Race and Ethnic Disparities in Stroke Incidence in the Northern Manhattan Study

Abstract

Background and Purpose— An excess incidence of strokes among blacks versus whites has been shown, but data on disparities related to Hispanic ethnicity remain limited. This study examines race/ethnic differences in stroke incidence in the multiethnic, largely Caribbean Hispanic, NOMAS (Northern Manhattan Study), and whether disparities vary by age. Methods— The study population included participants in the prospective population-based NOMAS, followed for a mean of 14±7 years. Multivariable-adjusted Cox proportional hazards models were constructed to estimate the association between race/ethnicity and incident stroke of any subtype and ischemic stroke, stratified by age. Results— Among 3298 participants (mean baseline age 69±10 years, 37% men, 24% black, 21% white, 52% Hispanic), 460 incident strokes accrued (400 ischemic, 43 intracerebral hemorrhage, 9 subarachnoid hemorrhage). The most common ischemic subtype was cardioembolic, followed by lacunar infarcts, then cryptogenic. The greatest incidence rate was observed in blacks (13/1000 person-years), followed by Hispanics (10/1000 person-years), and lowest in whites (9/1000 person-years), and this order was observed for crude incidence rates until age 75. By age 85, the greatest incidence rate was in Hispanics. Blacks had an increased risk of stroke versus whites overall in multivariable models that included sociodemographics (hazard ratio, 1.51 [95% CI, 1.13–2.02]), and stratified analyses showed that this disparity was driven by women of age ≥70. The increased rate of stroke among Hispanics (age/sex-adjusted hazard ratio, 1.48 [95% CI, 1.13–1.93]) was largely explained by education and insurance status (a proxy for socieoeconomic status; hazard ratio after further adjusting for these variables, 1.17 [95% CI, 0.85–1.62]) but remained significant for women age ≥70. Conclusions— This study provides novel data regarding the increased stroke risk among Caribbean Hispanics in this elderly population. Results highlight the need to create culturally tailored campaigns to reach black and Hispanic populations to reduce race/ethnic stroke disparities and support the important role of low socioeconomic status in driving an elevated risk among Caribbean Hispanics.

Racial Disparities in Ischemic Stroke Among Patients with COVID-19 in the United States

“…The current analysis focused on disparities among patients with COVID-19 visiting ED across the US and carrying a clinical diagnosis of stroke, therefore providing insights into stroke prevalence disparity in the era of COVID-19 pandemic. Thus, this study expands well established evidence for an increased occurrence of stroke in minorities 14 . This analysis confirms these observations and further suggests that Blacks unlike Non-Hispanic Whites and White Hispanics with COVID-19 have a higher rate of stroke.…”

Stroke in young adults: Current trends, opportunities for prevention and pathways forward

“…The burden of stroke also varies by race and ethnicity. The Northern Manhattan study documented that the incidence of stroke in Black and Hispanic adults was higher in all age groups compared with Whites [ 45 ]. The incidence of all stroke in young adults (aged 20–45 years) per 100,000 for Blacks was 25, in Hispanics 26, and in Whites 10 [ 46 , 47 ].…”

Multi-omic analysis of stroke recurrence in African Americans from the Vitamin Intervention for Stroke Prevention (VISP) clinical trial

“…Studies of AA with global metabolite, methylation, and genetic data, as well as adjudicated recurrent stroke outcomes are rare, further limiting our ability to include a replication cohort. Although stroke subtype is not adjudicated in VISP, these stroke cases most likely represent small vessel variety due to the inclusion/exclusion criteria and higher proportion of small vessel (lacunar) ischemic stroke typically overserved in AA [ 41 ].…”