title: Risk of stroke in children: ethnic and gender disparities.
abstract: METHODS
  Using a California-wide hospital discharge database, the authors analyzed all first admissions for stroke in children 1 month through 19 years of age from 1991 through 2000. Incidence rates were estimated as the number of first hospitalizations divided by the person-years at risk; case fatality rates were based on in-hospital deaths.
  
  
  RESULTS
  The authors identified 2,278 first admissions for childhood stroke, yielding an annual incidence rate of 2.3 per 100,000 children (1.2 for ischemic stroke, 1.1 for hemorrhagic stroke). Compared with whites, black children were at higher risk of stroke (for ischemic stroke, relative risk [RR] 2.59, 95% CI 2.17 to 3.09, p < 0.0001; subarachnoid hemorrhage [SAH], RR 1.59, CI 1.06 to 2.33, p = 0.02; intracerebral hemorrhage [ICH], RR 1.66, CI 1.23 to 2.13, p = 0.0001). Hispanics, however, had a lower risk of ischemic stroke (RR 0.70, CI 0.60 to 0.82, p < 0.0001) and ICH (RR 0.77, CI 0.64 to 0.93, p = 0.0004), whereas Asians had similar risks as whites. Boys were at higher risk for all stroke types than girls (ischemic stroke, RR 1.25, CI 1.11 to 1.40, p = 0.0002; SAH, RR 1.24, CI 1.00 to 1.53, p = 0.047; ICH, RR 1.34, CI 1.16 to 1.56, p = 0.0001). After eliminating cases with coexisting sickle cell disease, excess stroke risk persisted in blacks; after elimination of trauma, excess stroke risk persisted in boys. Case fatality rates were similar among different ethnic groups. Compared with girls, boys had a higher case fatality rate for ischemic stroke (17 vs 12%; p = 0.002) but not for ICH or SAH.
  
  
  CONCLUSIONS
  Rates of hospitalization for stroke are higher among black children and boys; sickle cell disease and trauma do not fully account for these findings.
authors.affiliation: Department of Neurology, University of California, San Francisco, CA 94143-0114, USA. hjfc@itsa.ucsf.edu
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Fullerton
authors.forename: Yvonne W
authors.initials: YW
authors.lastname: Wu
authors.forename: Shoujun
authors.initials: S
authors.lastname: Zhao
authors.forename: S Claiborne
authors.initials: SC
authors.lastname: Johnston
mesh_terms: D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000453:epidemiology; D044383:Black People; D001778:Blood Coagulation Disorders / Q000453:epidemiology; D002140:California / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003681:Dehydration / Q000453:epidemiology; D004660:Encephalitis / Q000453:epidemiology; D006330:Heart Defects, Congenital / Q000453:epidemiology; D006630:Hispanic or Latino; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008581:Meningitis / Q000453:epidemiology; D010343:Patient Admission / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012306:Risk; D012737:Sex Factors; D020521:Stroke / Q000145:classification / Q000453:epidemiology* / Q000208:ethnology; D044465:White People; D001741:Black or African American