Temporal Trends in Ischemic Stroke Rates by Ethnicity, Sex, and Age (2000-2017): The Brain Attack Surveillance in Corpus Christi Project

Objective

To compare 18-year (2000–2017) temporal trends in ischemic stroke rates by ethnicity, sex, and age.

Methods

Data are from a population-based stroke surveillance study conducted in Nueces County, Texas, a geographically isolated, biethnic, urban community. Active (screening hospital admission logs, hospital wards, intensive care units) and passive (screening inpatient/emergency department discharge diagnosis codes) surveillance were used to identify cases aged ≥45 (n = 4,875) validated by stroke physicians using a consistent stroke definition over time. Ischemic stroke rates were derived from Poisson regression using annual population counts from the US Census to estimate the at-risk population.

Results

In those aged 45–59 years, rates increased in non-Hispanic Whites (104.3% relative increase; p < 0.001) but decreased in Mexican Americans (–21.9%; p = 0.03) such that rates were significantly higher in non-Hispanic Whites in 2016–2017 (p for ethnicity–time interaction < 0.001). In those age 60–74, rates declined in both groups but more so in Mexican Americans (non-Hispanic Whites –18.2%, p = 0.05; Mexican Americans –40.1%, p = 0.002), resulting in similar rates for the 2 groups in 2016–2017 (p for ethnicity–time interaction = 0.06). In those aged ≥75, trends did not vary by ethnicity, with declines noted in both groups (non-Hispanic Whites –33.7%, p = 0.002; Mexican Americans –26.9%, p = 0.02). Decreases in rates were observed in men (age 60–74, –25.7%, p = 0.009; age ≥75, –39.2%, p = 0.002) and women (age 60–74, –34.3%, p = 0.007; age ≥75, –24.0%, p = 0.02) in the 2 older age groups, while rates did not change in either sex in those age 45–59.

Conclusion

Previously documented ethnic stroke incidence disparities have ended as a result of declining rates in Mexican Americans and increasing rates in non-Hispanic Whites, most notably in midlife.

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