RESUMEN
OBJECTIVE: Residential ethnic segregation may operate through multiple mechanisms to increase stroke risk. The current study evaluated if residential ethnic segregation was associated with stroke risk in a bi-ethnic population. DESIGN: Incident strokes were identified in Nueces County, Texas from 2000 to 2010. Residential ethnic segregation (range: 0-1) was derived for each census tract in the county (n=64) using 2000 US Census data, and categorized into: predominantly non-Hispanic White (NHW, <.3); ethnically mixed (.3-.7); predominantly Mexican American (MA, >.7). Multilevel Poisson regression models were fitted separately for NHWs and MAs to assess the association between residential ethnic segregation (predominantly NHW referent) and relative risk for stroke, adjusted for age category, sex and census tract-level median per capita income. Effect modification by age was also examined. RESULTS: In adjusted models, residential ethnic segregation was not associated with stroke risk in either ethnic group. Effect modification by age was significant in both groups. Young MAs and NHWs living in predominantly MA census tracts were at greater relative risk for stroke than those living in predominantly NHW census tracts, but this association was only significant for MAs (MAs: RR = 2.38 [95% CI: 1.31-4.31]; NHWs: RR = 1.53 [95% CI: .92-2.52]). CONCLUSION: Our findings demonstrate that residential ethnic segregation may influence downstream stroke risk in young MAs. Pathways between residential ethnic segregation and stroke in young MAs should be explored.
Asunto(s)
Americanos Mexicanos , Características de la Residencia , Accidente Cerebrovascular/etnología , Accidente Cerebrovascular/epidemiología , Anciano , Comorbilidad , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Vigilancia de la Población , Prevalencia , Factores de Riesgo , Texas/epidemiologíaRESUMEN
BACKGROUND: A wide variety of racial and ethnic disparities in stroke epidemiology and treatment have been reported. Race-ethnic differences in initial stroke severity may be one important determinant of differences in the outcome after stroke. The overall goal of this study was to move beyond ethnic comparisons in the mean or median severity, and instead investigate ethnic differences in the entire distribution of initial stroke severity. Additionally, we investigated whether age modifies the relationship between ethnicity and initial stroke severity as this may be an important determinant of racial differences in the outcome after stroke. METHODS: Ischemic stroke cases were identified from the population-based Brain Attack Surveillance in Corpus Christi (BASIC) project. National Institutes of Health Stroke Scale (NIHSS) was determined from the medical record or abstracted from the chart. Ethnicity was reported as Mexican American (MA) or non-Hispanic white (NHW). Quantile regression was used to model the distribution of NIHSS score by age category (45-59, 60-74, 75+) to test whether ethnic differences exist over different quantiles of NIHSS (5 percentile increments). Crude models examined the interaction between age category and ethnicity; models were then adjusted for history of stroke/transient ischemic attack, hypertension, atrial fibrillation, coronary artery disease, and diabetes. RESULTS were adjusted for multiple comparisons. RESULTS: There were 4,366 ischemic strokes, with median age 72 (IQR: 61-81), 55% MA, and median NIHSS of 4 (IQR: 2-8). MAs were younger, more likely to have a history of hypertension and diabetes, but less likely to have atrial fibrillation compared to NHWs. In the crude model, the ethnicity-age interaction was not statistically significant. After adjustment, the ethnicity-age interaction became significant at the 85th and 95th percentiles of NIHSS distribution. MAs in the younger age category (45-59) were significantly less severe by 3 and 6 points on the initial NIHSS than NHWs, at the 85th and 95th percentiles, respectively. However, in the older age category (75+), there was a reversal of this pattern; MAs had more severe strokes than NHWs by about 2 points, though not reaching statistical significance. CONCLUSIONS: There was no overall ethnic difference in stroke severity by age in our crude model. However, several potentially important ethnic differences among individuals with the most severe strokes were seen in younger and older stroke patients that were not explained by traditional risk factors. Age should be considered in future studies when looking at the complex distributional relationship between ethnicity and stroke severity.
Asunto(s)
Isquemia Encefálica/epidemiología , Accidente Cerebrovascular/epidemiología , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Hipertensión/epidemiología , Masculino , Americanos Mexicanos , Persona de Mediana Edad , Vigilancia de la Población , Factores de Riesgo , Estados Unidos , Población BlancaRESUMEN
BACKGROUND AND PURPOSE: Mexican Americans (MAs) were previously found to have lower mortality after ischemic stroke than non-Hispanic whites. We studied mortality trends in a population-based design. METHODS: Active and passive surveillance were used to find all ischemic stroke cases from January 2000 to December 2011 in Nueces County, TX. Deaths were ascertained from the Texas Department of Health through December 31, 2012. Cumulative 30-day and 1-year mortality adjusted for covariates was estimated using log-binomial models with a linear term for year of stroke onset used to model time trends. Models used data from the entire study period to estimate adjusted mortality among stroke cases in 2000 and 2011 and to calculate projected ethnic differences. RESULTS: There were 1974 ischemic strokes among non-Hispanic whites and 2439 among MAs. Between 2000 and 2011, model estimated mortality declined among non-Hispanic whites at 30 days (7.6% to 5.6%; P=0.24) and 1 year (20.8% to 15.5%; P=0.02). Among MAs, 30-day model estimated mortality remained stagnant at 5.1% to 5.2% (P=0.92), and a slight decline from 17.4% to 15.3% was observed for 1-year mortality (P=0.26). Although ethnic differences in 30-day (P=0.01) and 1-year (P=0.06) mortality were apparent in 2000, they were not so in 2011 (30-day mortality, P=0.63; 1-year mortality, P=0.92). CONCLUSIONS: Overall, mortality after ischemic stroke has declined in the past decade, although significant declines were only observed for non-Hispanic whites and not MAs at 1 year. The survival advantage previously documented among MAs vanished by 2011. Renewed stroke prevention and treatment efforts for MAs are needed.
Asunto(s)
Isquemia Encefálica/etnología , Isquemia Encefálica/mortalidad , Americanos Mexicanos , Accidente Cerebrovascular/etnología , Accidente Cerebrovascular/mortalidad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Vigilancia de la Población , Texas/epidemiología , Resultado del Tratamiento , Población BlancaRESUMEN
BACKGROUND AND PURPOSE: Our objective was to compare neurological, functional, and cognitive stroke outcomes in Mexican Americans (MAs) and non-Hispanic whites using data from a population-based study. METHODS: Ischemic strokes (2008-2012) were identified from the Brain Attack Surveillance in Corpus Christi (BASIC) Project. Data were collected from patient or proxy interviews (conducted at baseline and 90 days poststroke) and medical records. Ethnic differences in neurological (National Institutes of Health Stroke Scale: range, 0-44; higher scores worse), functional (activities of daily living/instrumental activities of daily living score: range, 1-4; higher scores worse), and cognitive (Modified Mini-Mental State Examination: range, 0-100; lower scores worse) outcomes were assessed with Tobit or linear regression adjusted for demographics and clinical factors. RESULTS: A total of 513, 510, and 415 subjects had complete data for neurological, functional, and cognitive outcomes and covariates, respectively. Median age was 66 (interquartile range, 57-78); 64% were MAs. In MAs, median National Institutes of Health Stroke Scale, activities of daily living/instrumental activities of daily living, and Modified Mini-Mental State Examination score were 3 (interquartile range, 1-6), 2.5 (interquartile range, 1.6-3.5), and 88 (interquartile range, 76-94), respectively. MAs scored 48% worse (95% CI, 23%-78%) on National Institutes of Health Stroke Scale, 0.36 points worse (95% CI, 0.16-0.57) on activities of daily living/instrumental activities of daily living score, and 3.39 points worse (95% CI, 0.35-6.43) on Modified Mini-Mental State Examination than non-Hispanic whites after multivariable adjustment. CONCLUSIONS: MAs scored worse than non-Hispanic whites on all outcomes after adjustment for confounding factors; differences were only partially explained by ethnic differences in survival. These findings in combination with the increased stroke risk in MAs suggest that the public health burden of stroke in this growing population is substantial.
Asunto(s)
Trastornos del Conocimiento/etnología , Trastornos del Conocimiento/fisiopatología , Americanos Mexicanos/estadística & datos numéricos , Recuperación de la Función/fisiología , Accidente Cerebrovascular/etnología , Accidente Cerebrovascular/fisiopatología , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Trastornos del Conocimiento/mortalidad , Demencia/etnología , Demencia/mortalidad , Demencia/fisiopatología , Evaluación de la Discapacidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Factores de Riesgo , Accidente Cerebrovascular/mortalidad , Texas/epidemiología , Población Blanca/estadística & datos numéricosRESUMEN
OBJECTIVE: To determine trends in ischemic stroke incidence among Mexican Americans and non-Hispanic whites. METHODS: We performed population-based stroke surveillance from January 1, 2000 to December 31, 2010 in Corpus Christi, Texas. Ischemic stroke patients 45 years and older were ascertained from potential sources, and charts were abstracted. Neurologists validated cases based on source documentation blinded to ethnicity and age. Crude and age-, sex-, and ethnicity-adjusted annual incidence was calculated for first ever completed ischemic stroke. Poisson regression models were used to calculate adjusted ischemic stroke rates, rate ratios, and trends. RESULTS: There were 2,604 ischemic strokes in Mexican Americans and 2,042 in non-Hispanic whites. The rate ratios (Mexican American:non-Hispanic white) were 1.94 (95% confidence interval [CI] = 1.67-2.25), 1.50 (95% CI = 1.35-1.67), and 1.00 (95% CI = 0.90-1.11) among those aged 45 to 59, 60 to 74, and 75 years and older, respectively, and 1.34 (95% CI = 1.23-1.46) when adjusted for age. Ischemic stroke incidence declined during the study period by 35.9% (95% CI = 25.9-44.5). The decline was limited to those aged ≥60 years, and happened in both ethnic groups similarly (p > 0.10), implying that the disparities seen in the 45- to 74-year age group persist unabated. INTERPRETATION: Ischemic stroke incidence rates have declined dramatically in the past decade in both ethnic groups for those aged ≥60 years. However, the disparity between Mexican American and non-Hispanic white stroke rates persists in those <75 years of age. Although the decline in stroke is encouraging, additional prevention efforts targeting young Mexican Americans are warranted.
Asunto(s)
Isquemia Encefálica/etnología , Americanos Mexicanos/etnología , Accidente Cerebrovascular/etnología , Población Blanca/etnología , Anciano , Anciano de 80 o más Años , Femenino , Encuestas Epidemiológicas , Disparidades en Atención de Salud/etnología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estados Unidos/etnologíaRESUMEN
BACKGROUND AND PURPOSE: Atrial fibrillation is a common cause of stroke with a known preventive treatment. We compared poststroke recurrence and survival in Mexican Americans (MAs) and non-Hispanic whites (NHWs) with atrial fibrillation in a population-based study. METHODS: Using surveillance methods from the Brain Attack Surveillance in Corpus Christi Project, cases of ischemic stroke/transient ischemic attack with atrial fibrillation were prospectively identified from January 2000 to June 2008. Recurrent stroke and all-cause mortality were compared by ethnicity with survival analysis methods. RESULTS: A total of 236 patients were available (88 MAs, 148 NHWs). MAs were younger than NHWs, with no ethnic differences in severity of the first stroke or proportion discharged on warfarin. MAs had a higher risk of stroke recurrence than did NHWs (Kaplan-Meier estimates of survival free of stroke recurrence risk at 28 days and 1 year were 0.99 and 0.85 in MAs and 0.98 and 0.96 in NHWs, respectively; P=0.01, log-rank test), which persisted despite adjustment for age and sex (hazard ratio=2.46; 95% CI, 1.19-5.11). Severity of the recurrent stroke was higher in MAs than in NHWs (P=0.02). There was no ethnic difference in survival after stroke in unadjusted analysis or after adjusting for demographic and clinical factors (hazard ratio=1.03; 95% CI, 0.63-1.67). CONCLUSIONS: MAs with atrial fibrillation have a higher stroke recurrence risk and more severe recurrences than do NHWs but no difference in all-cause mortality. Aggressive stroke prevention measures focused on MAs are warranted.
Asunto(s)
Fibrilación Atrial/etnología , Accidente Cerebrovascular/etnología , Accidente Cerebrovascular/mortalidad , Factores de Edad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Americanos Mexicanos , Persona de Mediana Edad , Vigilancia de la Población , Estudios Prospectivos , Recurrencia , Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores Sexuales , Texas , Población BlancaRESUMEN
PURPOSE: To estimate ethnic-specific all-cause mortality risk following ischemic stroke and to compare mortality risk by ethnicity. METHODS: DATA from the Brain Attack Surveillance in Corpus Christi Project, a population-based stroke surveillance study, were used. Stroke cases between January 1, 2000 and December 31, 2002 were identified from emergency department (ED) and hospital sources (n = 1,234). Deaths for the same period were identified from the surveillance of stroke cases, the Texas Department of Health, the coroner, and the Social Security Death Index. Ethnic-specific all-cause cumulative mortality risk was estimated at 28 days and 36 months using Kaplan Meier analysis. Cox proportional hazards regression was used to compare mortality risk by ethnicity. RESULTS: Cumulative 28-day all-cause mortality risk for Mexican Americans (MAs) was 7.8% and for non-Hispanic whites (NHWs) was 13.5%. Cumulative 36-month all-cause mortality risk was 31.3% in MAs and 47.2% in NHWs. MAs had lower 28-day (RR = 0.58; 95% CI: 0.41, 0.84) and 36-month all-cause mortality risk (RR = 0.79, 95% CI: 0.64, 0.98) compared with NHWs, adjusted for confounders. CONCLUSIONS: Better survival after stroke in MAs is surprising considering their similar stroke subtype and severity compared with NHWs. Social or psychological factors, which may explain this difference, should be explored.
Asunto(s)
Isquemia Encefálica/mortalidad , Americanos Mexicanos/estadística & datos numéricos , Accidente Cerebrovascular/mortalidad , Anciano , Isquemia Encefálica/etnología , Causas de Muerte , Femenino , Humanos , Masculino , Persona de Mediana Edad , Vigilancia de la Población , Modelos de Riesgos Proporcionales , Accidente Cerebrovascular/etnología , Texas/epidemiologíaRESUMEN
Family history of stroke may differ by ethnicity. This study examined the associations of ethnicity and stroke risk factors with family history of stroke using data from the Brain Attack Surveillance in Corpus Christi Project. A random sample of stroke/transient ischemic attack cases was interviewed about family history of stroke (n = 524). Thirty-six percent of the cases reported a family history of stroke, with 26% reporting a parental and 13% a sibling history. Compared to non-Hispanic whites (NHWs), Mexican-Americans (MAs) were two times (OR = 2.07; 95% CI: 1.09-3.95) more likely to have a sibling with stroke. More MAs (8.1%; 95% CI: 4.6-11.6) had living siblings with stroke compared to NHWs (1.9%; 95% CI: 0.1-3.8). Since MAs are more likely to have living siblings with stroke compared with NHWs, MAs may be a more feasible population for family stroke studies than predominantly white populations.
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Ataque Isquémico Transitorio/epidemiología , Ataque Isquémico Transitorio/genética , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/genética , Anciano , Donantes de Sangre , Análisis por Conglomerados , Métodos Epidemiológicos , Familia , Estudios de Factibilidad , Femenino , Humanos , Masculino , Americanos Mexicanos , Persona de Mediana Edad , Proyectos de Investigación , Factores de Riesgo , Factores Sexuales , Población BlancaRESUMEN
Mexican Americans are the largest subgroup of Hispanics, the largest minority population in the United States. Stroke is the leading cause of disability and third leading cause of death. The authors compared stroke incidence among Mexican Americans and non-Hispanic Whites in a population-based study. Stroke cases were ascertained in Nueces County, Texas, utilizing concomitant active and passive surveillance. Cases were validated on the basis of source documentation by board-certified neurologists masked to subjects' ethnicity. From January 2000 to December 2002, 2,350 cerebrovascular events occurred. Of the completed strokes, 53% were in Mexican Americans. The crude cumulative incidence was 168/10,000 in Mexican Americans and 136/10,000 in non-Hispanic Whites. Mexican Americans had a higher cumulative incidence for ischemic stroke (ages 45-59 years: risk ratio = 2.04, 95% confidence interval: 1.55, 2.69; ages 60-74 years: risk ratio = 1.58, 95% confidence interval: 1.31, 1.91; ages >or=75 years: risk ratio = 1.12, 95% confidence interval: 0.94, 1.32). Intracerebral hemorrhage was more common in Mexican Americans (age-adjusted risk ratio = 1.63, 95% confidence interval: 1.24, 2.16). The subarachnoid hemorrhage age-adjusted risk ratio was 1.57 (95% confidence interval: 0.86, 2.89). Mexican Americans experience a substantially greater ischemic stroke and intracerebral hemorrhage incidence compared with non-Hispanic Whites. As the Mexican-American population grows and ages, measures to target this population for stroke prevention are critical.
Asunto(s)
Americanos Mexicanos/estadística & datos numéricos , Accidente Cerebrovascular/etnología , Población Blanca/estadística & datos numéricos , Distribución por Edad , Anciano , Anciano de 80 o más Años , Hemorragia Cerebral/etnología , Fibrinolíticos/uso terapéutico , Humanos , Incidencia , Ataque Isquémico Transitorio/etnología , Persona de Mediana Edad , Inhibidores de Agregación Plaquetaria/uso terapéutico , Vigilancia de la Población , Factores de Riesgo , Texas/epidemiologíaRESUMEN
BACKGROUND AND PURPOSE: Mexican Americans are the largest subgroup of Hispanic Americans, now the most numerous US minority population. We compared access to care, acculturation, and biological risk factors among Mexican American and non-Hispanic white stroke patients and the general population. METHODS: The Brain Attack Surveillance in Corpus Christi project is a population-based stroke surveillance study conducted in southeast Texas. All stroke cases were ascertained through active and passive surveillance from January 2000 through April 2002 and compared with population estimates from a random-digit telephone survey. RESULTS: Compared with non-Hispanic white stroke patients (n=405), Mexican American stroke patients (n=403) were less likely to have graduated from high school (odds ratio [OR], 15.4; 95% confidence interval [CI], 10.6 to 22.4) and more likely to earn less than 20 000 dollars per year (OR, 6.5; 95% CI, 4.5 to 9.4). Mexican American stroke patients were more likely to have diabetes (OR, 2.7; 95% CI, 2.0 to 3.7) and less likely to have atrial fibrillation (OR, 0.5; 95% CI, 0.4 to 0.8). Compared with population estimates (n=719), stroke was associated with diabetes (Mexican Americans: OR, 3.6; 95% CI, 2.2 to 5.8; non-Hispanic whites: OR, 3.0; 95% CI, 1.7 to 5.5), hypertension (Mexican Americans: OR, 2.8; 95% CI, 1.8 to 4.3; non-Hispanic whites: OR, 3.3; 95% CI, 2.2 to 5.0), lower incomes (Mexican Americans: OR, 3.4; 95% CI, 2.1 to 5.4; non-Hispanic whites: OR, 3.0; 95% CI, 1.7 to 5.2), and lower educational attainment (Mexican Americans: OR, 5.1; 95% CI, 3.2 to 8.1; non-Hispanic whites: OR, 4.5; 95% CI, 2.2 to 9.3). CONCLUSIONS: Biological and social variables are associated with stroke to a similar extent in both Mexican Americans and non-Hispanic whites. Health behavior interventions for both populations may follow from this work. Stroke disparities between these populations may be explained only partially by differences in the prevalence of currently identified biological and social factors.