A Systematic Review and Meta‐Analysis of the Associations between Immigration Status and Stroke Incidence and Mortality

Chen, Jun-Zhen; Wang, Hai-mei; Zhu, Wenhao

doi:10.1155/2022/1926744

Cited by 3 publications

(1 citation statement)

References 59 publications

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“…4 Immigrants to high-income countries have been found to have a lower incidence of first stroke than host populations. 5,6 In Canada, however, immigrants from Africa, the Caribbean, Latin America, and South Asia seem to have a 30%–60% higher rate of recurrent events than nonimmigrants. 7 Prior work has found minimal differences in the quality of acute stroke care between immigrant and nonimmigrants.…”

Section: Introductionmentioning

confidence: 99%

Association Between Immigration Status and Ambulatory Secondary Stroke Preventive Care in Ontario, Canada

Vyas,

Saposnik,

et al. 2024

Neurology

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Background and ObjectivesSecondary stroke preventive care includes evaluation and control of vascular risk factors to prevent stroke recurrence. Our objective was to evaluate the quality of ambulatory stroke preventive care and its variation by immigration status in adult stroke survivors in Ontario, Canada. MethodsWe conducted a population-based administrative database-derived retrospective cohort study in Ontario, Canada. Using immigration records, we defined immigrants as those immigrating after 1985 and long-term residents as those arriving before 1985 or those born in Canada. We included community-dwelling stroke survivors 40 years and older with a first-ever stroke between 2011 and 2017. In the year following their stroke, we evaluated the following metrics of stroke prevention: testing for hyperlipidemia and diabetes; among those with the condition, control of diabetes (hemoglobin A1c ≤7%) and hyperlipidemia (low-density lipoprotein <2 mmol/L); medication use to control hypertension, diabetes, and atrial fibrillation; and visit to a family physician and a specialist (neurologist, cardiologist, or geriatrician). We determined age and sex-adjusted absolute prevalence difference (APD) between immigrants and long-term residents for each metric using generalized linear models with binomial distribution and an identity link function. ResultsWe included 34,947 stroke survivors (median age 70 years, 46.9% women) of whom 12.4% were immigrants. The receipt of each metric ranged from 68% to 90%. Compared with long-term residents, after adjusting for age and sex, immigrants were slightly more likely to receive screening for hyperlipidemia (APD 5.58%; 95% CI 4.18-6.96) and diabetes (5.49%; 3.76-7.23), have visits to family physicians (1.19%; 0.49-1.90), receive a prescription for antihypertensive (3.12%; 1.76-4.49) and antihyperglycemic medications (9.51%; 6.46-12.57), and achieve control of hyperlipidemia (3.82%; 1.01-6.63). By contrast, they were less likely to achieve diabetes control (−4.79%; −7.86 to −1.72) or have visits to a specialist (−1.68%; −3.12 to −0.24). There was minimal variation by region of origin or time since immigration in immigrants. DiscussionCompared with long-term residents, many metrics of secondary stroke preventive care were better in immigrants, albeit with small absolute differences. However, future work is needed to identify and mitigate the factors associated with the suboptimal quality of stroke preventive care for all stroke survivors. H0 Null Hypothesis A collection of negative, inconclusive, or replication studies; in partnership with the Center for Biomedical Research Transparency NPub.org/Null

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Section: Introductionmentioning

confidence: 99%

Association Between Immigration Status and Ambulatory Secondary Stroke Preventive Care in Ontario, Canada

Vyas,

Saposnik,

et al. 2024

Neurology

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Impact of war on stroke incidence in Ivano-Frankivsk, Ukraine

Shkoruta,

Senkiv,

Vovchuk

et al. 2024

Sci Rep

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Stroke is an extensive health problem in Ukraine, the prominence and effects of which are aggravated by the burden of the ongoing Russo-Ukrainian War. In this study, we aimed to holistically examine the overall stroke epidemiology in Ivano-Frankivsk using data from a secondary healthcare center in the city. We determine an increasing trend in stroke admissions since 2020, with a notable 22.4% increase in 2023, mainly due to ischemic stroke occurrence. In the same year, a significant non-linear relationship between stroke incidence and frequency of news about attacks was observed. Ordinal regression analysis of general sociodemographic, clinical, and healthcare-related factors influencing outcomes for intravenous thrombolysis-treated patients, revealed the significance of the 24-h National Institutes of Health Stroke Scale score (0.32 ± 0.03) and interaction of age and Door-to-Needle Time (− 0.28 ± 0.08). However, the extension of the latter independently is not significantly correlated with patient outcomes. In conclusion, war-induced stress, intranational migrations, and lack of adequate chronic cardiovascular disease management are primarily responsible for these results. Modulations and improvements to the current healthcare system, including managing chronic diseases and early stroke symptom recognition, are necessary to optimize patient outcomes.

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Endothelial Dysfunction and Pre-Existing Cognitive Disorders in Stroke Patients

Mendyk-Bordet,

Ouk,

Muhr-Tailleux

et al. 2024

Biomolecules

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Background: The origin of pre-existing cognitive impairment in stroke patients remains controversial, with a vascular or a degenerative hypothesis. Objective: To determine whether endothelial dysfunction is associated with pre-existing cognitive problems, lesion load and biological anomalies in stroke patients. Methods: Patients originated from the prospective STROKDEM study. The baseline cognitive state, assessed using the IQ-CODE, and risk factors for stroke were recorded at inclusion. Patients with an IQ-CODE score >64 were excluded. Endothelial function was determined 72 h after stroke symptom onset by non-invasive digital measurement of endothelium-dependent flow-mediated dilation and calculation of the reactive hyperemia index (RHI). RHI ≤ 1.67 indicated endothelial dysfunction. Different biomarkers of endothelial dysfunction were analysed in blood or plasma. All patients underwent MRI 72 h after stroke symptom onset. Results: A total of 86 patients were included (52 males; mean age 63.5 ± 11.5 years). Patients with abnormal RHI have hypertension or antihypertensive treatment more often. The baseline IQ-CODE was abnormal in 33 (38.4%) patients, indicating a pre-existing cognitive problem. Baseline IQ-CODE > 48 was observed in 15 patients (28.3%) with normal RHI and in 18 patients (54.6%) with abnormal RHI (p = 0.016). The RHI median was significantly lower in patients with abnormal IQ-CODE. Abnormal RHI was associated with a significantly higher median FAZEKAS score (2.5 vs. 2; p = 0.008), a significantly higher frequency of periventricular lesions (p = 0.015), more white matter lesions (p = 0.007) and a significantly higher cerebral atrophy score (p < 0.001) on MRI. Vascular biomarkers significantly associated with abnormal RHI were MCP-1 (p = 0.009), MIP_1a (p = 0.042), and homocysteinemia (p < 0.05). Conclusions: A vascular mechanism may be responsible for cognitive problems pre-existing stroke. The measurement of endothelial dysfunction after stroke could become an important element of follow-up, providing an indication of the functional and cognitive prognosis of stroke patients.

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A Systematic Review and Meta‐Analysis of the Associations between Immigration Status and Stroke Incidence and Mortality

Cited by 3 publications

References 59 publications

Association Between Immigration Status and Ambulatory Secondary Stroke Preventive Care in Ontario, Canada

Association Between Immigration Status and Ambulatory Secondary Stroke Preventive Care in Ontario, Canada

Impact of war on stroke incidence in Ivano-Frankivsk, Ukraine

Endothelial Dysfunction and Pre-Existing Cognitive Disorders in Stroke Patients

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