Published Online
on December 8, 2005

A more recent version of this article appeared on January 1, 2006

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Submitted on September 13, 2005
Accepted on October 23, 2005

Trends in Ethnic Disparities in Stroke Incidence in Auckland, New Zealand, During 1981 to 2003

Kristie Carter MSc (hons); Craig Anderson PhD, FRACP^*; Maree Hacket MA (hons); Valery Feigin MD, PhD; P. Alan Barber PhD, FRACP; Joanna B. Broad MPH; Ruth Bonita PhD; on behalf of the Auckland Regional Community Stroke (ARCOS) Study Group

From the Clinical Trials Research Unit (K.C., C.A., M.H., V.F.), School of Population Health, Faculty of Medicine and Health Sciences, The University of Auckland, New Zealand; The George Institute for International Health (K.C., C.A., M.H.), The University of Sydney and Royal Prince Alfred Hospital, Australia; Neuroservices, Auckland City Hospital, and Department of Medicine (P.A.B.), Faculty of Medicine and Health Sciences, The University of Auckland; Department of Epidemiology and Biostatistics (J.B.B.), School of Population Health, Faculty of Medicine and Health Sciences, The University of Auckland; and Office of the Assistant Director-General of Health (R.B.), Evidence for Information and Policy, World Health Organization.

^* To whom correspondence should be addressed. E-mail: canderson{at}thegeorgeinstitute.org.

Background and Purpose--Although geographical variations in stroke rates are well documented, limited data exist on temporal trends in ethnic-specific stroke incidence.

Methods--We assessed trends in ethnic-specific stroke rates using standard diagnostic criteria and community-wide surveillance procedures in Auckland, New Zealand (NZ) in 1981 to 1982, 1991 to 1992, and 2002 to 2003. Indirect and direct methods were used to adjust first-ever (incident) and total (attack) rates for changes in the structure of the population and reported with 95% CIs. Ethnicity was self-defined and categorized as "NZ/European," "Maori," "Pacific peoples," and "Asian and other."

Results--Stroke attack (19%; 95% CI, 11% to 26%) and incidence rates (19%; 95% CI, 12% to 24%) declined significantly in NZ/Europeans from 1981 to 1982 to 2002 to 2003. These rates remained high or increased in other ethnic groups, particularly for Pacific peoples in whom stroke attack rates increased by 66% (95% CI; 11% to 225%) over the periods. Some favorable downward trends in vascular risk factors, such as cigarette smoking, were counterbalanced by increasing age, body mass index, and diabetes in certain ethnic groups.

Conclusions--Divergent trends in ethnic-specific stroke incidence and attack rates, and of associated risk factors, have occurred in Auckland over recent decades. The findings provide mixed views as to the future burden of stroke in populations undergoing similar lifestyle and structural changes.

Key words: stroke • epidemiology • incidence

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