Email updates

Keep up to date with the latest news and content from BMC Neurology and BioMed Central.

Open Access Research article

Risk factors, quality of care and prognosis in South Asian, East Asian and White patients with stroke

Nadia A Khan1*, Hude Quan2, Michael D Hill23, Louise Pilote4, Finlay A McAlister5, Anita Palepu1, Baiju R Shah67, Limei Zhou7, Hong Zhen7 and Moira K Kapral67

Author Affiliations

1 Department of Medicine, University of British Columbia, 620 B, 1081 Burrard Street, St. Paul’s Hospita, Vancouver, BC V6Z 1Y6, Canada

2 Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada

3 Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada

4 Department of Medicine, McGill University, Montreal, QC, Canada

5 Department of Medicine, University of Alberta, Edmonton, AB, Canada

6 Department of Medicine, University of Toronto, Toronto, ON, Canada

7 Institute for Clinical Evaluative Sciences, Toronto, ON, Canada

For all author emails, please log on.

BMC Neurology 2013, 13:74  doi:10.1186/1471-2377-13-74

Published: 5 July 2013

Abstract

Background

Stroke has emerged as a significant and escalating health problem for Asian populations. We compared risk factors, quality of care and risk of death or recurrent stroke in South Asian, East Asian and White patients with acute ischemic and hemorrhagic stroke.

Methods

Retrospective analysis was performed on consecutive patients with ischemic stroke or intracerebral hemorrhage admitted to 12 stroke centers in Ontario, Canada (July 2003-March 2008) and included in the Registry of the Canadian Stroke Network database. The database was linked to population-based administrative databases to determine one-year risk of death or recurrent stroke.

Results

The study included 253 South Asian, 513 East Asian and 8231 White patients. East Asian patients were more likely to present with intracerebral hemorrhage (30%) compared to South Asian (17%) or White patients (15%) (p<0.001). Time from stroke to hospital arrival was similarly poor with delays >2 hours for more than two thirds of patients in all ethnic groups. Processes of stroke care, including thrombolysis, diagnostic imaging, antithrombotic medications, and rehabilitation services were similar among ethnic groups. Risk of death or recurrent stroke at one year after ischemic stroke was similar for patients who were White (27.6%), East Asian (24.7%, aHR 0.97, 95% CI 0.78-1.21 vs. White), or South Asian (21.9%, aHR 0.91, 95% CI 0.67-1.24 vs. White). Although risk of death or recurrent stroke at one year after intracerebral hemorrhage was higher in East Asian (35.5%) and White patients (47.9%) compared to South Asian patients (30.2%) (p=0.002), these differences disappeared after adjustment for age, sex, stroke severity and comorbid conditions (aHR 0.89 [0.67-1.19] for East Asian vs White and 0.99 [0.54-1.81] for South Asian vs. White).

Conclusion

After stratification by stroke type, stroke care and outcomes are similar across ethnic groups in Ontario. Enhanced health promotion is needed to reduce delays to hospital for all ethnic groups.