Ethnic differences in incidence of stroke: prospective study with stroke register

BMJ 1999;318:967-971 ( 10 April )

Papers

Ethnic differences in incidence of stroke: prospective study with stroke register

Judith A Stewart, lecturer in stroke medicine, ^a R Dundas, research associate, ^a R S Howard, consultant neurologist, ^b A G Rudd, consultant physician, ^c C D A Wolfe, reader in public health medicine. ^a

^a Department of Public Health Sciences, Guy's, King's College, and St Thomas's School of Medicine, 5th Floor, Capital House, London SE1 3QD, ^b Department of Neurology, St Thomas's Hospital, London SE1 5EH, ^c Stroke Unit, St Thomas's Hospital, London SE1 5EH

Correspondence to: Dr Wolfe c.wolfe{at}umds.ac.uk

Objective: To identify ethnic differences in the incidenceof first everstroke.
Design: A prospective community stroke register (1995-6)with multiple notification sources. Pathological classificationof stroke in all cases was based on brain imaging or necropsydata. Rates were standardised to European and world populationsand adjusted for age, sex, and social class in multivariateanalysis.
Setting: A multi-ethnic population of 234 533 in southLondon, of whom 21% areblack.
Results: 612 strokes were registered. The crude annualincidence rate was 1.3 strokes per 1000 population per year (95%confidence interval 1.20 to 1.41) and 1.25 per 1000 populationper year (1.15 to 1.35) age adjusted to the standard Europeanpopulation. Incidence rates adjusted for age and sex were significantlyhigher in black compared with white people (P<0.0001), with anincidence rate ratio of 2.21 (1.77 to 2.76). In multivariableanalysis increasing age (P<0.0001), male sex (P<0.003), blackethnic group (P<0.0001), and lower social class (P<0.0001) inpeople aged 35-64 were independently associated with an increasedincidence ofstroke.
Conclusions: Incidence rates of stroke are higher in theblack population; this is not explained by confounders such associal class, age, and sex. Ethnic differences in genetic, physiological,and behavioural risk factors for stroke require further elucidationto aid development of effective strategies for stroke preventionin multi-ethniccommunities.

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

© BMJ 1999

CiteULike

Complore

Connotea

Del.icio.us Add to Digg

Digg

Technorati What's this?

Predicting cardiovascular risk in England and Wales: prospective derivation and validation of QRISK2: Julia Hippisley-Cox, Carol Coupland, Yana Vinogradova, John Robson, Rubin Minhas, Aziz Sheikh, and Peter Brindle
BMJ 2008 336: 1475-1482. [Abstract] [Full Text] [PDF]

Persistent high stroke mortality in Bangladeshi populations: Raj Bhopal, Taslin Rahemtulla, and Aziz Sheikh
BMJ 2005 331: 1096-1097. [Extract] [Full Text] [PDF]

Survival differences after stroke in a multiethnic population: follow-up study with the south London stroke register: Charles D A Wolfe, Nigel C Smeeton, Catherine Coshall, Kate Tilling, and Anthony G Rudd
BMJ 2005 331: 431. [Abstract] [Full Text] [PDF]

Black people are twice as likely as white people to suffer stroke
BMJ 1999 318: 0. [Full Text]

This article has been cited by other articles:

Hippisley-Cox, J., Coupland, C., Vinogradova, Y., Robson, J., Minhas, R., Sheikh, A., Brindle, P. (2008). Predicting cardiovascular risk in England and Wales: prospective derivation and validation of QRISK2. BMJ 336: 1475-1482 [Abstract] [Full text]
Brand-Herrmann, S.-M. (2008). Where Do We Go for Atherothrombotic Disease Genetics?. Stroke 39: 1070-1075 [Full text]
Sarker, S J, Heuschmann, P U, Burger, I, Wolfe, C D A, Rudd, A G, Smeeton, N C, Toschke, A M (2008). Predictors of survival after haemorrhagic stroke in a multi-ethnic population: the South London Stroke Register (SLSR). J. Neurol. Neurosurg. Psychiatry 79: 260-265 [Abstract] [Full text]
Smeeton, N. C., Heuschmann, P. U., Rudd, A. G., McEvoy, A. W., Kitchen, N. D., Sarker, S. J., Wolfe, C. D.A. (2007). Incidence of Hemorrhagic Stroke in Black Caribbean, Black African, and White Populations: The South London Stroke Register, 1995 2004. Stroke 38: 3133-3138 [Abstract] [Full text]
Patel, M. D., McKevitt, C., Lawrence, E., Rudd, A. G., Wolfe, C. D. A. (2007). Clinical determinants of long-term quality of life after stroke. Age Ageing 36: 316-322 [Abstract] [Full text]
Smithard, D. G., Smeeton, N. C., Wolfe, C. D. A. (2007). Long-term outcome after stroke: does dysphagia matter?. Age Ageing 36: 90-94 [Abstract] [Full text]
Wolfe, C. D.A., Corbin, D. O.C., Smeeton, N. C., Gay, G. H.E., Rudd, A. G., Hennis, A. J., Wilks, R. J., Fraser, H. S. (2006). Estimation of the Risk of Stroke in Black Populations in Barbados and South London. Stroke 37: 1986-1990 [Abstract] [Full text]
Patel, M. D., Tilling, K., Lawrence, E., Rudd, A. G., Wolfe, C. D. A., McKevitt, C. (2006). Relationships between long-term stroke disability, handicap and health-related quality of life.. Age Ageing 35: 273-279 [Abstract] [Full text]
Kalra, L., Rambaran, C., Iveson, E., Chowienczyk, P. J., Hambleton, I., Ritter, J. M., Shah, A., Wilks, R., Forrester, T. (2006). The Role of Inheritance and Environment in Predisposition to Vascular Disease in People of African Descent. J Am Coll Cardiol 47: 1126-1133 [Abstract] [Full text]
Jiang, B., Wang, W.-z., Chen, H., Hong, Z., Yang, Q.-d., Wu, S.-p., Du, X.-l., Bao, Q.-j. (2006). Incidence and Trends of Stroke and Its Subtypes in China: Results From Three Large Cities. Stroke 37: 63-65 [Abstract] [Full text]
Carter, K., Anderson, C., Hacket, M., Feigin, V., Barber, P. A., Broad, J. B., Bonita, R., on behalf of the Auckland Regional Community Strok, (2006). Trends in Ethnic Disparities in Stroke Incidence in Auckland, New Zealand, During 1981 to 2003. Stroke 37: 56-62 [Abstract] [Full text]
Bourke, J, Sylvester, R, Sharma, P (2006). Ethnic variations in the management of patients with acute stroke. Postgrad. Med. J. 82: 13-15 [Abstract] [Full text]
Bhopal, R., Rahemtulla, T., Sheikh, A. (2005). Persistent high stroke mortality in Bangladeshi populations. BMJ 331: 1096-1097 [Full text]
Syme, P. D., Byrne, A. W., Chen, R., Devenny, R., Forbes, J. F. (2005). Community-Based Stroke Incidence in a Scottish Population: The Scottish Borders Stroke Study. Stroke 36: 1837-1843 [Abstract] [Full text]
Wolfe, C. D A, Smeeton, N. C, Coshall, C., Tilling, K., Rudd, A. G (2005). Survival differences after stroke in a multiethnic population: follow-up study with the south London stroke register. BMJ 331: 431- [Abstract] [Full text]
Bravata, D. M., Wells, C. K., Gulanski, B., Kernan, W. N., Brass, L. M., Long, J., Concato, J. (2005). Racial Disparities in Stroke Risk Factors: The Impact of Socioeconomic Status. Stroke 36: 1507-1511 [Abstract] [Full text]
Ogun, S.A., Ojini, F.I., Ogungbo, B., Kolapo, K.O., Danesi, M.A. (2005). Stroke in South West Nigeria: A 10-Year Review. Stroke 36: 1120-1122 [Abstract] [Full text]
McKevitt, C., Coshall, C., Tilling, K., Wolfe, C. (2005). Are There Inequalities in the Provision of Stroke Care?: Analysis of an Inner-City Stroke Register. Stroke 36: 315-320 [Abstract] [Full text]
Feigin, V. L., Rodgers, A. (2004). Editorial Comment--Ethnic Disparities in Risk Factors for Stroke: What Are the Implications?. Stroke 35: 1568-1569 [Full text]
Hajat, C., Tilling, K., Stewart, J. A., Lemic-Stojcevic, N., Wolfe, C. D.A. (2004). Ethnic Differences in Risk Factors for Ischemic Stroke: A European Case-Control Study. Stroke 35: 1562-1567 [Abstract] [Full text]
Corbin, D. O.C., Poddar, V., Hennis, A., Gaskin, A., Rambarat, C., Wilks, R., Wolfe, C. D.A., Fraser, H. S. (2004). Incidence and Case Fatality Rates of First-Ever Stroke in a Black Caribbean Population: The Barbados Register of Strokes. Stroke 35: 1254-1258 [Abstract] [Full text]
Hillen, T, Davies, S, Rudd, A G, Kieselbach, T, Wolfe, C D (2003). Self ratings of health predict functional outcome and recurrence free survival after stroke. J. Epidemiol. Community Health 57: 960-966 [Abstract] [Full text]
Daneski, K, Coshall, C, Tillingand, K, Wolfe, C D A (2003). Reliability and validity of a postal version of the Reintegration to Normal Living Index, modified for use with stroke patients. Clin Rehabil 17: 835-839 [Abstract]
Jerrard-Dunne, P., Evans, A., McGovern, R., Hajat, C., Kalra, L., Rudd, A. G., Wolfe, C. D., Markus, H. S. (2003). Ethnic Differences in Markers of Thrombophilia: Implications for the Investigation of Ischemic Stroke in Multiethnic Populations: The South London Ethnicity and Stroke Study. Stroke 34: 1821-1826 [Abstract] [Full text]
Hilari, K., Byng, S., Lamping, D. L., Smith, S. C. (2003). Stroke and Aphasia Quality of Life Scale-39 (SAQOL-39): Evaluation of Acceptability, Reliability, and Validity. Stroke 34: 1944-1950 [Abstract] [Full text]
Olindo, S., Cabre, P., Deschamps, R., Chatot-Henry, C., Rene-Corail, P., Fournerie, P., Saint-Vil, M., May, F., Smadja, D. (2003). Acute Stroke in the Very Elderly: Epidemiological Features, Stroke Subtypes, Management, and Outcome in Martinique, French West Indies. Stroke 34: 1593-1597 [Abstract] [Full text]
Hillen, T., Coshall, C., Tilling, K., Rudd, A. G., McGovern, R., Wolfe, C. D.A. (2003). Cause of Stroke Recurrence Is Multifactorial: Patterns, Risk Factors, and Outcomes of Stroke Recurrence in the South London Stroke Register. Stroke 34: 1457-1463 [Abstract] [Full text]
Nazroo, J. Y. (2003). The Structuring of Ethnic Inequalities in Health: Economic Position, Racial Discrimination, and Racism. Am. J. Public Health 93: 277-284 [Abstract] [Full text]
Patel, M., Coshall, C., Rudd, A. G, Wolfe, C. D. (2003). Natural history of cognitive impairment after stroke and factors associated with its recovery. Clin Rehabil 17: 158-166 [Abstract]
Harari, D., Coshall, C., Rudd, A. G., Wolfe, C. D.A. (2003). New-Onset Fecal Incontinence After Stroke: Prevalence, Natural History, Risk Factors, and Impact. Stroke 34: 144-150 [Abstract] [Full text]
Redfern, J., McKevitt, C., Rudd, A. G, Wolfe, C. D. (2002). Health care follow-up after stroke: opportunities for secondary prevention. Fam Pract 19: 378-382 [Abstract] [Full text]
Wolfe, C D A, Rudd, A G, Howard, R, Coshall, C, Stewart, J, Lawrence, E, Hajat, C, Hillen, T (2002). Incidence and case fatality rates of stroke subtypes in a multiethnic population: the South London Stroke Register. J. Neurol. Neurosurg. Psychiatry 72: 211-216 [Abstract] [Full text]
Tilling, K., Sterne, J. A., Wolfe, C. D. (2001). Estimation of the incidence of stroke using a capture-recapture model including covariates. Int J Epidemiol 30: 1351-1359 [Abstract] [Full text]
Smadja, D., Cabre, P., May, F., Fanon, J.-L., Rene-Corail, P., Riocreux, C., Charpentier, J.-C., Fournerie, P., Saint-Vil, M., Ketterle, J. (2001). ERMANCIA: Epidemiology of Stroke in Martinique, French West Indies: Part I: Methodology, Incidence, and 30-Day Case Fatality Rate. Stroke 32: 2741-2747 [Abstract] [Full text]
Tilling, K., Sterne, J. A.C., Rudd, A. G., Glass, T. A., Wityk, R. J., Wolfe, C. D.A. (2001). A New Method for Predicting Recovery After Stroke. Stroke 32: 2867-2873 [Abstract] [Full text]
Markus, H., Kapozsta, Z., Ditrich, R., Wolfe, C., Ali, N., Powell, J., Mendell, M., Cullinane, M. (2001). Increased Common Carotid Intima-Media Thickness in UK African Caribbeans and Its Relation to Chronic Inflammation and Vascular Candidate Gene Polymorphisms. Stroke 32: 2465-2471 [Abstract] [Full text]
Stewart, R. (2001). NICE guidelines and the treatment of Alzheimer's disease: evidence-based medicine may be discriminatory. Br. J. Psychiatry 179: 367-367 [Full text]
Lawrence, E. S., Coshall, C., Dundas, R., Stewart, J., Rudd, A. G., Howard, R., Wolfe, C. D. A. (2001). Estimates of the Prevalence of Acute Stroke Impairments and Disability in a Multiethnic Population. Stroke 32: 1279-1284 [Abstract] [Full text]
Sandercock, J., Burls, A., Hyde, C., Fry-Smith, A., Barton, P., Bryan, S., Stewart, A., Wheatley, K., Gray, R., Stewart, R. (2001). Riluzole for motor neurone disease. BMJ 322: 1305-1305 [Full text]
Rudd, A. G, Irwin, P, Rutledge, Z, Lowe, D, Wade, D T, Pearson, M (2001). Regional variations in stroke care in England, Wales and Northern Ireland: results from the National Sentinel Audit of Stroke. Clin Rehabil 15: 562-572 [Abstract]
Cook, D. G., Cappuccio, F. P., Atkinson, R. W., Wicks, P. D., Chitolie, A., Nakandakare, E. R., Sagnella, G. A., Humphries, S. E. (2001). Ethnic Differences in Fibrinogen Levels: The Role of Environmental Factors and the {beta}-Fibrinogen Gene. Am J Epidemiol 153: 799-806 [Abstract] [Full text]
Tilling, K. (2001). Capture-recapture methods--useful or misleading?. Int J Epidemiol 30: 12-14 [Full text]
Hajat, C., Dundas, R., Stewart, J. A., Lawrence, E., Rudd, A. G., Howard, R., Wolfe, C. D. A. (2001). Cerebrovascular Risk Factors and Stroke Subtypes : Differences Between Ethnic Groups. Stroke 32: 37-42 [Abstract] [Full text]
Patel, M., Coshall, C., Rudd, A. G., Wolfe, C. D.A. (2001). Natural History and Effects on 2-Year Outcomes of Urinary Incontinence After Stroke. Stroke 32: 122-127 [Abstract] [Full text]
STEWART, R., PRINCE, M., MANN, A., RICHARDS, M., BRAYNE, C. (2001). Stroke, vascular risk factors and depression: Cross-sectional study in a UK Caribbean-born population. Br. J. Psychiatry 178: 23-28 [Abstract] [Full text]
Wolfe, C. D.A., Giroud, M., Kolominsky-Rabas, P., Dundas, R., Lemesle, M., Heuschmann, P., Rudd, A. (2000). Variations in Stroke Incidence and Survival in 3 Areas of Europe. Stroke 31: 2074-2079 [Abstract] [Full text]
Redfern, J., McKevitt, C., Dundas, R., Rudd, A. G., Wolfe, C. D.A. (2000). Behavioral Risk Factor Prevalence and Lifestyle Change After Stroke : A Prospective Study. Stroke 31: 1877-1881 [Abstract] [Full text]
Skelton, J. R, Edwards, S. J L (2000). The function of the discussion section in academic medical writing. BMJ 320: 1269-1270 [Full text]
Hillen, T., Dundas, R., Lawrence, E., Stewart, J. A., Rudd, A. G., Wolfe, C. D. A. (2000). Antithrombotic and Antihypertensive Management 3 Months After Ischemic Stroke : A Prospective Study in an Inner City Population. Stroke 31: 469-475 [Abstract] [Full text]
Johansson, B., Norrving, B., Lindgren, A. (2000). Increased Stroke Incidence in Lund-Orup, Sweden, Between 1983 to 1985 and 1993 to 1995. Stroke 31: 481-486 [Abstract] [Full text]
Dong, Y., Zhu, H., Sagnella, G. A., Carter, N. D., Cook, D. G., Cappuccio, F. P. (1999). Association Between the C825T Polymorphism of the G Protein {beta}3-Subunit Gene and Hypertension in Blacks. Hypertension 34: 1193-1196 [Abstract] [Full text]