Danish Research Centre for Migration, Ethnicity and Health, Department of Public Health, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
Danish Centre for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
BMJ Open. 2021 Oct 21;11(10):e049347. doi: 10.1136/bmjopen-2021-049347.
Using recent registry data, we aimed to quantify the incidence of stroke and transient ischaemic attack (TIA) and to examine factors influencing the risk of poststroke mortality among immigrants compared with Danish-born individuals.
Population-based cohort study between 2004 and 2018. We estimated age-standardised incidence rate ratios (IRR) of stroke, stroke types and TIA for each ethnic group using Danish-born individuals as the reference by direct method of standardisation. We calculated the risk of poststroke mortality using Cox proportional hazard regression.
The study was conducted using Danish nationwide registers.
All cases of first-ever stroke and TIA by country of origin (n=132 936) were included.
Overall, Western immigrants (IRR=2.25; 95% CI 2.20 to 2.31) and non-Western immigrants (IRR=1.37; 95% CI 1.30 to 1.44) had a higher risk of stroke than Danish-born individuals. The risk of TIA was higher in Western immigrants (IRR=2.08; 95% CI 1.93 to 2.23) followed by non-Western immigrants (IRR=1.45; 95% CI 1.27 to 1.63) than in Danish-born individuals. All-cause 1-year mortality hazard was higher but not significantly different in non-Western men (adjusted HR=1.38; 95% CI 0.92 to 2.08) compared with Danish-born men and additional adjustment for comorbidities reduced the HR to 0.85 (0.51 to 1.40) among ischaemic stroke cases. Among intracerebral haemorrhage cases, the adjusted mortality hazard was decreased in Western men (from HR of 1.76; 95% CI 1.09 to 2.85 to HR of 1.30; 95% CI 0.80 to 2.11) compared with Danish-born men after adjustment for stroke severity. Immigrants with ≤15 years of residence had a lower poststroke mortality hazard than Danish-born individuals after additional adjustment for sociodemographic factors (HR=0.36; 95% CI 0.14 to 0.91).
The age-standardised risk of stroke and TIA was significantly higher among the majority of immigrants than Danish-born individuals. Interventions that reduce the burden of comorbidities, improve acute stroke care and target sociodemographic factors may address the higher risk of poststroke mortality among immigrants.
利用最近的登记数据，我们旨在量化中风和短暂性脑缺血发作（TIA）的发生率，并研究与丹麦出生者相比，移民中风后死亡风险的影响因素。
2004 年至 2018 年期间的基于人群的队列研究。我们使用丹麦出生者作为参考，通过直接标准化方法，估计了每个族裔中风、中风类型和 TIA 的年龄标准化发病率比值（IRR）。我们使用 Cox 比例风险回归计算中风后死亡的风险。
研究使用丹麦全国登记册进行。
所有按原籍国划分的首次中风和 TIA 病例（n=132936）均包括在内。
总体而言，西方移民（IRR=2.25；95%CI 2.20 至 2.31）和非西方移民（IRR=1.37；95%CI 1.30 至 1.44）的中风风险高于丹麦出生者。西方移民的 TIA 风险更高（IRR=2.08；95%CI 1.93 至 2.23），其次是非西方移民（IRR=1.45；95%CI 1.27 至 1.63）。与丹麦出生者相比，非西方男性（调整后的 HR=1.38；95%CI 0.92 至 2.08）的 1 年全因死亡率风险更高，但差异无统计学意义，而在缺血性中风病例中，对合并症进行额外调整后，HR 降至 0.85（0.51 至 1.40）。在颅内出血病例中，与丹麦出生者相比，西方男性的调整后死亡率风险降低（从 HR 1.76（95%CI 1.09 至 2.85）降至 HR 1.30（95%CI 0.80 至 2.11）），在调整了中风严重程度后。居住时间≤15 年的移民在调整社会人口因素后，中风后死亡率风险低于丹麦出生者（HR=0.36；95%CI 0.14 至 0.91）。
与丹麦出生者相比，大多数移民的年龄标准化中风和 TIA 风险明显更高。减少合并症负担、改善急性中风护理和针对社会人口因素的干预措施，可能有助于降低移民中风后死亡的风险。
