Incidence of hemorrhagic stroke in black Caribbean, black African, and white populations: the South London stroke register, 1995-2004.
OBJECTIVE
Data are lacking on the differences in hemorrhagic stroke incidence between black Caribbean (BC), black African (BA), and white ethnic groups. We estimated the incidence for primary intracerebral hemorrhage (PICH) and subarachnoid hemorrhage (SAH) and the associated risk factors for BCs, BAs, and whites.


METHODS
First-ever stroke patients were drawn from a prospective community stroke register based in a multiethnic population in South London with 9% BCs, 15% BAs, and 63% whites. Incidence rates were standardized to European and world populations and adjusted for age and sex. Incidence rate ratios (IRRs) relative to whites were calculated by Poisson regression.


RESULTS
Between 1995 and 2004, 566 incident stroke patients were registered: 395 PICHs and 171 SAHs. For PICH, age- and sex-adjusted IRRs were higher in BAs (IRR, 2.80; 95% CI, 2.00 to 3.91) than in BCs (IRR, 1.46; 95% CI, 1.07 to 1.99) and were particularly pronounced for patients age 0 to 64 years: IRR=3.95 (95% CI, 2.65 to 5.87) in BAs and 2.38 (95% CI, 1.50 to 3.80) in BCs. For those <65 years, prestroke hypertension was more prevalent in BAs and BCs (P=0.049). For SAH, the IRR was higher in BCs (IRR; 1.62; 95% CI, 1.05 to 2.48) than in BAs (IRR, 0.80; 95% CI, 0.43 to 1.46).


CONCLUSIONS
The higher incidence of PICH observed in BCs and BAs could be explained by prestroke hypertension being more common among young blacks. The different incidences of SAH in BCs and BAs suggest that the baseline risk of stroke for distinct black ethnic groups is not homogeneous.
Smeeton
Nigel C
NC
King's College London, Division of Health and Social Care Research, Capital House, 42 Weston St, London SE1 3QD, UK. nigel.smeeton@kcl.ac.uk
Heuschmann
Peter U
PU
Rudd
Anthony G
AG
McEvoy
Andrew W
AW
Kitchen
Neil D
ND
Sarker
Shah Jalal
SJ
Wolfe
Charles D A
CD
D000328:Adult; D000349:Africa; D000368:Aged; D044383:Black People; D017691:Caribbean Region; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000208:ethnology; D005006:Ethnicity; D005260:Female; D006801:Humans; D015994:Incidence; D008131:London; D008297:Male; D008875:Middle Aged; D012042:Registries; D012044:Regression Analysis; D012307:Risk Factors; D012923:Social Class; D020521:Stroke / Q000453:epidemiology* / Q000208:ethnology*; D044465:White People