Incidence rates of first-ever ischemic stroke subtypes among blacks: A population-based study

Daniel Woo, James Gebel, Rosemary Miller, Rashmi Kothari, Thomas G Brott, Jane Khoury, Shelia Salisbury, Rakesh Shukla, Arthur Pancioli, Edward Jauch, Joseph Broderick

Research output: Contribution to journalArticle

95 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2517-2522
Number of pages6
JournalStroke
Volume30
Issue number12
StatePublished - Dec 1999
Externally publishedYes

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Stroke
Incidence
Confidence Intervals
Population
Odds Ratio
Hypertension
Echocardiography
Transient Ischemic Attack
Carotid Arteries
Coronary Artery Disease

Keywords

  • Blacks
  • Cardioembolic stroke
  • Incidence
  • Lacunar infarction
  • Risk factors
  • Stroke, ischemic

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

Woo, D., Gebel, J., Miller, R., Kothari, R., Brott, T. G., Khoury, J., ... Broderick, J. (1999). Incidence rates of first-ever ischemic stroke subtypes among blacks: A population-based study. Stroke, 30(12), 2517-2522.

Incidence rates of first-ever ischemic stroke subtypes among blacks : A population-based study. / Woo, Daniel; Gebel, James; Miller, Rosemary; Kothari, Rashmi; Brott, Thomas G; Khoury, Jane; Salisbury, Shelia; Shukla, Rakesh; Pancioli, Arthur; Jauch, Edward; Broderick, Joseph.

In: Stroke, Vol. 30, No. 12, 12.1999, p. 2517-2522.

Research output: Contribution to journalArticle

Woo, D, Gebel, J, Miller, R, Kothari, R, Brott, TG, Khoury, J, Salisbury, S, Shukla, R, Pancioli, A, Jauch, E & Broderick, J 1999, 'Incidence rates of first-ever ischemic stroke subtypes among blacks: A population-based study', Stroke, vol. 30, no. 12, pp. 2517-2522.
Woo D, Gebel J, Miller R, Kothari R, Brott TG, Khoury J et al. Incidence rates of first-ever ischemic stroke subtypes among blacks: A population-based study. Stroke. 1999 Dec;30(12):2517-2522.
Woo, Daniel ; Gebel, James ; Miller, Rosemary ; Kothari, Rashmi ; Brott, Thomas G ; Khoury, Jane ; Salisbury, Shelia ; Shukla, Rakesh ; Pancioli, Arthur ; Jauch, Edward ; Broderick, Joseph. / Incidence rates of first-ever ischemic stroke subtypes among blacks : A population-based study. In: Stroke. 1999 ; Vol. 30, No. 12. pp. 2517-2522.
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abstract = "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.",
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author = "Daniel Woo and James Gebel and Rosemary Miller and Rashmi Kothari and Brott, {Thomas G} and Jane Khoury and Shelia Salisbury and Rakesh Shukla and Arthur Pancioli and Edward Jauch and Joseph Broderick",
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T1 - Incidence rates of first-ever ischemic stroke subtypes among blacks

T2 - A population-based study

AU - Woo, Daniel

AU - Gebel, James

AU - Miller, Rosemary

AU - Kothari, Rashmi

AU - Brott, Thomas G

AU - Khoury, Jane

AU - Salisbury, Shelia

AU - Shukla, Rakesh

AU - Pancioli, Arthur

AU - Jauch, Edward

AU - Broderick, Joseph

PY - 1999/12

Y1 - 1999/12

N2 - 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.

AB - 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.

KW - Blacks

KW - Cardioembolic stroke

KW - Incidence

KW - Lacunar infarction

KW - Risk factors

KW - Stroke, ischemic

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