947. Stroke demographics and risk factor profile in HIV infected individuals in Florida

Abstract Background The risk of ischemic stroke (IS) is known to be higher in people living with HIV (PLWH) than uninfected controls. However, information about the demographics and risk factors for hemorrhagic stroke (HS) in PLWH is scant. Specifically, very little is known about the differences in the stroke risk factors between HS and IS in PLWH. The goal of this study was to determine the demographics and risk factor differences between HS and IS in PLWH. Methods We retrospectively analyzed the demographic and clinical data of PLWH in OneFlorida (1FL) Clinical Research Consortium from October 2015 to December 2018. 1FL is a large statewide clinical research network and database which contains health information of over 15 million patients, 1240 clinical practices, and 22 hospitals. We compared HS and IS based on documented ICD 9 and 10 diagnostic codes and extracted information about sociodemographic data, traditional stroke risk factors, Charlson comorbidity scores, habits, HIV factors, diagnostic modalities and medications. Statistical significance was determined using 2-sample T-test for continuous variables and adjusted Pearson chi square for categorical variables. Odds ratio (OR) and 95% confidence intervals (CI) between groups were compared. Results Overall, from 1FL sample of 13986 people living with HIV, 574 subjects had strokes during the study period. The rate of any stroke was 18.2/1000 person-years (PYRS). The rate of IS was 10.8/1000 PYRS while the rate of HS was 3.7/1000 PYRS, corresponding to 25.4% HS of all strokes in the study. Table 1 summarizes the pertinent demographic and risk factors for HS and IS in PLWH in the study. Table 1: Summary of pertinent demographic and risk factors for hemorrhagic and ischemic strokes in people living with HIV from One Florida database Conclusion In this large Floridian health database, demographics and risk factor profile differs between HS and IS in PLWH. Younger age group is associated with HS than IS. However, hypertension, hyperlipidemia and coronary artery disease are more likely to contribute to IS than HS in PLWH. Further research is needed to better understand the interplay between known and yet unidentified risk factors that may be contributing to HS and IS in PLWH. Disclosures All Authors: No reported disclosures

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Abstract T P136: Potential Contributors to the Declining Impact of Stroke Risk Factors with Age: Implications for Stroke Epidemiology in the Elderly

Stroke ◽

10.1161/str.45.suppl_1.tp136 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

George Howard ◽

Mary Cushman ◽

Maciej Banach ◽

Brett M Kissela ◽

David C Goff ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Stroke Risk ◽

Multivariable Analysis ◽

The Elderly ◽

Stroke Risk Factors ◽

Age Related ◽

Increased Risk ◽

The Impact ◽

Age Related Changes

Purpose: The importance of stroke research in the elderly is increasing as America is “graying.” For most risk factors for most diseases (including stroke), the magnitude of association with incident events decreases at older ages. Potential changes in the impact of risk factors could be a “true” effect, or could be due to methodological issues such as age-related changes in residual confounding. Methods: REGARDS followed 27,748 stroke-free participants age 45 and over for an average of 5.3 years, during which 715 incident strokes occurred. The association of the “Framingham” risk factors (hypertension [HTN], diabetes, smoking, AFib, LVH and heart disease) with incident stroke risk was assessed in age strata of 45-64 (Young), 65-74 (Middle), and 75+ (Old). For those with and without an “index” risk factor (e.g., HTN), the average number of “other” risk factors was calculated. Results: With the exception of AFib, there was a monotonic decrease in the magnitude of the impact across the age strata, with HTN, diabetes, smoking and LVH even becoming non-significant in the elderly (Figure 1). However, for most factors, the increasing prevalence of other risk factors with age impacts primarily those with the index risk factor absent (Figure 2, example HTN as the “index” risk factor). Discussion: The impact of stroke risk factors substantially declined at older ages. However, this decrease is partially attributable to increases in the prevalence of other risk factors among those without the index risk factor, as there was little change in the prevalence of other risk factors in those with the index risk factor. Hence, the impact of the index risk factor is attenuated by increased risk in the comparison group. If this phenomenon is active with latent risk factors, estimates from multivariable analysis will also decrease with age. A deeper understanding of age-related changes in the impact of risk factors is needed.

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Abstract P602: Stroke Risk Factors Among the Young Over Time in the GCNKSS

Stroke ◽

10.1161/str.52.suppl_1.p602 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Tracy E Madsen ◽

Jane C Khoury ◽

Kathleen S Alwell ◽

Opeolu M Adeoye ◽

Felipe De Los Rios La Rosa ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Stroke Risk ◽

Large Population ◽

High Cholesterol ◽

Stroke Incidence ◽

Stroke Risk Factors ◽

Obesity And Diabetes ◽

Trends Over Time ◽

Over Time

Background: Data from the Greater Cincinnati Northern Kentucky Stroke Study (GCNKSS) have demonstrated stable or increasing stroke incidence rates in young adults with differences by sex and race, suggesting the need for targeted approaches to stroke prevention in the young. We aimed to describe trends over time in prevalence of stroke risk factors among adults ages 20-54 with stroke by sex and race. Methods: Cases of incident stroke (IS, ICH, SAH) occurring in those 20-54 years old and living in a 5-county area of southern Ohio/northern Kentucky were ascertained during 5 study periods (1993-1994, 1999, 2005, 2010, 2015). All physician-adjudicated inpatient events and a sampling of outpatient events were included, excluding nursing home events. Data on risk factors (hypertension, diabetes, obesity (BMI≥30), and high cholesterol) diagnosed prior to stroke were abstracted from medical records, and prevalence of each risk factor was reported over time in race/sex groups. Trends over time were examined using the Cochran-Armitage test. Results: Over the 5 study periods, 1204 incident strokes were included; 49% were women, 33% were black, and mean age was 46 (SD 7) years. Premorbid hypertension increased over time in Black women (48% in 1993/4 to 76% in 2015, p=0.005) but not in any other race/sex group (all p>0.05). Premorbid high cholesterol increased significantly in all race/sex groups (Figure, all p<0.05) except for White men (p=0.06). There were no significant trends over time in pre-stroke diagnoses of diabetes or obesity in any of the race/sex groups (Figure). Conclusions: Among patients aged 20-54 with incident stroke in a large population-based study, the change in the prevalence of hypertension and high cholesterol differed by sex and race, while obesity and diabetes were stable over time in all race/sex groups. Future research is needed to address risk factor control at a population level and to understand the role of undiagnosed pre-stroke risk factors in the young.

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Abstract NS6: Family History of Stroke: Invisibility of a Key Stroke Risk Factor among High Risk African Americans

Stroke ◽

10.1161/str.44.suppl_1.ans6 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Dawn M Aycock ◽

Kenya D Kirkendoll ◽

Kisha C Coleman ◽

Karen C Albright ◽

Anne W Alexandrov

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Family History ◽

Perceived Control ◽

Stroke Risk ◽

Perceived Threat ◽

Stroke Risk Factor ◽

Stroke Risk Factors ◽

History Of ◽

Physiologic Data

Background & Purpose: Young to middle aged African Americans (AA) are at greater risk for a first-ever stroke, severe neurologic disability, and stroke-related mortality, than Caucasians of similar age; however, it remains unclear what role a family history of stroke (FHS) plays in promoting adoption of healthier lifestyles in this cohort. The purpose of this study was to explore differences between rural Stroke Belt AA with a FHS (e.g. parent/grandparent/sibling) on modifiable stroke risk factors, knowledge, perceived threat and perceived control of stroke, and exercise behaviors to AA without a FHS. Methods: A cross-sectional study was conducted recruiting AA aged 19-54 from the Black Belt region of Alabama via a mobile health clinic. Participants’ perceptions, knowledge, exercise history/intent, physiologic data, and health history were recorded. Results: Participants (N=66) averaged 43.3+9.4 years, were 71% female, with at least 12 years of school (89%), and unemployed (62%). Common risk factors were insufficient exercise (76%), obesity (59%), hypertension (53%; blood pressure M=145+17.6/88.3+12.9), and cigarette smoking (38%). Participants with a FHS (n=33) did not differ on average number of risk factors compared to those without a FHS (FHS 2.8+1.4 vs. 2.2+1.5; t(64)= 1.73, p=.089), nor did they differ on physiologic data. However, participants with a FHS were more likely to report a history of hypertension (67%) compared to those without a FHS (33%; χ2 =4.93, p <.05). There were no significant differences between groups for knowledge of stroke risk factors, perceived threat and perceived control of stroke, or recent exercise performance, although participants with a FHS (3.4+1.2) had significantly lower future intentions to exercise compared to those without a FHS (3.9+0.8); t(64)=2.45, p<.05). Conclusions: Although FHS is a significant non-modifiable risk factor for stroke and was common in this young to middle-aged AA cohort, FHS did not drive perceived stroke risk, risk factor control, or current/future intentions to exercise. Identification of interventions designed to personalize FHS as a key stroke risk factor, while promoting lifestyle change and self-management, may play an important role in future primary stroke prevention.

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Abstract TP203: Reducing Stroke Burden in Uganda

Stroke ◽

10.1161/str.48.suppl_1.tp203 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Mark Kaddumukasa ◽

Jane Nakibuuka ◽

James Kayima ◽

Elly Katabira ◽

Carol Blixen ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Stroke Risk ◽

Growth Patterns ◽

Warning Signs ◽

Clear Understanding ◽

Stroke Risk Factor ◽

Stroke Risk Factors ◽

Study Participants ◽

Stroke Knowledge

Background: Stroke is a neurological condition with rapidly increasing burden in many low- and middle-income countries. Africa is particularly hard-hit due to rapid population growth, patterns of industrialization, adoption of harmful western diets, and increased prevalence of risk factors such as hypertension and obesity. Reducing stroke risk factors and teaching people to respond to stroke warning signs can prevent stroke and reduce burden. However, being able to address gaps in knowledge and improving both preventative and early-response care requires a clear understanding of practical and potentially modifiable topics. Methods: A cross sectional survey was conducted in urban Mukono district in central Uganda. Through a systematic sampling method, data were gathered from 440 adult participants who were interviewed about selected aspects of stroke knowledge, attitudes and perception, using a pretested structured questionnaire. Results: Of the 440 study participants enrolled for this study nearly 52% correctly reported that stroke involves the brain, while 57% reported that stroke is preventable. Majority of the participants 75.7% reported stress as a contributing factor. Only 45.7% of the study participants reported hypertension as a risk factor. Only two (0.5%) study participants identified cigarette smoking as a stroke risk factor. Of the eighty six study participants with hypertension only 39.5% knew hypertension as a risk factor and only 10.7% knew three or more stroke risk factors. Conclusion: Stroke knowledge is poor in urban Uganda. Individuals with hypertension had poor knowledge regarding stroke in spite their high risk for stroke. Stress and hypertension are the leading perceived risk factors in our settings. While stress is highly reported as a stroke risk factor in this study hypertension is likely a more amenable and practical intervention target.

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Non-valvular atrial fibrillation patients with none or one additional risk factor of the CHA2DS2-VASc score

Thrombosis and Haemostasis ◽

10.1160/th15-07-0565 ◽

2015 ◽

Vol 114 (10) ◽

pp. 826-834 ◽

Cited By ~ 70

Author(s):

Flemming Skjøth ◽

Peter Nielsen ◽

Torben Bjerregaard Larsen ◽

Gregory Lip

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Stroke Risk ◽

Additional Risk Factor ◽

Stroke Risk Factor ◽

Stroke Risk Factors ◽

Long Run ◽

One Year ◽

Net Clinical Benefit

SummaryOral anticoagulation (OAC) to prevent stroke has to be balanced against the potential harm of serious bleeding, especially intracranial haemorrhage (ICH). We determined the net clinical benefit (NCB) balancing effectiveness and safety of no antithrombotic therapy, aspirin and warfarin in AF patients with none or one stroke risk factor. Using Danish registries, we determined NCB using various definitions intrinsic to our cohort (Danish weights at 1 and 5 year follow-up), with risk weights which were derived from the hazard ratio (HR) of death following an event, relative to HR of death after ischaemic stroke. When aspirin was compared to no treatment, NCB was neutral or negative for both risk strata. For warfarin vs no treatment, NCB using Danish weights was neutral where no risk factors were present and using five years follow-up. For one stroke risk factor, NCB was positive for warfarin vs no treatment, for one year and five year follow-up. For warfarin vs aspirin use in patients with no risk factors, NCB was positive with one year follow-up, but neutral with five year follow-up. With one risk factor, NCB was generally positive for warfarin vs aspirin. In conclusion, we show a positive overall advantage (i.e. positive NCB) of effective stroke prevention with OAC, compared to no therapy or aspirin with one additional stroke risk factor, using Danish weights. ‘Low risk’ AF patients with no additional stroke risk factors (i.e. CHA2DS2-VASc 0 in males, 1 in females) do not derive any advantage (neutral or negative NCB) with aspirin, nor with warfarin therapy in the long run.Note: The review process for this manuscript was fully handled by Christian Weber, Editor in Chief.

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Trends of risk profile among middle-aged adults hospitalized for acute ischemic stroke in United States 2006–2017

International Journal of Stroke ◽

10.1177/1747493020979379 ◽

2020 ◽

pp. 174749302097937

Author(s):

Xin Tong ◽

Quanhe Yang ◽

Mary G George ◽

Cathleen Gillespie ◽

Robert K Merritt

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Stroke Risk ◽

Stroke Patients ◽

Stroke Risk Factors ◽

Percent Change ◽

Lipid Disorders ◽

Major Stroke

Background Recent studies reported increasing trends in hospitalization of stroke patients aged 35–64 years. Aim To examine changes in risk factor profiles among patients aged 35–64 years hospitalized with acute ischemic stroke between 2006 and 2017 in the United States. Methods We used data from the National Inpatient Sample of the Healthcare Cost and Utilization Project from 2006 through 2017. Principal ICD-9-CM/ICD-10-CM codes were used to identify acute ischemic stroke hospitalizations, and secondary codes were used to identify the presence of four major stroke risk factors: hypertension, diabetes, lipid disorders, and tobacco use. We used the relative percent change to assess the changes in the prevalence of risk profile between 2006–2007 and 2016–2017 and linear regression models to obtain the p values for the overall trends across six time periods. Results Approximately 1.5 million acute ischemic stroke hospitalizations occurred during 2006–2017. The prevalence of having all four risk factors increased from 4.1% in 2006–2007 to 9.1% in 2016–2017 (relative percent change 122.0%, p < 0.001 for trend), prevalence of any three risk factors increased from 24.5% to 33.8% (relative percent change 38.0%, p < 0.001). Prevalence of only two risk factors decreased from 36.1% to 32.7% (p < 0.001), only one risk factor decreased from 25.2% to 18.1% (p < 0.001), and absence of risk factors decreased from 10.1% to 6.2% (p < 0.001). The most prevalent triad of risk factors was hypertension, diabetes, and lipid disorders (14.3% in 2006–2007 and 19.8% in 2016–2017), and the most common dyad risk factors was hypertension and lipid disorders (12.6% in 2006–2007 and 11.9% in 2016–2017). Conclusions The prevalence of hospitalized acute ischemic stroke patients aged 35–64 years with all four or any three of four major stroke risk factors increased by 122% and 38%, while those with only one risk factor or no risk factor has declined by 28% and 39%, respectively, from 2006 to 2017. Younger adults are increasingly at higher risk for stroke from preventable and treatable risk factors. This growing public health problem will require clinicians, healthcare systems, and public health efforts to implement more effective prevention strategies among this population.

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Knowledge of stroke risk factors among the patients with previous stroke or transient ischemic attack in a tertiary care hospital of Bangladesh

BIRDEM Medical Journal ◽

10.3329/birdem.v11i1.51026 ◽

2020 ◽

Vol 11 (1) ◽

pp. 22-29

Author(s):

Md Rashedul Islam ◽

Tanbin Rahman ◽

Rafi Nazrul Islam ◽

Mohammad Sakhawat Hossen Khan ◽

Mofizul Islam ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Carotid Stenosis ◽

Analysis Of Variance ◽

Stroke Risk ◽

Categorical Variables ◽

Care Hospital ◽

Stroke Risk Factors ◽

Previous Stroke ◽

History Of

Background: Patients of stroke or transient ischaemic attacks (TIA) are at risk of further stroke. Our objective was to study patients admitted with stroke/TIA regarding their knowledge about risk factors for having anew event of stroke/TIA, possible associations between patient characteristics and patients’ knowledge about risk factors, and patients’ knowledge about their preventive treatment for stroke/TIA. Methods: A questionnaire was used for 200 patients with stroke/TIA diagnoses. We asked 13 questions about diseases/conditions and lifestyle factors known to be risk factors and four questions regarding other diseases/ conditions (“distractors”). Additional questions concerned with the patients’ social and functional status and their drug use were asked. Categorical variables were analyzed using chi square test, while one-way analysis of variance and univariate analysis of variance were used for continuous variables. Logistic regression was employed to describe risk. A p value of, p < 0.05 was considered statistically significant. Results: The risk factors that were most often identified by the patients were Diabetes(75.9%), hypertension(83.3%), previous stroke or TIA(81.5%), smoking (85.2%), regular exercise(75.9%), older age(83.3%), overweight (75.9%) and patients with ischemic heart disease (70.4%). Atrial fibrillation and carotid stenosis were identified by less than 50% of the patients. 44.5% of the patients could identify 10 or more stroke/TIA risk factors. We observed that higher age, having a diagnosis of cerebral infarction/TIA, patients residing in urban area, high income group, businessman/retired service holder, family history of cardiovascular disease, past history of stroke / TIA were related to better knowledge of stroke/TIA risk factors. Anticoagulants and antiplatelets are important drugs for stroke/TIA prevention but only 20(9.3%) of the patients who reported anticoagulants and 76(35.2%) of the patients taking these drugs marked them as intended for prevention. Conclusion: Knowledge about diabetes, hypertension and smoking as risk factors was good, and patients who suffered from atrial fibrillation or carotid stenosis seemed to be less informed about these conditions as risk factors. The knowledge level was low regarding the use of anticoagulants and antiplatelets for stroke/TIA prevention. Better patient educational strategies for stroke/TIA patients should be developed. Furthermore, individuals with less knowledge should be given special consideration when developing strategies and programmes thus improving awareness of stroke risk factors. Birdem Med J 2021; 11(1): 22-29

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Abstract W P423: Women Perceive Differences in Stroke Prevention Care Based on their Primary Care Physician’s Specialty

Stroke ◽

10.1161/str.46.suppl_1.wp423 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Hanna King ◽

Clotilde Balucani ◽

Dimitre Stefanov ◽

Mary Rosser ◽

Brian Tark ◽

...

Keyword(s):

Risk Factors ◽

Stroke Prevention ◽

Stroke Risk ◽

Demographic Variables ◽

Categorical Variables ◽

Exact Test ◽

Stroke Risk Factors ◽

Patient Demographics ◽

Stroke Prevalence ◽

Women’S Perceptions

BACKGROUND: Women have higher lifetime risk of stroke than men. Many women rely solely on their Ob/Gyn as their PCP; however, there are no data on women’s perceptions of stroke prevention (SP) care by their Ob/Gyn. OBJECTIVES: to explore (1) women’s perceptions of SP based on their PCP’s specialty; (2) if ethnicity or age influenced women’s selection of PCP specialty; and (3) women’s awareness of stroke prevalence and preferences for which type of PCP address their stroke risk factors. METHODS: We administered surveys to 224 women at Ob/Gyn (n = 132) and PCP (n = 94) clinics in Brooklyn, NY. Surveys consisted of 16 questions on patient demographics, awareness of stroke prevalence, stroke risk factors, specialties of physicians they regularly visit, preferences for SP and SP care received. Kruskall-Wallis and Mann-Whitney tests were used to compare ordinal variables. Fisher’s exact test was used for categorical variables. RESULTS: We found a difference (p < 0.0001) in the mean age (but not in other demographic variables) of women who only visited an Ob/Gyn (30.0yrs±6.0) compared with those who visited an Ob/Gyn and another PCP (44.2±15.9) and those who visited at least one non-Ob/Gyn PCP (55.7±17.7). Women recalled: BP measurement by Ob/Gyn in 75% vs. 95% by other PCP (p<0.001); cholesterol measurement by Ob/Gyn 24% vs. other PCP 59% (p<0.0001); diabetes screening (p = 0.17) and weight measurement (p = 1.0) were similar. Awareness of stroke prevalence differed (p = 0.04) among women visiting only an Ob/Gyn (mean 0.5±0.7 correct answers), women visiting Ob/Gyn and at least one other PCP (1.0±0.8) and women visiting only a non-Ob/Gyn PCP (1.2±0.8). Women reported a greater preference for addressing SP with their non-Ob/Gyn PCP (73%) vs. their Ob/Gyn (2%) vs. no preference (26%). CONCLUSIONS: Ob/Gyn are perceived to provide less SP care than non-Ob/Gyn PCP. However, most women would prefer to address SP with their non-Ob/Gyn PCP. Women who visit only an Ob/Gyn and no other PCP were younger and less aware of stroke prevalence than women who visited other PCP. This surrogate approach to actual SP care evaluation suggests a need for assessing Ob/Gyn practices in SP.

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Abstract WMP54: Estimates of the U.S. Burden of Pregnancy-Associated Stroke Attributable to Common Vascular Risk Factors

Stroke ◽

10.1161/str.51.suppl_1.wmp54 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Abhinaba Chatterjee ◽

Neal S Parikh ◽

Babak B Navi ◽

Hooman Kamel

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Ischemic Stroke ◽

Pregnant Women ◽

Stroke Risk ◽

Hypertensive Disorders Of Pregnancy ◽

Stroke Risk Factors ◽

Hypertensive Disorders ◽

The U.S ◽

In Pregnancy

Background: The incidence of pregnancy-associated stroke may be increasing. The degree to which this increase is associated with increases in common stroke risk factors is uncertain. Methods: We used the National Inpatient Sample (NIS) and National Health and Nutrition Examination Survey (NHANES) to estimate the change between 1999 through 2014 in the prevalence of common stroke risk factors among women 12-45 years of age. These risk factors were hypertensive disorders of pregnancy (gestational hypertension, preeclampsia, or eclampsia), which was ascertained using NIS, and diabetes mellitus, obesity, and smoking, which were ascertained using NHANES. We extracted previously published relative risk estimates for the association between each risk factor and ischemic stroke in pregnant women. Using these estimates, we calculated the attributable risk and expected number of ischemic strokes among pregnant women with each risk factor. We used the NIS to estimate the trend in ischemic strokes documented during a hospitalization for labor and delivery, and modeled trends in such strokes attributable to changes in the prevalence of each stroke risk factor over time. Results: The rate of ischemic stroke increased from 7.7 (95% CI, 5.0-10.5) per 100,000 deliveries in 1999-2000 to 12.7 (95% CI, 9.5-15.9) per 100,000 deliveries in 2013-2014 (Fig). Based on changes in the prevalence of hypertensive disorders of pregnancy, diabetes, obesity, and smoking between 1999 and 2014, the expected increase in pregnancy-associated stroke attributable to these risk factors would be approximately 10%, in contrast to the nearly 65% relative increase in strokes documented during pregnancy hospitalizations during this period. Conclusions: Changes in the prevalence of common stroke risk factors explain a small fraction of the apparent increase in pregnancy-associated stroke in the U.S. during the past 2 decades.

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Abstract WP224: Impact of Stroke Risk Factors on Ethnic Stroke Disparities Among Midlife Mexican Americans and Non-hispanic Whites

Stroke ◽

10.1161/str.48.suppl_1.wp224 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Rajiv C Patel ◽

Brisa Sanchez ◽

Lewis Morgenstern ◽

Chengwei Li ◽

Lynda Lisabeth

Keyword(s):

Risk Factors ◽

High School ◽

At Risk ◽

Risk Factor ◽

Health Insurance ◽

Mexican Americans ◽

Stroke Risk ◽

Census Data ◽

Population At Risk ◽

Stroke Risk Factors

Introduction: Overall ischemic stroke (IS) incidence has declined in the US, but has remained stable among midlife (age 45-59) adults and is higher in midlife Mexican Americans (MAs). We examined the contribution of stroke risk factors to ethnic differences in IS rates among midlife MAs and non-Hispanic Whites (NHWs) in a population-based study. Methods: Incident IS (N=823) counts and corresponding risk factors were identified from the BASIC Project, Nueces County, Texas (2000-2010). US Census data (2000) for Nueces County was used to estimate the population at-risk for stroke, and the Texas Behavioral Risk Factor Surveillance System for Public Health Region 11(2000-2010) was used to estimate prevalence of risk factors in the stroke free population. Poisson regressions were run combining stroke counts (numerator) and population at-risk counts (denominator) classified by ethnicity and risk factor status to estimate unadjusted and risk factor adjusted associations between ethnicity and IS rates. Separate models were run for each risk factor (diabetes, hypertension, coronary heart disease, high cholesterol, education < high school, no health insurance, current smoking, BMI>30), and extended to include an interaction term between ethnicity and risk factor. Results: The crude ethnic IS rate ratio (RR) comparing MAs with NHWs was 2.13 (95% CI: 1.84-2.47). The ethnic RR was lower in models that adjusted for diabetes (RR:1.54; 95% CI: 1.31-1.78), hypertension (RR: 1.92; 95% CI: 1.65-2.22), and education < high school (RR: 2.02; 95% CI: 1.72-2.38) compared to the crude association. Ethnicity significantly modified associations between diabetes, smoking, health insurance, education and IS rates. Associations between diabetes and IS rates was greater among MAs (RR: 6.82, 95% CI: 5.76-8.07) compared with NHWs (RR: 4.40, 95% CI: 3.33-5.81), while smoking associations were greater in NHWs (MA RR: 2.61, 95% CI: 2.20-3.10; NHW RR: 3.49, 95% CI: 2.73-4.46). Socioeconomic variables increased IS risk in NHWs but were insignificant or protective in MAs. Conclusion: Traditional stroke risk factors may contribute to midlife ethnic stroke disparities; particularly diabetes, given its high prevalence and stronger association with IS among midlife MAs as compared with NHWs.

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