Stroke incidence and subtypes in Aboriginal people in remote Australia: a healthcare network population-based study. Issue 10 (8th October 2020)

• Record Type: Journal Article
• Authors: Balabanski, Anna H; Goldsmith, Kendall; Giarola, Blake; Buxton, David; Castle, Sally; McBride, Katharine; Brady, Stephen; Thrift, Amanda G; Katzenellenbogen, Judith; Brown, Alex; Burrow, James; Donnan, Geoffrey A; Koblar, Simon; Kleinig, Timothy J
• Is Part Of: BMJ open. Volume 10:Issue 10(2020)
• Publication Date: 2020-10-08
• Subjects: stroke -- intracerebral haemorrhage -- ischaemic stroke -- epidemiology -- Indigenous; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2020-039533
• Languages: English
• ISSNs: 2044-6055

Abstract

Abstract : Objectives: We aimed to compare the incidence, subtypes and aetiology of stroke, and in-hospital death due to stroke, between Aboriginal and non-Aboriginal people in Central Australia, a remote region of Australia where a high proportion Aboriginal people reside (40% of the population). We hypothesised that the rates of stroke, particularly in younger adults, would be greater in the Aboriginal population, compared with the non-Aboriginal population; we aimed to elucidate causes for any identified disparities. Design: A retrospective population-based study of patients hospitalised with stroke within a defined region from 1 January 2011 to 31 December 2014. Setting: Alice Springs Hospital, the only neuroimaging-capable acute hospital in Central Australia, serving a network of 50 healthcare facilities covering 672 000 km 2 . Participants: 161 residents (63.4% Aboriginal) of the catchment area admitted to hospital with stroke. Primary and secondary outcome measures: Rates of first-ever stroke, overall (all events) stroke and in-hospital death. Results: Of 121 residents with first-ever stroke, 61% identified as Aboriginal. Median onset-age (54 years) was 17 years younger in Aboriginal patients (p<0.001), and age-standardised stroke incidence was threefold that of non-Aboriginal patients (153 vs 51 per 100 000, incidence rate ratio 3.0, 95% CI 2 to 4). The rate ratios for the overall rate of stroke (first-ever and recurrent) were similar. In Aboriginal patients aged <55 years, the incidence of ischaemic stroke was 14-fold greater (95% CI 4 to 45), and intracerebral haemorrhage 19-fold greater (95% CI 3 to 142) than in non-Aboriginal patients. Crude prevalence of diabetes mellitus (70.3% vs 34.0%, p<0.001) and hypercholesterolaemia (68.9% vs 51.1%, p=0.049) was greater, and age-standardised in-hospital deaths were fivefold greater (35 vs 7 per 100 000, 95% CI 2 to 11) in Aboriginal patients than in non-Aboriginal patients. Conclusions: Stroke incidence (both subtypes) and in-hospital deaths for remote Aboriginal Australians are dramatically greater than in non-Aboriginal people, especially in patients aged <55 years.