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

Abstract

To compare 18-year (2000-2017) temporal trends in ischemic stroke rates by ethnicity, sex, and age. 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. In those aged 45-59 years, rates increased in non-Hispanic Whites (104.3% relative increase; <i>p</i> < 0.001) but decreased in Mexican Americans (-21.9%; <i>p</i> = 0.03) such that rates were significantly higher in non-Hispanic Whites in 2016-2017 (<i>p</i> 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%, <i>p</i> = 0.05; Mexican Americans -40.1%, <i>p</i> = 0.002), resulting in similar rates for the 2 groups in 2016-2017 (<i>p</i> 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%, <i>p</i> = 0.002; Mexican Americans -26.9%, <i>p</i> = 0.02). Decreases in rates were observed in men (age 60-74, -25.7%, <i>p</i> = 0.009; age ≥75, -39.2%, <i>p</i> = 0.002) and women (age 60-74, -34.3%, <i>p</i> = 0.007; age ≥75, -24.0%, <i>p</i> = 0.02) in the 2 older age groups, while rates did not change in either sex in those age 45-59. 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.