Abstract WP204: Paradoxical Increase in Stroke Mortality Among Asian Indians in United States

Abstract

Background and Purpose: Asian Indians are one of the largest groups of Asians living in the United States. Due to a paucity of data, we performed this study to better characterize the stroke mortality and risk factors among Asian Indians in the United States. Methods: Analysis of the U.S. multiple-cause-of-death files for 2004 to 2009 and National Health and Interview Survey (2004-2005 and 2009-2010) were analyzed. Age-adjusted fatal stroke incidence, stroke rate ratio with 95% confidence interval (CI), and average annual percentage change over 5 years were also calculated. Results: The annual incidence of fatal strokes was lowest among Asian Indians (194 per 100,000) followed by American Indians and Alaska Natives (207 per 100,000), Whites (282 per 100,000) and African Americans (362 per 100,000). Compared with Whites, the stroke rate ratio was 0.7(95% CI 0.5-0.8) for Asian Indians. Significantly lower rates of hypertension and cigarette smoking among Asian Indians in 2004-2005 (compared with whites) explained the lower rates of fatal stroke. The average annual percentage change over 5 years was 12.2%, -0.6%, -2.6%, and -2.6% Asian Indians, American Indians and Alaska Natives, Whites, and African Americans, respectively. The increase in stroke mortality among Asian Indians was observed despite lower rates of hypertension and cigarette smoking in 2009-2010. Conclusions: The paradoxical increase in stroke mortality among Asian Indians over the last 5 years (in contrast to other population subsets) is concerning. A better understanding of the predisposing factors for the observed increase is required through targeted efforts.

Ethnic differences between South Asians and White Caucasians in cardiovascular disease-related mortality in developed countries: a systematic literature review

“… Adjusted result? Adil, 2013 [ 30 ] Stroke-related mortality CVD RR 0.92 (0.80, 1.00) Overall Adjusted Albarak, 2013 [ 31 ] 30-day mortality All cause HR 0.81 (0.53, 1.26) Overall Adjusted Bansal, 2013 MI-related mortality CVD HR 0.95(0.66, 1.37) Indian male Adjusted 0.62 (0.33, 1.15) Indian female 0.87 (0.66, 1.16) Pakistan male 0.44 (0.25, 0.80) Pakistan female 0.77 (0.40, 1.47) Other South Asian male 1.22 (0.69, 2.14) Other South Asian female Bellary, 2010 [ 33 ] CVD-related mortality CVD OR 1.40 (0.90, 2.20) Overall Unadjusted Blackledge, 2003 [ 34 ] All-cause mortality All cause HR 0.82 (0.68, 0.99) Overall Adjusted Heart-failure-related mortality CVD 0.94 (0.8, 1.09) Overall Chaturvedi, 1996 [ 35 ] All-cause mortality All cause RR 3.9 (3.4, 4.4) 45–64 years, male Unadjusted 3.8 (3.2, 4.6) 45–64 years, female 2.2 (2.0, 2.5) 65+ years, male 2.2 (1.9, 2.4) 65+ years, female CVD-related mortality CVD RR 4.1 (3.4, 4.8) 45–64 years, male 3.9 (3.0, 5.0) 45–64 years, f...…”

“…The search identified 9879 records through the literature search and 10 records via other methods. Among them, 41 studies fulfilled the predetermined inclusion and exclusion criteria [ 17 , 30 – 69 ]. A further 3 publications were included via the search done prior to publication [ 70 – 72 ].…”