Department of Neurology, Emory University School of Medicine and Grady Memorial Hospital, Atlanta, GA, USA;; Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA;.
Center for Populations Health Research, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
J Stroke Cerebrovasc Dis. 2022 Jun;31(6):106467. doi: 10.1016/j.jstrokecerebrovasdis.2022.106467. Epub 2022 Apr 6.
Native Americans have a higher incidence and prevalence of stroke and the highest stroke-related mortality among race-ethnic groups in the United States. We aimed to analyze trends in the ischemic stroke (IS) vascular risk factor prevalence in Native Americans along with a comparison to the other race-ethnic groups.
National Inpatient Sample (NIS) database was used to explore the prevalence of risk factors among hospitalized IS patients during 2000 - 2016. Prevalence estimates were calculated for each risk factor within each race-ethnic group in 6 time periods. Linear trends were explored using linear regression models, with differences in trends between the Native American group and the other race-ethnic groups assessed using interaction terms. The analysis accounted for the complex sampling design, including hospital clusters, NIS stratum, and trend weights for analyzing multiple years of NIS data.
Native Americans constituted 5472 of the 1,278,784 IS patients. The age-and-sex-standardized prevalence of hypertension (slope = 2.24, p < 0.001), hyperlipidemia (slope = 6.29, p < 0.001), diabetes (slope = 2.04, p = 0.005), atrial fibrillation/flutter (trend slope = 0.80, p = 0.011), heart failure (trend slope = 0.73, p = 0.036) smoking (trend slope= 3.65, p < 0.001), and alcohol (slope = 0.60, p = 0.019) increased among Native Americans. They showed larger increases in hypertension prevalence compared to Blacks, Hispanics, and Asian/Pacific Islanders and in smoking prevalence compared to Hispanics and Asian/Pacific Islanders. By the year 2015-2016, Native Americans had the highest overall prevalence of diabetes, coronary artery disease, smoking, and alcohol among all race-ethnic groups.
The prevalence of most vascular risk factors among ischemic stroke patients has increased in Native Americans over the last two decades. Significantly larger increases in hypertension and smoking prevalence were seen in Native Americans compared to other groups along with them having the highest prevalence in multiple risk factors in recent years.
在美国的种族群体中，美国原住民中风的发病率和患病率更高，中风相关死亡率最高。我们旨在分析美国原住民缺血性中风（IS）血管风险因素的流行趋势，并与其他种族群体进行比较。
使用国家住院患者样本（NIS）数据库，在 2000 年至 2016 年期间，探讨住院 IS 患者中风风险因素的流行率。在 6 个时间段内，计算每个种族群体内每个风险因素的流行率估计值。使用线性回归模型探讨线性趋势，使用交互项评估美国原住民组与其他种族群体之间趋势的差异。该分析考虑了复杂的抽样设计，包括医院群集、NIS 层和分析多年 NIS 数据的趋势权重。
在 1278784 例 IS 患者中，美国原住民有 5472 例。高血压（斜率 2.24，p < 0.001）、高血脂（斜率 6.29，p < 0.001）、糖尿病（斜率 2.04，p = 0.005）、心房颤动/扑动（趋势斜率 0.80，p = 0.011）、心力衰竭（趋势斜率 0.73，p = 0.036）、吸烟（趋势斜率 3.65，p < 0.001）和酒精（斜率 0.60，p = 0.019）的年龄和性别标准化患病率增加。与黑人、西班牙裔和亚裔/太平洋岛民相比，美国原住民高血压患病率增加幅度更大，与西班牙裔和亚裔/太平洋岛民相比，吸烟患病率增加幅度更大。到 2015-2016 年，美国原住民在所有种族群体中具有最高的糖尿病、冠心病、吸烟和酒精总体患病率。
在过去二十年中，缺血性中风患者的大多数血管风险因素的流行率在美国原住民中有所增加。与其他群体相比，高血压和吸烟流行率的显著增加更为明显，而近年来，他们在多个风险因素中也具有最高的患病率。
