title: Risk factors, quality of care and prognosis in South Asian, East Asian and White patients with stroke.
abstract: BACKGROUND
  Stroke has emerged as a significant and escalating health problem for Asian populations. We compared risk factors, quality of care and risk of death or recurrent stroke in South Asian, East Asian and White patients with acute ischemic and hemorrhagic stroke.
  
  
  METHODS
  Retrospective analysis was performed on consecutive patients with ischemic stroke or intracerebral hemorrhage admitted to 12 stroke centers in Ontario, Canada (July 2003-March 2008) and included in the Registry of the Canadian Stroke Network database. The database was linked to population-based administrative databases to determine one-year risk of death or recurrent stroke.
  
  
  RESULTS
  The study included 253 South Asian, 513 East Asian and 8231 White patients. East Asian patients were more likely to present with intracerebral hemorrhage (30%) compared to South Asian (17%) or White patients (15%) (p<0.001). Time from stroke to hospital arrival was similarly poor with delays >2 hours for more than two thirds of patients in all ethnic groups. Processes of stroke care, including thrombolysis, diagnostic imaging, antithrombotic medications, and rehabilitation services were similar among ethnic groups. Risk of death or recurrent stroke at one year after ischemic stroke was similar for patients who were White (27.6%), East Asian (24.7%, aHR 0.97, 95% CI 0.78-1.21 vs. White), or South Asian (21.9%, aHR 0.91, 95% CI 0.67-1.24 vs. White). Although risk of death or recurrent stroke at one year after intracerebral hemorrhage was higher in East Asian (35.5%) and White patients (47.9%) compared to South Asian patients (30.2%) (p=0.002), these differences disappeared after adjustment for age, sex, stroke severity and comorbid conditions (aHR 0.89 [0.67-1.19] for East Asian vs White and 0.99 [0.54-1.81] for South Asian vs. White).
  
  
  CONCLUSIONS
  After stratification by stroke type, stroke care and outcomes are similar across ethnic groups in Ontario. Enhanced health promotion is needed to reduce delays to hospital for all ethnic groups.
authors.affiliation: Department of Medicine, University of British Columbia, 620 B, 1081 Burrard Street, St, Paul's Hospita, Vancouver, BC V6Z 1Y6, Canada. nakhanubc@gmail.com
authors.forename: Nadia A
authors.initials: NA
authors.lastname: Khan
authors.forename: Hude
authors.initials: H
authors.lastname: Quan
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hill
authors.forename: Louise
authors.initials: L
authors.lastname: Pilote
authors.forename: Finlay A
authors.initials: FA
authors.lastname: McAlister
authors.forename: Anita
authors.initials: A
authors.lastname: Palepu
authors.forename: Baiju R
authors.initials: BR
authors.lastname: Shah
authors.forename: Limei
authors.initials: L
authors.lastname: Zhou
authors.forename: Hong
authors.initials: H
authors.lastname: Zhen
authors.forename: Moira K
authors.initials: MK
authors.lastname: Kapral
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People / Q000208:ethnology; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000208:ethnology / Q000628:therapy; D016009:Chi-Square Distribution; D018672:Community Health Planning; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011787:Quality of Health Care; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000208:ethnology* / Q000401:mortality* / Q000628:therapy*; D044465:White People / Q000208:ethnology