title: Stroke in Indigenous Africans, African Americans, and European Americans: Interplay of Racial and Geographic Factors.
abstract: The relative contributions of racial and geographic factors to higher risk of stroke in people of African ancestry have not been unraveled. We compared stroke type and contributions of vascular risk factors among indigenous Africans (IA), African Americans (AA), and European Americans (EA).
  
  
  
  SIREN (Stroke Investigative Research and Educational Network) is a large multinational case-control study in West Africa-the ancestral home of 71% AA-whereas REGARDS (Reasons for Geographic and Racial Differences in Stroke) is a cohort study including AA and EA in the United States. Using harmonized assessments and standard definitions, we compared data on stroke type and established risk factors for stroke in acute stroke cases aged ≥55 years in both studies.
  
  
  
  There were 811 IA, 452 AA, and 665 EA stroke subjects, with mean age of 68.0±9.3, 73.0±8.3, and 76.0±8.3 years, respectively (P<0.0001). Hemorrhagic stroke was more frequent among IA (27%) compared with AA (8%) and EA (5.4%;P<0.001). Lacunar strokes were more prevalent in IA (47.1%), followed by AA (35.1%) and then EA (21.0%;P<0.0001). The frequency of hypertension in decreasing order was IA (92.8%), followed by AA (82.5%) and then EA (64.2%;P<0.0001) and similarly for diabetes mellitus IA (38.3%), AA (36.8%), and EA (21.0%;P<0.0001). Premorbid sedentary lifestyle was similar in AA (37.7%) and EA (34.0%) but lower frequency in IA (8.0%).
  
  
  
  Environmental risk factors such as sedentary lifestyle may contribute to the higher proportion of ischemic stroke in AA compared with IA, whereas racial factors may contribute to the higher proportion of hypertension and diabetes mellitus among stroke subjects of African ancestry.
authors.affiliation: From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.).
authors.forename: Mayowa
authors.initials: M
authors.lastname: Owolabi
authors.affiliation: From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.).
authors.forename: Fred
authors.initials: F
authors.lastname: Sarfo
authors.affiliation: From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.).
authors.forename: Virginia J
authors.initials: VJ
authors.lastname: Howard
authors.affiliation: From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.).
authors.forename: Marguerite R
authors.initials: MR
authors.lastname: Irvin
authors.affiliation: From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.).
authors.forename: Mulugeta
authors.initials: M
authors.lastname: Gebregziabher
authors.affiliation: From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.).
authors.forename: Rufus
authors.initials: R
authors.lastname: Akinyemi
authors.affiliation: From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.).
authors.forename: Aleena
authors.initials: A
authors.lastname: Bennett
authors.affiliation: From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.).
authors.forename: Kevin
authors.initials: K
authors.lastname: Armstrong
authors.affiliation: From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.).
authors.forename: Hemant K
authors.initials: HK
authors.lastname: Tiwari
authors.affiliation: From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.).
authors.forename: Albert
authors.initials: A
authors.lastname: Akpalu
authors.affiliation: From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.).
authors.forename: Kolawole W
authors.initials: KW
authors.lastname: Wahab
authors.affiliation: From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.).
authors.forename: Lukman
authors.initials: L
authors.lastname: Owolabi
authors.affiliation: From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.).
authors.forename: Bimbo
authors.initials: B
authors.lastname: Fawale
authors.affiliation: From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.).
authors.forename: Morenikeji
authors.initials: M
authors.lastname: Komolafe
authors.affiliation: From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.).
authors.forename: Reginald
authors.initials: R
authors.lastname: Obiako
authors.affiliation: From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.).
authors.forename: Philip
authors.initials: P
authors.lastname: Adebayo
authors.affiliation: From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.).
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Manly
authors.affiliation: From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.).
authors.forename: Godwin
authors.initials: G
authors.lastname: Ogbole
authors.affiliation: From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.).
authors.forename: Ezinne
authors.initials: E
authors.lastname: Melikam
authors.affiliation: From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.).
authors.forename: Ruth
authors.initials: R
authors.lastname: Laryea
authors.affiliation: From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.).
authors.forename: Raelle
authors.initials: R
authors.lastname: Saulson
authors.affiliation: From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.).
authors.forename: Carolyn
authors.initials: C
authors.lastname: Jenkins
authors.affiliation: From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.).
authors.forename: Donna K
authors.initials: DK
authors.lastname: Arnett
authors.affiliation: From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.).
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Lackland
authors.affiliation: From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.). ovibes@musc.edu.
authors.forename: Bruce
authors.initials: B
authors.lastname: Ovbiagele
authors.affiliation: From the Department of Medicine (M.O., E.M.) and Department of Radiology (G.O.), University of Ibadan, Nigeria; Department of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana (F.S.); Department of Epidemiology (V.J.H., M.R.I.) and Department of Biostatistics (A.B., H.K.T., G.H.), University of Alabama at Birmingham; Department of Public Health Sciences (M.G.), Department of Psychiatry and Behavioural Sciences (K.A.), Department of Neurology (R.S., D.T.L., B.O.), and Department of Nursing (C.J.), Medical University of South Carolina, Charleston; Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria (R.A.); Department of Medicine and Therapeutics, University of Ghana, Accra (A.A., R.L.); Department of Medicine, University of Ilorin, Nigeria (K.W.W.); Department of Medicine, Aminu Kano Teaching Hospital, Nigeria (L.O.); Department of Medicine, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria (B.F., M.K.); Department of Medicine, Ahmadu Bello University, Zaria, Nigeria (R.O.); Department of Internal Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria (P.A.); Department of Neurology, Columbia University, New York (J.M.M.); and College of Public Health, University of Kentucky at Lexington (D.K.A.).
authors.forename: George
authors.initials: G
authors.lastname: Howard
mesh_terms: D000354:Africa, Western / Q000208:ethnology; D001741:Black or African American / Q000208:ethnology*; D000368:Aged; D044383:Black People / Q000208:ethnology*; D002545:Brain Ischemia / Q000208:ethnology*; D016022:Case-Control Studies; D002543:Cerebral Hemorrhage / Q000208:ethnology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000208:ethnology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D057185:Sedentary Behavior / Q000208:ethnology*; D020521:Stroke / Q000208:ethnology*; D059409:Stroke, Lacunar / Q000208:ethnology; D014481:United States / Q000208:ethnology; D044465:White People / Q000208:ethnology*
keywords: case–control study; cohort study; death; risk factors; stroke