title: Burden of stroke in indigenous Western Australians: a study using data linkage.
abstract: OBJECTIVE
  Despite the disproportionate burden of cardiovascular disease among indigenous Australians, information on stroke is sparse. This article documents the incidence and burden of stroke (in disability-adjusted life years) in indigenous and non-indigenous people in Western Australia (1997-2002), a state resident to 15% of indigenous Australians comprising 3.4% of the population of Western Australia.
  
  
  METHODS
  Indigenous and non-indigenous stroke incidence and excess mortality rates were estimated from linked hospital and mortality data, with adjustment for nonadmitted events. Nonfatal burden was calculated from nonfatal incidence, duration (modeled from incidence, excess mortality, and remission), and disability weights. Stroke death counts formed the basis of fatal burden. Nonfatal and fatal burden were summed to obtain disability-adjusted life years, by indigenous status.
  
  
  RESULTS
  The total burden was 55 099 and 2134 disability-adjusted life years in non-indigenous and indigenous Western Australians, respectively. The indigenous to non-indigenous age-standardized stroke incidence rate ratio (≥15 years) was 2.6 in males (95% CI, 2.3-3.0) and 3.0 (95% CI, 2.6-3.5) in females, with similar rate ratios of disability-adjusted life years. The burden profile differed substantially between populations, with rate ratios being highest at younger ages.
  
  
  CONCLUSIONS
  The differential between indigenous and non-indigenous stroke burden is considerable, highlighting the need for comprehensive intersectoral interventions to reduce indigenous stroke incidence and improve outcomes. Programs to reduce risk factors and increase access to culturally appropriate stroke services are required. The results here provide the quantitative basis for policy development and monitoring of stroke outcomes.
authors.affiliation: Curtin Health Innovation Research Institute, Curtin University, GPO Box U1987, Perth, Western Australia. j.katzenellenbogen@curtin.edu.au
authors.forename: Judith M
authors.initials: JM
authors.lastname: Katzenellenbogen
authors.forename: Theo
authors.initials: T
authors.lastname: Vos
authors.forename: Peter
authors.initials: P
authors.lastname: Somerford
authors.forename: Stephen
authors.initials: S
authors.lastname: Begg
authors.forename: James B
authors.initials: JB
authors.lastname: Semmens
authors.forename: James P
authors.initials: JP
authors.lastname: Codde
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000191:economics / Q000453:epidemiology / Q000208:ethnology / Q000401:mortality; D017281:Cost of Illness; D003625:Data Collection / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000191:economics* / Q000453:epidemiology / Q000208:ethnology* / Q000401:mortality; D014904:Western Australia / Q000453:epidemiology; D055815:Young Adult