Differences in Risk Factors Between Black Caribbean Patients With Stroke in Barbados and South London

Abstract

Background and Purpose-Risk of stroke is higher in black Caribbeans in the United Kingdom compared with black Caribbeans in their country of origin. We investigated if these differences were caused by variations in prior-to-stroke risk factors. Summary of Report-Data were collected from the South London Stroke Register (SLSR) and the Barbados Register of Strokes (BROS). Differences in prevalence and management of stroke risk factors were adjusted for age, sex, living conditions prestroke, stroke subtype, and socioeconomic status by multivariable logistic regression. Patients in BROS were on average older (mean difference 4 years) and more likely to have a nonmanual occupation. Key Words: ethnicity Ⅲ risk factors Ⅲ stroke A previous comparison of stroke incidence in black Caribbeans (BC) between Barbados and South London showed that BC in the United Kingdom had an agestandardized incidence of total stroke of approximately 25% greater compared with BC in their region of origin. 1 These findings could be due to differences in the prevalence of the main risk factors for stroke. We therefore compared risk factors and their treatment in BC in South London and Barbados adjusting for differences in demographic and socioeconomic characteristics. Methods Data CollectionThe South London Stroke Register (SLSR), a population-based stroke register recording all first-ever strokes in patients of all age groups for a defined area of South London, was set up in January 1995. 2 The source population of the SLSR are the 271 817 residents (UK Census 2001) of whom 63% were white, 9% BC, 15% black African, 4% black Mixed, 5% Asian, and 4% other. The populationbased Barbados Register of Strokes (BROS) was set up in October 2001. 3 The BROS cases came from a population of 268 762 (Barbados Census 2000) comprising 93% BC, 3% black mixed, 3% white, and 1% other. Both SLSR and BROS record hospitalized and nonhospitalized cases.The SLSR and BROS used identical data collection methods and standardized variable definitions. For both registers, overlapping sources of patient notification were used to ensure completeness of case ascertainment; details have been published elsewhere. 4 Variable DefinitionStroke was defined by the World Health Organization categories 3 and classified according to the underlying pathology into cerebral infarction, primary intracerebral hemorrhage, and subarachnoid hemorrhage.Ethnic group was self-defined by the patients or their relatives. Socioeconomic status was recorded for the SLSR using the UK Registrar General's codes based on occupation 5 and for BROS the national census questions 3 and was grouped into nonmanual, manual, and unknown according to the patient's current (or for the retired and others not currently working, the most recent) employment. Living circumstances prestroke were grouped into fully independent (private household alone), some independence (private household with others, sheltered home), nursing or hospital care. Data were collected from their general practice or hospital records on hype...

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