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    Stroke incidence and subtypes in Aboriginal people in remote Australia: a healthcare network population-based study.

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    Author
    Balabanski, AH; Goldsmith, K; Giarola, B; Buxton, D; Castle, S; McBride, K; Brady, S; Thrift, AG; Katzenellenbogen, J; Brown, A; ...
    Date
    2020-10-08
    Source Title
    BMJ Open
    Publisher
    BMJ
    University of Melbourne Author/s
    Donnan, Geoffrey
    Affiliation
    Medicine and Radiology
    Metadata
    Show full item record
    Document Type
    Journal Article
    Citations
    Balabanski, A. H., Goldsmith, K., Giarola, B., Buxton, D., Castle, S., McBride, K., Brady, S., Thrift, A. G., Katzenellenbogen, J., Brown, A., Burrow, J., Donnan, G. A., Koblar, S. & Kleinig, T. J. (2020). Stroke incidence and subtypes in Aboriginal people in remote Australia: a healthcare network population-based study.. BMJ Open, 10 (10), pp.e039533-. https://doi.org/10.1136/bmjopen-2020-039533.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/251755
    DOI
    10.1136/bmjopen-2020-039533
    Open Access at PMC
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7545633
    Abstract
    OBJECTIVES: We aimed to compare the incidence, subtypes and aetiology of stroke, and in-hospital death due to stroke, between Aboriginal and non-Aboriginal people in Central Australia, a remote region of Australia where a high proportion Aboriginal people reside (40% of the population). We hypothesised that the rates of stroke, particularly in younger adults, would be greater in the Aboriginal population, compared with the non-Aboriginal population; we aimed to elucidate causes for any identified disparities. DESIGN: A retrospective population-based study of patients hospitalised with stroke within a defined region from 1 January 2011 to 31 December 2014. SETTING: Alice Springs Hospital, the only neuroimaging-capable acute hospital in Central Australia, serving a network of 50 healthcare facilities covering 672 000 km2. PARTICIPANTS: 161 residents (63.4% Aboriginal) of the catchment area admitted to hospital with stroke. PRIMARY AND SECONDARY OUTCOME MEASURES: Rates of first-ever stroke, overall (all events) stroke and in-hospital death. RESULTS: Of 121 residents with first-ever stroke, 61% identified as Aboriginal. Median onset-age (54 years) was 17 years younger in Aboriginal patients (p<0.001), and age-standardised stroke incidence was threefold that of non-Aboriginal patients (153 vs 51 per 100 000, incidence rate ratio 3.0, 95% CI 2 to 4). The rate ratios for the overall rate of stroke (first-ever and recurrent) were similar. In Aboriginal patients aged <55 years, the incidence of ischaemic stroke was 14-fold greater (95% CI 4 to 45), and intracerebral haemorrhage 19-fold greater (95% CI 3 to 142) than in non-Aboriginal patients. Crude prevalence of diabetes mellitus (70.3% vs 34.0%, p<0.001) and hypercholesterolaemia (68.9% vs 51.1%, p=0.049) was greater, and age-standardised in-hospital deaths were fivefold greater (35 vs 7 per 100 000, 95% CI 2 to 11) in Aboriginal patients than in non-Aboriginal patients. CONCLUSIONS: Stroke incidence (both subtypes) and in-hospital deaths for remote Aboriginal Australians are dramatically greater than in non-Aboriginal people, especially in patients aged <55 years.

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