Prevalence of stroke and coexistent conditions: disparities between indigenous and nonindigenous Western Australians
- Conflicts of interests: None declared.
- Funding: This work was supported by the National Health and Medical Research Council of Australia (Grant Number 1031057) and Early Career Fellowship (Grant Number 037429). The Western Australian Centre for Rural Health received funding from the Australian Department of Health and Ageing.
- Author contributions: J. M. Katzenellenbogen conceptualized the study, extracted and analyzed the data, and was main contributor to the write-up. M. W. Knuiman contributed substantially to the statistical analysis, data interpretation, and presentation, and reviewed the manuscript. F. M. Sanfilippo advised on study design, data extraction, and integrity, and reviewed the manuscript. M. S. T. Hobbs and S. C. Thompson assisted with the interpretation of the data and reviewed the manuscript. All authors read and approved the final manuscript.
Worldwide, the prevalence of stroke is poorly described in indigenous populations, despite high stroke burden. This paper reports the average point prevalence of hospitalized stroke and coexistent conditions (2007–2011) in indigenous and nonindigenous people in Western Australia, the largest and most sparsely populated Australian jurisdiction.
Using state-wide linked hospital and mortality data, indigenous and nonindigenous prevalent stroke cases (aged 25–84 years) were identified after reviewing stroke admissions over a fixed 20-year look-back period. Prevalent cases were those alive at midyear of each study year. The 2007–2011 period prevalence was a weighted average of annual prevalence. Histories of 11 comorbidities were identified using the 20-year look-back period.
Indigenous cases comprised 5% of the average 13 591 annual prevalent cases. Indigenous patients were more likely to be younger, female, and have unknown stroke type. Indigenous prevalence was higher at every age. The age-standardized prevalence in indigenous men (33·7 per 1000; 95% confidence interval 31·9–35·4) was 3.7 times greater than in nonindigenous men (9·1 per 1000; 95% confidence interval 9·0–9·2). The corresponding estimates for women were 27·1 per 1000 (25·7–28·4) and 6·1 per 1000 (6·0–6·2) (ratio = 4·4). The percentage with selected comorbid conditions was substantially higher for indigenous patients.
The high stroke prevalence in indigenous Western Australians, coupled with clinical complexity from comorbid conditions, requires access to culturally appropriate medical, rehabilitation, and logistical support. Intensified primary and secondary prevention is needed to reduce the impact of stroke on indigenous people.