Persistent ischemic stroke disparities despite declining incidence in Mexican Americans

Authors

  • Lewis B. Morgenstern MD,

    Corresponding author
    1. Stroke Program, Department of Neurology, Veterans Affairs Center for Clinical Management and Research, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI
    2. Department of Emergency Medicine, University of Michigan Medical School, Veterans Affairs Center for Clinical Management and Research, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI
    3. Department of Epidemiology, Veterans Affairs Center for Clinical Management and Research, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI
    • Address correspondence to Dr Morgenstern, Stroke Program, University of Michigan Medical School, 1500 East Medical Center Dr, CVC 3194, SPC 5855, Ann Arbor, MI 48109-5855. E-mail: Lmorgens@umich.edu

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  • Melinda A. Smith DrPh,

    1. Stroke Program, Department of Neurology, Veterans Affairs Center for Clinical Management and Research, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI
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  • Brisa N. Sánchez PhD,

    1. Department of Biostatistics, University of Michigan School of Public Health, Veterans Affairs Center for Clinical Management and Research, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI
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  • Devin L. Brown MD, MS,

    1. Stroke Program, Department of Neurology, Veterans Affairs Center for Clinical Management and Research, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI
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  • Darin B. Zahuranec MD, MS,

    1. Stroke Program, Department of Neurology, Veterans Affairs Center for Clinical Management and Research, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI
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  • Nelda Garcia BS,

    1. Stroke Program, Department of Neurology, Veterans Affairs Center for Clinical Management and Research, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI
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  • Kevin A. Kerber MD, MS,

    1. Stroke Program, Department of Neurology, Veterans Affairs Center for Clinical Management and Research, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI
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  • Lesli E. Skolarus MD, MS,

    1. Stroke Program, Department of Neurology, Veterans Affairs Center for Clinical Management and Research, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI
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  • William J. Meurer MD, MS,

    1. Stroke Program, Department of Neurology, Veterans Affairs Center for Clinical Management and Research, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI
    2. Department of Emergency Medicine, University of Michigan Medical School, Veterans Affairs Center for Clinical Management and Research, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI
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  • James F. Burke MD, MS,

    1. Stroke Program, Department of Neurology, Veterans Affairs Center for Clinical Management and Research, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI
    2. Department of Veterans Affairs, Veterans Affairs Center for Clinical Management and Research, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI
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  • Eric E. Adelman MD,

    1. Stroke Program, Department of Neurology, Veterans Affairs Center for Clinical Management and Research, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI
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  • Jonggyu Baek MS,

    1. Department of Biostatistics, University of Michigan School of Public Health, Veterans Affairs Center for Clinical Management and Research, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI
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  • Lynda D. Lisabeth PhD

    1. Stroke Program, Department of Neurology, Veterans Affairs Center for Clinical Management and Research, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI
    2. Department of Epidemiology, Veterans Affairs Center for Clinical Management and Research, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI
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Abstract

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. Ann Neurol 2013;74:778–785

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