Published Online
on May 20, 2004

A more recent version of this article appeared on July 1, 2004

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Submitted on November 6, 2003
Revised on February 23, 2004
Accepted on April 15, 2004

Ischemic Stroke Subtypes. A Population-Based Study of Incidence Rates Among Blacks and Whites

Alexander T. Schneider MD^*; Brett Kissela MD; Daniel Woo MD; Dawn Kleindorfer MD; Kathleen Alwell RN, BSN; Rosemary Miller RN; Jerzy Szaflarski MD; James Gebel MD; Jane Khoury MS; Rakesh Shukla PhD; Charles Moomaw PhD; Arthur Pancioli MD; Edward Jauch MD; and Joseph Broderick MD

From the Departments of Neurology and The Neuroscience Institute (A.T.S., B.K., D.W., D.K., K.A., R.M., J.S., J.B.), Emergency Medicine and The Neuroscience Institute (A.P., E.J.), Environmental Health (J.K., R.S.), and the Institute for Health Policy and Health Services Research (C.M.), University of Cincinnati, Cincinnati, Ohio; and the Jewish Hospital (J.G.), Louisville, Kentucky.

^* To whom correspondence should be addressed. E-mail: schneiar{at}ucmail.uc.edu.

Background and Purpose--Blacks have an excess burden of stroke compared with whites; however, data comparing ischemic stroke subtypes among the 2 groups are limited and typically involve relative frequencies. The objective of this study is to compare the incidence rates of ischemic stroke subtypes between blacks and whites within a large, representative, biracial population.

Methods--The Greater Cincinnati/Northern Kentucky Stroke Study is designed to measure incidence rates and trends of all strokes within a well-defined, large, biracial population. Hospitalized cases were ascertained by International Classification of Disease (9th revision; ICD-9) discharge codes. Out-of-hospital events were ascertained by prospective screening of emergency department admission logs, review of coroners’ cases, and monitoring all public health and hospital-based primary care clinics. A sampling scheme was used to ascertain events from nursing homes and all other primary care physician offices. All potential cases underwent detailed chart abstraction and confirmed by physician review. Based on all available clinical, laboratory, and radiographic information, ischemic stroke cases were subtyped into the following categories: cardioembolic, large-vessel, small-vessel, other, and stroke of undetermined cause. Race-specific incidence rates were calculated and compared after adjusting for age and gender, and standardizing to the 1990 US population.

Results--Between July 1, 1993, and June 30, 1994, 1956 first-ever ischemic strokes occurred among blacks and whites in the study population. Small-vessel strokes and strokes of undetermined cause were nearly twice as common among blacks. Large-vessel strokes were 40% more common among blacks than whites, and there was a trend toward cardioembolic strokes being more common among blacks.

Conclusions--The excess burden of ischemic strokes among blacks compared with whites is not uniformly spread across the different subtypes. Large-vessel strokes are more common and cardioembolic stroke are as common among blacks, traditionally thought to be more common among whites.

Key words: stroke • racial differences • incidence • epidemiology • stroke, ischemic

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