http://dgnews.docguide.com/haemorrhagic-strokes-more-common-asians-other-ethnicities-us?
By Brian Hoyle
SAN DIEGO, California -- October 18, 2017 -- In the United States, haemorrhagic strokes are more frequent among patients of Asian ethnicity compared with those of other ethnicities, according to results of a large, retrospective study presented at the 142nd Annual Meeting of the American Neurological Association (ANA).
“In the U.S., Asian patients [also] appear to have a higher rate of in-hospital mortality after stroke compared with patients of other ethnicities,” added lead author Antonio Moya, MD, Weill Cornell Medical Center, New York, New York, and colleagues, speaking at a poster presentation here on October 15.
Dr. Moya and colleagues analysed data from the Nationwide Inpatients Sample database, 2002 to 2012 -- the largest publicly available all-payer inpatient healthcare database in the U.S. The team used standard codes to retrieve medical records of ischaemic and haemorrhagic stroke cases. The primary outcome was the relative proportion of haemorrhagic strokes compared with ischaemic strokes. In-hospital death and number of discharges were secondary outcomes.
The analysis included 4,449,516 stroke patients in the general population. The majority had experienced ischaemic stroke (3,794,438 or 85.3%) with the remaining 655,078 (14.7%) having had a haemorrhagic stroke.
Comparing the Asian population (n = 98,965 or 2.2%) with the non-Asian population (n = 4,350,551 or 97.8%) revealed significant differences (all P < .001) in median age (71 vs 73 years), proportion of males (50.5% vs 46.4%), prevalence of diabetes mellitus (37.1% vs 31.4%), hypertension (82.3% vs 75.6%), hyperlipidaemia (41.3% vs 35.9%), coronary-artery disease (18.6% vs 25.0%), congestive heart failure (8.4% vs 12.5%), atrial fibrillation (14.7% vs 17.2%), and chronic kidney disease (8.4% vs 7.1%).
The proportion of haemorrhagic strokes was higher for Asians than for the general population (24.0% vs 14.5%; P < .001).
A multivariate logistic regression analysis adjusting for age, sex, comorbidities, hospital characteristics, complications, mechanical ventilation, procedures, and withdrawal of care revealed that in-hospital mortality was more likely in Asian patients compared with the general population (9,731 [9.8%] vs 378,771 [8.7%]; odds ratio [OR]: 1.22, 95% confidence interval [CI]: 1.19 to 1.35; P < .001).
No difference was evident between Asians and the general population concerning home discharge (34.5% vs 33.6%; OR: 0.92, 95% CI: 0.86 to 1.03; P = .865). The researchers observed no appreciable differences in stroke subtypes between Asians and the general population.
The majority of patients in this study were in relatively good health, with a low risk of another stroke (Modified Charlson’s Index 0: 39.0% vs 34.9%).
Studies undertaken in Asia have indicated that a markedly higher proportion of the population experiences haemorrhagic stroke compared with elsewhere in the world. Whether this reflects a genetic disposition or an environmental influence (or aspects of both) has been unclear. If the environment were the dominant influence, then a lower incidence of haemorrhagic stroke might be expected among Asians living in the United States, Dr. Moya noted.
More studies are required to determine the dominant cause of this increased risk.
Funding for this study was provided by the National Institutes of Health, Bethesda, Maryland and the Florence Gould Endowment for Discovery in Stroke.
[Presentation title: Incidence of Ischemic and Hemor
SAN DIEGO, California -- October 18, 2017 -- In the United States, haemorrhagic strokes are more frequent among patients of Asian ethnicity compared with those of other ethnicities, according to results of a large, retrospective study presented at the 142nd Annual Meeting of the American Neurological Association (ANA).
“In the U.S., Asian patients [also] appear to have a higher rate of in-hospital mortality after stroke compared with patients of other ethnicities,” added lead author Antonio Moya, MD, Weill Cornell Medical Center, New York, New York, and colleagues, speaking at a poster presentation here on October 15.
Dr. Moya and colleagues analysed data from the Nationwide Inpatients Sample database, 2002 to 2012 -- the largest publicly available all-payer inpatient healthcare database in the U.S. The team used standard codes to retrieve medical records of ischaemic and haemorrhagic stroke cases. The primary outcome was the relative proportion of haemorrhagic strokes compared with ischaemic strokes. In-hospital death and number of discharges were secondary outcomes.
The analysis included 4,449,516 stroke patients in the general population. The majority had experienced ischaemic stroke (3,794,438 or 85.3%) with the remaining 655,078 (14.7%) having had a haemorrhagic stroke.
Comparing the Asian population (n = 98,965 or 2.2%) with the non-Asian population (n = 4,350,551 or 97.8%) revealed significant differences (all P < .001) in median age (71 vs 73 years), proportion of males (50.5% vs 46.4%), prevalence of diabetes mellitus (37.1% vs 31.4%), hypertension (82.3% vs 75.6%), hyperlipidaemia (41.3% vs 35.9%), coronary-artery disease (18.6% vs 25.0%), congestive heart failure (8.4% vs 12.5%), atrial fibrillation (14.7% vs 17.2%), and chronic kidney disease (8.4% vs 7.1%).
The proportion of haemorrhagic strokes was higher for Asians than for the general population (24.0% vs 14.5%; P < .001).
A multivariate logistic regression analysis adjusting for age, sex, comorbidities, hospital characteristics, complications, mechanical ventilation, procedures, and withdrawal of care revealed that in-hospital mortality was more likely in Asian patients compared with the general population (9,731 [9.8%] vs 378,771 [8.7%]; odds ratio [OR]: 1.22, 95% confidence interval [CI]: 1.19 to 1.35; P < .001).
No difference was evident between Asians and the general population concerning home discharge (34.5% vs 33.6%; OR: 0.92, 95% CI: 0.86 to 1.03; P = .865). The researchers observed no appreciable differences in stroke subtypes between Asians and the general population.
The majority of patients in this study were in relatively good health, with a low risk of another stroke (Modified Charlson’s Index 0: 39.0% vs 34.9%).
Studies undertaken in Asia have indicated that a markedly higher proportion of the population experiences haemorrhagic stroke compared with elsewhere in the world. Whether this reflects a genetic disposition or an environmental influence (or aspects of both) has been unclear. If the environment were the dominant influence, then a lower incidence of haemorrhagic stroke might be expected among Asians living in the United States, Dr. Moya noted.
More studies are required to determine the dominant cause of this increased risk.
Funding for this study was provided by the National Institutes of Health, Bethesda, Maryland and the Florence Gould Endowment for Discovery in Stroke.
[Presentation title: Incidence of Ischemic and Hemor
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