title: Ethnic variations in the incidence and mortality of stroke in the Scottish Health and Ethnicity Linkage Study of 4.65 million people.
abstract: BACKGROUND
  Ethnic variations in stroke require more European studies, especially as differences are reportedly large.
  
  
  METHODS
  We created a retrospective cohort study of 4.65 million people in Scotland linking ethnicity from the census and stroke incidence and mortality from NHS databases. Rate ratios using direct age standardization and risk ratios were calculated, the latter to model the influence of educational qualification in a Poisson regression model.
  
  
  RESULTS
  Age-adjusted rate ratios varied little, compared to the White Scottish group (reference value 100) and the 95% CIs usually included 100, e.g. higher in Pakistani men (120.5, 95% CI 95.2-145.8) and in African men (137.9, 95% CI 91.5-184.4) but not in Pakistani or African women. Stroke rates were low in the Other White British (78.3, 95% CI 75.4-81.2 in men and 84.9, 95% CI 82.0-87.8 in women), Other White (89.8, 95% CI 81.5-98.1 in men and 88.8, 95% CI 80.9-96.7 in women) and Chinese men (70.3, 95% CI 45.7-94.8). Adjusting for highest educational qualification attenuated some and augmented other risk ratios, e.g. in Other White British men, the risk ratio changed from 71.4 to 80.2 (95% CI 74.2-86.6) and in African men from 124.2 to 138.8 (95% CI 107.7-178.8).
  
  
  CONCLUSIONS
  Ethnic variations deserve further study, including in White European origin subgroups and the Chinese. Extremely high rates in South Asian and African origin were not corroborated in Scotland. Linkage methods are practical in Europe.
authors.affiliation: Edinburgh Ethnicity and Health Research Group, Centre for Population Health Sciences, University of Edinburgh, Teviot Place, Edinburgh, UK. Raj.Bhopal@ed.ac.uk
authors.forename: R S
authors.initials: RS
authors.lastname: Bhopal
authors.forename: N
authors.initials: N
authors.lastname: Bansal
authors.forename: C M
authors.initials: CM
authors.lastname: Fischbacher
authors.forename: H
authors.initials: H
authors.lastname: Brown
authors.forename: S
authors.initials: S
authors.lastname: Capewell
mesh_terms: D044466:Asian People / Q000706:statistics & numerical data; D044383:Black People / Q000706:statistics & numerical data; D019352:Censuses; D002681:China / Q000208:ethnology; D004522:Educational Status; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008297:Male; D010154:Pakistan / Q000208:ethnology; D044469:Racial Groups / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D012737:Sex Factors; D020521:Stroke / Q000208:ethnology* / Q000401:mortality*; D044465:White People / Q000706:statistics & numerical data