title: Persistent ischemic stroke disparities despite declining incidence in Mexican Americans.
abstract: OBJECTIVE
  To determine trends in ischemic stroke incidence among Mexican Americans and non-Hispanic whites.
  
  
  METHODS
  We performed population-based stroke surveillance from January 1, 2000 to December 31, 2010 in Corpus Christi, Texas. Ischemic stroke patients 45 years and older were ascertained from potential sources, and charts were abstracted. Neurologists validated cases based on source documentation blinded to ethnicity and age. Crude and age-, sex-, and ethnicity-adjusted annual incidence was calculated for first ever completed ischemic stroke. Poisson regression models were used to calculate adjusted ischemic stroke rates, rate ratios, and trends.
  
  
  RESULTS
  There were 2,604 ischemic strokes in Mexican Americans and 2,042 in non-Hispanic whites. The rate ratios (Mexican American:non-Hispanic white) were 1.94 (95% confidence interval [CI] = 1.67-2.25), 1.50 (95% CI = 1.35-1.67), and 1.00 (95% CI = 0.90-1.11) among those aged 45 to 59, 60 to 74, and 75 years and older, respectively, and 1.34 (95% CI = 1.23-1.46) when adjusted for age. Ischemic stroke incidence declined during the study period by 35.9% (95% CI = 25.9-44.5). The decline was limited to those aged ≥60 years, and happened in both ethnic groups similarly (p > 0.10), implying that the disparities seen in the 45- to 74-year age group persist unabated.
  
  
  CONCLUSIONS
  Ischemic stroke incidence rates have declined dramatically in the past decade in both ethnic groups for those aged ≥60 years. However, the disparity between Mexican American and non-Hispanic white stroke rates persists in those <75 years of age. Although the decline in stroke is encouraging, additional prevention efforts targeting young Mexican Americans are warranted.
authors.affiliation: Stroke Program, Department of Neurology, Veterans Affairs Center for Clinical Management and Research, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI; Department of Emergency Medicine, University of Michigan Medical School, Veterans Affairs Center for Clinical Management and Research, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI; Department of Epidemiology, Veterans Affairs Center for Clinical Management and Research, Ann Arbor Veterans Affairs Healthcare System, Ann Arbor, MI.
authors.forename: Lewis B
authors.initials: LB
authors.lastname: Morgenstern
authors.forename: Melinda A
authors.initials: MA
authors.lastname: Smith
authors.forename: Brisa N
authors.initials: BN
authors.lastname: Sánchez
authors.forename: Devin L
authors.initials: DL
authors.lastname: Brown
authors.forename: Darin B
authors.initials: DB
authors.lastname: Zahuranec
authors.forename: Nelda
authors.initials: N
authors.lastname: Garcia
authors.forename: Kevin A
authors.initials: KA
authors.lastname: Kerber
authors.forename: Lesli E
authors.initials: LE
authors.lastname: Skolarus
authors.forename: William J
authors.initials: WJ
authors.lastname: Meurer
authors.forename: James F
authors.initials: JF
authors.lastname: Burke
authors.forename: Eric E
authors.initials: EE
authors.lastname: Adelman
authors.forename: Jonggyu
authors.initials: J
authors.lastname: Baek
authors.forename: Lynda D
authors.initials: LD
authors.lastname: Lisabeth
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000208:ethnology*; D005260:Female; D006306:Health Surveys; D054625:Healthcare Disparities / Q000208:ethnology; D006801:Humans; D015994:Incidence; D008297:Male; D017058:Mexican Americans / Q000208:ethnology*; D008875:Middle Aged; D020521:Stroke / Q000208:ethnology*; D014481:United States / Q000208:ethnology; D044465:White People / Q000208:ethnology*