(Stroke. 1999;30:2517.)
© 1999 American Heart Association, Inc.
Original Contributions |
Incidence Rates of First-Ever Ischemic Stroke Subtypes Among Blacks
A Population-Based Study
From the Departments of Neurology, Environmental Health, and Emergency Medicine, University of Cincinnati, Cincinnati, Ohio.
Correspondence to Daniel Woo, MD, Department of Neurology, University of Cincinnati College of Medicine, 231 Bethesda Ave, ML 0525, Cincinnati, OH 45267-0525. E-mail daniel.woo{at}uc.edu
Background and Purpose—The aim of this study was to determine the incidence rates of ischemic stroke subtypes among blacks.
Methods—Hospitalized and autopsied cases of stroke and transient ischemic attack among the 187 000 blacks in the 5-county region of greater Cincinnati/northern Kentucky From January 1, 1993, through June 30, 1993, were identified. Incidence rates were age- and sex-adjusted to the 1990 US population. Subtype classification was performed after extensive review of all available imaging, laboratory data, clinical information, and past medical history. Case-control comparisons of risk factors were made with age-, race-, and sex-matched control subjects.
Results—Annual incidence rates per 100 000 for first-ever ischemic stroke subtypes among blacks were as follows: uncertain cause, 103 (95% confidence interval [CI], 80 to 126); cardioembolic, 56 (95% CI, 40 to 73); small-vessel infarct, 52 (95% CI, 36 to 68); large vessel, 17 (95% CI, 8 to 26); and other causes, 17 (95% CI, 9 to 26). Of the patients diagnosed with an infarct of uncertain cause, 31% underwent echocardiography, 45% underwent carotid ultrasound, and 48% had neither. Compared with age-, race-, and sex- (proportionally) matched control subjects from the greater Cincinnati/northern Kentucky region, the attributable risk of hypertension for all causes of first-ever ischemic stroke is 27% (95% CI, 7 to 43); for diabetes, 21% (95% CI, 11 to 29); and for coronary artery disease, 9% (95% CI, 2 to 16). For small-vessel ischemic stroke, the attributable risk of hypertension is 68% (95% CI, 31 to 85; odds ratio [OR], 5.0), and the attributable risk of diabetes is 30% (95% CI, 10 to 45; OR, 4.4). For cardioembolic stroke, the attributable risk of diabetes is 25% (95% CI, 4 to 41; OR, 3.1).
Conclusions—Stroke of uncertain cause is the most common subtype of ischemic stroke among blacks. Cardioembolic stroke and small-vessel stroke are the most important, identifiable causes of first-ever ischemic stroke among blacks. The incidence rates of cardioembolic and large-vessel stroke are likely underestimated because noninvasive testing of the carotid arteries and echocardiography were not consistently obtained in stroke patients at the 18 regional hospitals. Most small-vessel strokes in blacks can be attributed to hypertension and diabetes.
Key Words: blacks • cardioembolic stroke • incidence • lacunar infarction • risk factors • stroke, ischemic
This article has been cited by other articles:
 |
|
 |
|
  W. Feng, P. J. Nietert, and R. J. Adams Influence of Age on Racial Disparities in Stroke Admission Rates, Hospital Charges, and Outcomes in South Carolina Stroke, September 1, 2009; 40(9): 3096 - 3101. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. S. Markus, U. Khan, J. Birns, A. Evans, L. Kalra, A. G. Rudd, C. D.A. Wolfe, and P. Jerrard-Dunne Differences in Stroke Subtypes Between Black and White Patients With Stroke: The South London Ethnicity and Stroke Study Circulation, November 6, 2007; 116(19): 2157 - 2164. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Roquer, A. Ois, A. Rodriguez-Campello, M. Gomis, E. Munteis, J. Jimenez-Conde, E. Cuadrado-Godia, and J. E. Martinez-Rodriguez Atherosclerotic Burden and Early Mortality in Acute Ischemic Stroke Arch Neurol, May 1, 2007; 64(5): 699 - 704. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. T. Meenan, S. Saha, R. Chou, K. Swarztrauber, K. Pyle Krages, M. C. O'Keeffe-Rosetti, M. McDonagh, B. K. S. Chan, M. C. Hornbrook, and M. Helfand Cost-Effectiveness of Echocardiography to Identify Intracardiac Thrombus among Patients with First Stroke or Transient Ischemic Attack Med Decis Making, March 1, 2007; 27(2): 161 - 177. [Abstract] [PDF]
|
|
|
|
 |
|
 A. Tuttolomondo, A. Pinto, D. Di Raimondo, P. Fernandez, G. Licata, M. Kubo, T. Ninomiya, Y. Tanizaki, and Y. Kiyohara Decreasing incidence of lacunar vs other types of cerebral infarction in a Japanese population Neurology, January 23, 2007; 68(4): 311 - 312. [Full Text] [PDF]
|
|
|
|
|
|
M. Kubo, Y. Kiyohara, T. Ninomiya, Y. Tanizaki, K. Yonemoto, Y. Doi, J. Hata, Y. Oishi, K. Shikata, and M. Iida Decreasing incidence of lacunar vs other types of cerebral infarction in a Japanese population Neurology, May 23, 2006; 66(10): 1539 - 1544. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. W. Petty, B. K. Khandheria, I. Meissner, J. P. Whisnant, W. A. Rocca, T. J. H. Christianson, J. D. Sicks, W. M. O'Fallon, R. L. McClelland, and D. O. Wiebers Population-Based Study of the Relationship Between Patent Foramen Ovale and Cerebrovascular Ischemic Events Mayo Clin. Proc., May 1, 2006; 81(5): 602 - 608. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. W. Petty, B. K. Khandheria, I. Meissner, J. P. Whisnant, W. A. Rocca, J. D. Sicks, T. J. H. Christianson, W. M. O'Fallon, R. L. McClelland, and D. O. Wiebers Population-Based Study of the Relationship Between Atherosclerotic Aortic Debris and Cerebrovascular Ischemic Events Mayo Clin. Proc., May 1, 2006; 81(5): 609 - 614. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. L. Sacco, R. Adams, G. Albers, M. J. Alberts, O. Benavente, K. Furie, L. B. Goldstein, P. Gorelick, J. Halperin, R. Harbaugh, et al. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline. Circulation, March 14, 2006; 113(10): e409 - e449. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. L. Sacco, R. Adams, G. Albers, M. J. Alberts, O. Benavente, K. Furie, L. B. Goldstein, P. Gorelick, J. Halperin, R. Harbaugh, et al. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline. Stroke, February 1, 2006; 37(2): 577 - 617. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Jackson and C. Sudlow Are Lacunar Strokes Really Different?: A Systematic Review of Differences in Risk Factor Profiles Between Lacunar and Nonlacunar Infarcts Stroke, April 1, 2005; 36(4): 891 - 901. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. White, B. Boden-Albala, C. Wang, M. S.V. Elkind, T. Rundek, C. B. Wright, and R. L. Sacco Ischemic Stroke Subtype Incidence Among Whites, Blacks, and Hispanics: The Northern Manhattan Study Circulation, March 15, 2005; 111(10): 1327 - 1331. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. P. Stansbury, H. Jia, L. S. Williams, W. B. Vogel, and P. W. Duncan Ethnic Disparities in Stroke: Epidemiology, Acute Care, and Postacute Outcomes Stroke, February 1, 2005; 36(2): 374 - 386. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. T. Schneider, B. Kissela, D. Woo, D. Kleindorfer, K. Alwell, R. Miller, J. Szaflarski, J. Gebel, J. Khoury, R. Shukla, et al. Ischemic Stroke Subtypes: A Population-Based Study of Incidence Rates Among Blacks and Whites Stroke, July 1, 2004; 35(7): 1552 - 1556. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
U.G.R. Schulz and P.M. Rothwell Differences in Vascular Risk Factors Between Etiological Subtypes of Ischemic Stroke: Importance of Population-Based Studies Stroke, August 1, 2003; 34(8): 2050 - 2059. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. P. Broderick and W. Hacke Treatment of Acute Ischemic Stroke: Part I: Recanalization Strategies Circulation, September 17, 2002; 106(12): 1563 - 1569. [Full Text] [PDF]
|
|
|
|
 |
|
 W. J. Powers Oral Anticoagulant Therapy for the Prevention of Stroke N. Engl. J. Med., November 15, 2001; 345(20): 1493 - 1495. [Full Text] [PDF]
|
|
|
|
|
|
A. Evans, S. Duckworth, L. Kalra, S. Claiborne Johnston, L. A. Gillum, and W. S. Smith Racism and tPA Use in African-Americans Stroke, October 1, 2001; 32(10): 2439 - 2439. [Full Text] [PDF]
|
|
|
|
|
|
B. Kissela, J. Broderick, D. Woo, R. Kothari, R. Miller, J. Khoury, T. Brott, A. Pancioli, E. Jauch, J. Gebel, et al. Greater Cincinnati/Northern Kentucky Stroke Study : Volume of First-Ever Ischemic Stroke Among Blacks in a Population-Based Study Editorial Comment : The Greater Cincinnati/Northern Kentucky Stroke Study: Volume of First-Ever Ischemic Stroke Among Black Americans in a Population-Based Study Stroke, June 1, 2001; 32(6): 1285 - 1290. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Tanizaki, Y. Kiyohara, I. Kato, H. Iwamoto, K. Nakayama, N. Shinohara, H. Arima, K. Tanaka, S. Ibayashi, and M. Fujishima Incidence and Risk Factors for Subtypes of Cerebral Infarction in a General Population : The Hisayama Study Stroke, November 1, 2000; 31(11): 2616 - 2622. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. W. Petty, R. D. Brown Jr, J. P. Whisnant, J. D. Sicks, W. M. O'Fallon, and D. O. Wiebers Ischemic Stroke Subtypes : A Population-Based Study of Functional Outcome, Survival, and Recurrence Stroke, May 1, 2000; 31(5): 1062 - 1068. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. W. Petty, R. D. Brown Jr, J. P. Whisnant, J. D. Sicks, W. M. O’Fallon, and D. O. Wiebers Ischemic Stroke Subtypes : A Population-Based Study of Incidence and Risk Factors Stroke, December 1, 1999; 30(12): 2513 - 2516. [Abstract] [Full Text] [PDF]
|
|