • 191 Downloads
Part of the Updates in Hypertension and Cardiovascular Protection book series (UHCP)

Abstract

Stroke is the second most common cause of mortality and the third most common cause of disability globally. While the incidence of stroke is falling in high-income countries, the incidence is increasing in low- and middle-income countries (Koton et al., JAMA 312:259, 2014; Vangen-Lønne et al., Stroke 48:544, 2017; Feigin et al., Lancet 383:245, 2014). The global estimate in 2013 shows that there were 6.5 million deaths due to stroke, 113 million disability-adjusted life years (DALYs) lost because of stroke, and 10.3 million new cases of strokes. The majority of the stroke burden, about 75% of all stroke-related mortality and 81.0% of the associated DALYs lost, occurred in low- and middle-income countries. In addition, stroke occurs 15 years earlier in people living in low- and middle-income countries than people living in high-income countries. Although the global estimates of stroke morbidity and mortality favor high-income countries than their low- and middle-income counterparts, there are clear ethnic disparities in stroke mortality, morbidity, and survival across ethnic groups in high-income countries. This chapter discusses ethnic disparities in stroke in high-income countries with major focus in Europe.

Keywords

Stroke Ethnic minority groups Migrants 

References

  1. 1.
    Feigin VL, Roth GA, Naghavi M, et al. Global burden of stroke and risk factors in 188 countries, during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet Neurol. 2016;15(9):913–24.PubMedPubMedCentralCrossRefGoogle Scholar
  2. 2.
    Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390(10100):1151–210.Google Scholar
  3. 3.
    Koton S, Schneider AL, Rosamond WD, et al. Stroke incidence and mortality trends in US communities, 1987 to 2011. JAMA. 2014;312:259.PubMedCrossRefGoogle Scholar
  4. 4.
    Vangen-Lønne AM, Wilsgaard T, Johnsen SH, et al. Declining incidence of ischemic stroke: what is the impact of changing risk factors? The Tromsø Study 1995 to 2012. Stroke. 2017;48:544.PubMedCrossRefGoogle Scholar
  5. 5.
    Feigin VL, Forouzanfar MH, Krishnamurthi R, et al. Global and regional burden of stroke during 1990-2010: findings from the Global Burden of Disease Study 2010. Lancet. 2014;383:245.PubMedPubMedCentralCrossRefGoogle Scholar
  6. 6.
    Feigin VL, Krishnamurthi RV, Parmar P, et al. Update on the global burden of ischemic and hemorrhagic stroke in 1990-2013: the GBD 2013 study. Neuroepidemiology. 2015;45(3):161–76.PubMedPubMedCentralCrossRefGoogle Scholar
  7. 7.
    Owolabi MO, Akarolo-Anthony S, Akinyemi R, et al. The burden of stroke in Africa: a glance at the present and a glimpse into the future. Cardiovasc J Afr. 2015;26(2):S27–38.PubMedPubMedCentralCrossRefGoogle Scholar
  8. 8.
    Cruickshank JK, Beevers DG, Osbourne VL, et al. Heart attack, stroke, diabetes, and hypertension in west Indians, Asians, and whites in Birmingham, England. Br Med J. 1980;281(6248):1108.PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Ethnic factors in disease. Br Med J (Clin Res Ed). 1981;282(6275):1496–7.Google Scholar
  10. 10.
    Balarajan R. Ethnic differences in mortality from ischaemic heart disease and cerebrovascular disease in England and Wales. BMJ. 1991;302(6776):560–4.PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Wild S, McKeigue P. Cross sectional analysis of mortality by country of birth in England and Wales, 1970-92. BMJ. 1997;314(7082):705–10.PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Cappuccio FP. Ethnicity and cardiovascular risk: variations in people of African ancestry and South Asian origin. J Hum Hypertens. 1997;11(9):571–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Hsu RT, Ardron ME, Brooks W, et al. The 1996 Leicestershire Community Stroke & Ethnicity Study: differences and similarities between South Asian and white strokes. Int J Epidemiol. 1999;28(5):853–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Kissela B, Schneider A, Kleindorfer D, et al. Stroke in a biracial population—the excess burden of stroke among blacks. Stroke. 2004;35(2):426–31.PubMedCrossRefGoogle Scholar
  15. 15.
    Stirbu I, Kunst AE, Bos V, et al. Differences in avoidable mortality between migrants and the native Dutch in the Netherlands. BMC Public Health. 2006;6:78.PubMedPubMedCentralCrossRefGoogle Scholar
  16. 16.
    Harding S, Rosato M, Teyhan A. Trends for coronary heart disease and stroke mortality among migrants in England and Wales, 1979-2003: slow declines notable for some groups. Heart. 2008;94(4):463–70.PubMedCrossRefGoogle Scholar
  17. 17.
    Agyemang C, Vaartjes I, Bots ML, et al. Risk of death after first admission for cardiovascular diseases by country of birth in the Netherlands: a nationwide record-linked retrospective cohort study. Heart. 2009;95(9):747–53.PubMedCrossRefGoogle Scholar
  18. 18.
    Keppel KG, Pearcy JN, Heron MP. Is there progress toward eliminating racial/ethnic disparities in the leading causes of death? Publ Health Rep. 2010;125(5):689–97.CrossRefGoogle Scholar
  19. 19.
    Bhopal RS, Bansal N, Fischbacher CM, et al. Ethnic variations in the incidence and mortality of stroke in the Scottish health and ethnicity linkage study of 4.65 million people. Eur J Prev Cardiol. 2012;19(6):1503–8.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Stewart JA, Dundas R, Howard RS, et al. Ethnic differences in incidence of stroke: prospective study with stroke register. BMJ. 1999;318(7189):967–71.PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Agyemang C, van Oeffelen AA, Norredam M, et al. Ethnic disparities in ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage incidence in the Netherlands. Stroke. 2014;45(11):3236–42.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Fedeli U, Pigato M, Avossa F, et al. Large variations in stroke hospitalization rates across immigrant groups in Italy. J Neurol. 2016;263(3):449–54.PubMedCrossRefGoogle Scholar
  23. 23.
    Agyemang C, Addo J, Bhopal R, et al. Cardiovascular disease, diabetes and established risk factors among populations of sub-Saharan African descent in Europe: a literature review. Glob Health. 2009;5:7.CrossRefGoogle Scholar
  24. 24.
    Modesti PA, Reboldi G, Cappuccio FP, et al. Panethnic differences in blood pressure in Europe: a systematic review and meta-analysis. PLoS One. 2016;11(1):e0147601.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Wang Y, Rudd AG, Wolfe CD. Age and ethnic disparities in incidence of stroke over time: the South London stroke register. Stroke. 2013;44(12):3298–304.PubMedCrossRefGoogle Scholar
  26. 26.
    Tillin T, Hughes AD, Mayet J, et al. The relationship between metabolic risk factors and incident cardiovascular disease in Europeans, south Asians, and African Caribbeans SABRE (Southall and Brent revisited)—a prospective population-based study. J Am Coll Cardiol. 2013;61(17):1777–86.PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Gunarathne A, Patel JV, Potluri R, et al. Secular trends in the cardiovascular risk profile and mortality of stroke admissions in an inner city, multiethnic population in the United Kingdom (1997-2005). J Hum Hypertens. 2008;22(1):18–23.PubMedCrossRefGoogle Scholar
  28. 28.
    Gunarathne A, Patel JV, Potluri R, et al. Increased 5-year mortality in the migrant south Asian stroke patients with diabetes mellitus in the United Kingdom: the West Birmingham stroke project. Int J Clin Pract. 2008;62(2):197–201.PubMedCrossRefGoogle Scholar
  29. 29.
    Meeks KA, Freitas-Da-Silva D, Adeyemo A, et al. Disparities in type 2 diabetes prevalence among ethnic minority groups resident in Europe: a systematic review and meta-analysis. Intern Emerg Med. 2016;11(3):327–40.PubMedCrossRefGoogle Scholar
  30. 30.
    Deleu D, Hamad AA, Kamram S, et al. Ethnic variations in risk factor profile, pattern and recurrence of non-cardioembolic ischemic stroke. Arch Med Res. 2006;37(5):655–62.PubMedCrossRefGoogle Scholar
  31. 31.
    Eastwood SV, Tillin T, Chaturvedi N, Hughes AD. Ethnic differences in associations between blood pressure and stroke in South Asian and European men. Hypertension. 2015;66(3):481–8.PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Howard VJ, Kleindorfer DO, Judd SE, McClure LA, Safford MM, Rhodes JD, Cushman M, Moy CS, Soliman EZ, Kissela BM, Howard G. Disparities in stroke incidence contributing to disparities in stroke mortality. Ann Neurol. 2011;69(4):619–27.PubMedPubMedCentralCrossRefGoogle Scholar
  33. 33.
    Chen R, McKevitt C, Rudd AG, Wolfe CDA. Socioeconomic deprivation and survival after stroke: findings from the Prospective South London Stroke Register of 1995 to 2011. Stroke. 2014;45(1):217–23.PubMedCrossRefGoogle Scholar
  34. 34.
    Mayeda ER, Banack HR, Bibbins-Domingo K, Zeki Al Hazzouri A, Marden JR, Whitmer RA, Glymour MM. Can survival bias explain the age attenuation of racial inequalities in stroke incidence?: a simulation study. Epidemiology. 2018;29(4):525–32.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Zhao D, Liu J, Xie W, et al. Cardiovascular risk assessment: a global perspective. Nat Rev Cardiol. 2015;12(5):301–11.PubMedCrossRefGoogle Scholar
  36. 36.
    Modesti PA. Ethnicity: new challenge for cardiovascular prevention in Europe. Hypertension. 2015;66(3):464–5.PubMedCrossRefGoogle Scholar
  37. 37.
    Brewster LM, van Montfrans GA, Oehlers GP, et al. Systematic review: antihypertensive drug therapy in patients of African and South Asian ethnicity. Intern Emerg Med. 2016;11(3):355–74.PubMedPubMedCentralCrossRefGoogle Scholar
  38. 38.
    Agyemang C, van Oeffelen AA, Norredam M, et al. Socioeconomic inequalities in stroke incidence among migrant groups: analysis of nationwide data. Stroke. 2014;45(8):2397–403.PubMedCrossRefGoogle Scholar
  39. 39.
    Adams HP Jr, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in acute stroke treatment. Stroke. 1993;24(1):35–41.PubMedPubMedCentralCrossRefGoogle Scholar
  40. 40.
    Markus HS, Khan U, Birns J, et al. Differences in stroke subtypes between black and white patients with stroke: the South London ethnicity and stroke study. Circulation. 2007;116(19):2157–64.PubMedCrossRefGoogle Scholar
  41. 41.
    Gulli G, Rutten-Jacobs LC, Kalra L, et al. Differences in the distribution of stroke subtypes in a UK black stroke population - final results from the South London ethnicity and stroke study. BMC Med. 2016;14:77.PubMedPubMedCentralCrossRefGoogle Scholar
  42. 42.
    Gunarathne A, Patel JV, Gammon B, et al. Ischemic stroke in South Asians: a review of the epidemiology, pathophysiology, and ethnicity-related clinical features. Stroke. 2009;40(6):e415–23.PubMedCrossRefGoogle Scholar
  43. 43.
    Banerjee S, Biram R, Chataway J, et al. South Asian strokes: lessons from the St Mary’s stroke database. QJM. 2010;103(1):17–21.PubMedCrossRefGoogle Scholar
  44. 44.
    Ramadan H, Patterson C, Maguire S, et al. Incidence of first stroke and ethnic differences in stroke pattern in Bradford, UK: Bradford Stroke Study. Int J Stroke. 2018;13(4):374–8.PubMedCrossRefGoogle Scholar
  45. 45.
    Syed NA, Khealani BA, Ali S, et al. Ischemic stroke subtypes in Pakistan: the Aga Khan University Stroke Data Bank. J Pak Med Assoc. 2003;53(12):584–8.PubMedGoogle Scholar
  46. 46.
    De Silva DA, Woon FP, Pin LM, et al. Intracranial large artery disease among OCSP subtypes in ethnic south Asian ischemic stroke patients. J Neurol Sci. 2007;260(1–2):147–9.PubMedCrossRefGoogle Scholar
  47. 47.
    Kim BJ, Kim JS. Ischemic stroke subtype classification: an Asian viewpoint. J Stroke. 2014;16(1):8–17.PubMedPubMedCentralCrossRefGoogle Scholar
  48. 48.
    Gorelick PB, Wong KS, Bae HJ, et al. Large artery intracranial occlusive disease: a large worldwide burden but a relatively neglected frontier. Stroke. 2008;39(8):2396–9.PubMedCrossRefGoogle Scholar
  49. 49.
    Sacco RL, Kargman DE, Zamanillo M. Race-ethnic differences in stroke risk-factors among hospitalized-patients with cerebral infarction—the Northern Manhattan Stroke Study. Neurology. 1995;45(4):659–63.PubMedPubMedCentralCrossRefGoogle Scholar
  50. 50.
    Kim JS, Kim YJ, Ahn SH, et al. Location of cerebral atherosclerosis: why is there a difference between east and west? Int J Stroke. 2018;13(1):35–46.PubMedCrossRefGoogle Scholar
  51. 51.
    Kim SJ, Ryoo S, Kwon S, et al. Is atrial fibrillation always a culprit of stroke in patients with atrial fibrillation plus stroke? Cerebrovasc Dis. 2013;36(5–6):373–82.PubMedCrossRefGoogle Scholar
  52. 52.
    Jackson C, Sudlow C. Comparing risks of death and recurrent vascular events between lacunar and non-lacunar infarction. Brain. 2005;128:2507–17.PubMedPubMedCentralCrossRefGoogle Scholar
  53. 53.
    Gouw AA, Seewann A, van der Flier WM, et al. Heterogeneity of small vessel disease: a systematic review of MRI and histopathology correlations. J Neurol Neurosurg Psychiatry. 2011;82(2):126–35.PubMedCrossRefGoogle Scholar
  54. 54.
    Charidimou A, Kakar P, Fox Z, et al. Cerebral microbleeds and recurrent stroke risk: systematic review and meta-analysis of prospective ischemic stroke and transient ischemic attack cohorts. Stroke. 2013;44(4):995–1001.PubMedCrossRefGoogle Scholar
  55. 55.
    Conklin J, Silver FL, Mikulis DJ, et al. Are acute infarcts the cause of leukoaraiosis? Brain mapping for 16 consecutive weeks. Ann Neurol. 2014;76(6):899–904.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Public Health, Academic Medical Center, Amsterdam Public Health Research InstituteUniversity of AmsterdamAmsterdamThe Netherlands
  2. 2.Department of Clinical and Experimental MedicineUniversity of FlorenceFirenzeItaly

Personalised recommendations