title: Ethnic disparities in ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage incidence in the Netherlands.
abstract: OBJECTIVE
  Data on the incidence of stroke subtypes among ethnic minority groups are limited. We assessed ethnic differences in the incidence of stroke subtypes in the Netherlands.
  
  
  METHODS
  A Dutch nationwide register-based cohort study (n=7 423 174) was conducted between 1998 and 2010. We studied the following stroke subtypes: ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Cox proportional hazard models were used to estimate incidence differences between first-generation ethnic minorities and the Dutch majority population (ethnic Dutch).
  
  
  RESULTS
  Compared with ethnic Dutch, Surinamese men and women had higher incidence rates of all stroke subtypes combined (adjusted hazard ratios, 1.43; 95% confidence interval, 1.35-1.50 and 1.34; 1.28-1.41), ischemic stroke (1.68; 1.57-1.81 and 1.57; 1.46-1.68), intracerebral hemorrhage (2.08; 1.82-2.39 and 1.74; 1.50-2.00), and subarachnoid hemorrhage (1.25; 0.92-1.69 and 1.26; 1.04-1.54). By contrast, Moroccan men and women had lower incidence rates of all stroke subtypes combined (0.42; 0.36-0.48 and 0.37; 0.30-0.46), ischemic stroke (0.35; 0.27-0.45 and 0.34; 0.24-0.49), intracerebral hemorrhage (0.61; 0.41-0.92 and 0.32; 0.16-0.72), and subarachnoid hemorrhage (0.42; 0.20-0.88 and 0.34; 0.17-0.68) compared with ethnic Dutch counterparts. The results varied by stroke subtype and sex for the other minority groups. For example, Turkish women had a reduced incidence of subarachnoid hemorrhage, whereas Turkish men had an increased incidence of ischemic stroke and intracerebral hemorrhage compared with ethnic Dutch.
  
  
  CONCLUSIONS
  Our findings suggest that Surinamese have an increased risk, whereas Moroccans have a reduced risk for all the various stroke subtypes. Among other ethnic minorities, the risk seems to depend on the stroke subtype and sex. These findings underscore the need to identify the root causes of these ethnic differences to assist primary and secondary prevention efforts.
authors.affiliation: From the Department of Public Health, Academic Medical Center, University of Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.M.v.O., M.L.B., I.V.); Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark (M.N.); Department of Immigrant Medicine, Section of Infectious Diseases, Hvidovre Hospital, Copenhagen, Denmark (M.N.); and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (L.J.K., C.J.M.K.).
authors.forename: Charles
authors.initials: C
authors.lastname: Agyemang
authors.affiliation: From the Department of Public Health, Academic Medical Center, University of Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.M.v.O., M.L.B., I.V.); Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark (M.N.); Department of Immigrant Medicine, Section of Infectious Diseases, Hvidovre Hospital, Copenhagen, Denmark (M.N.); and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (L.J.K., C.J.M.K.).
authors.forename: Aloysia A M
authors.initials: AA
authors.lastname: van Oeffelen
authors.affiliation: From the Department of Public Health, Academic Medical Center, University of Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.M.v.O., M.L.B., I.V.); Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark (M.N.); Department of Immigrant Medicine, Section of Infectious Diseases, Hvidovre Hospital, Copenhagen, Denmark (M.N.); and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (L.J.K., C.J.M.K.).
authors.forename: Marie
authors.initials: M
authors.lastname: Norredam
authors.affiliation: From the Department of Public Health, Academic Medical Center, University of Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.M.v.O., M.L.B., I.V.); Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark (M.N.); Department of Immigrant Medicine, Section of Infectious Diseases, Hvidovre Hospital, Copenhagen, Denmark (M.N.); and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (L.J.K., C.J.M.K.).
authors.forename: L Jaap
authors.initials: LJ
authors.lastname: Kappelle
authors.affiliation: From the Department of Public Health, Academic Medical Center, University of Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.M.v.O., M.L.B., I.V.); Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark (M.N.); Department of Immigrant Medicine, Section of Infectious Diseases, Hvidovre Hospital, Copenhagen, Denmark (M.N.); and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (L.J.K., C.J.M.K.).
authors.forename: Catharina J M
authors.initials: CJ
authors.lastname: Klijn
authors.affiliation: From the Department of Public Health, Academic Medical Center, University of Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.M.v.O., M.L.B., I.V.); Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark (M.N.); Department of Immigrant Medicine, Section of Infectious Diseases, Hvidovre Hospital, Copenhagen, Denmark (M.N.); and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (L.J.K., C.J.M.K.).
authors.forename: Michiel L
authors.initials: ML
authors.lastname: Bots
authors.affiliation: From the Department of Public Health, Academic Medical Center, University of Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.M.v.O., M.L.B., I.V.); Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark (M.N.); Department of Immigrant Medicine, Section of Infectious Diseases, Hvidovre Hospital, Copenhagen, Denmark (M.N.); and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (L.J.K., C.J.M.K.).
authors.forename: Karien
authors.initials: K
authors.lastname: Stronks
authors.affiliation: From the Department of Public Health, Academic Medical Center, University of Amsterdam, The Netherlands (C.A., K.S.); Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands (A.A.M.v.O., M.L.B., I.V.); Danish Research Centre for Migration, Ethnicity and Health, Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark (M.N.); Department of Immigrant Medicine, Section of Infectious Diseases, Hvidovre Hospital, Copenhagen, Denmark (M.N.); and Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands (L.J.K., C.J.M.K.).
authors.forename: Ilonca
authors.initials: I
authors.lastname: Vaartjes
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis / Q000208:ethnology*; D015331:Cohort Studies; D005006:Ethnicity / Q000208:ethnology*; D005260:Female; D005500:Follow-Up Studies; D054624:Health Status Disparities; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000208:ethnology; D012042:Registries; D020521:Stroke / Q000175:diagnosis / Q000208:ethnology*; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000208:ethnology*
keywords: Netherlands; ethnicity; intracerebral hemorrhage; minority groups; minority health; stroke; subarachnoid hemorrhage