Ethnic Differences in Stroke Outcomes in Aotearoa New Zealand: A National Linkage Study

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aut.relation.endpage671
aut.relation.issue6
aut.relation.journalInternational Journal of Stroke
aut.relation.startpage663
aut.relation.volume18
dc.contributor.authorDenison, Hayley
dc.contributor.authorCorbin, Marine
dc.contributor.authorDouwes, Jeroen
dc.contributor.authorThompson, Stephanie
dc.contributor.authorHarwood, Matire
dc.contributor.authorDavis, Alan
dc.contributor.authorFink, John N
dc.contributor.authorBarber, P Alan
dc.contributor.authorGommans, John
dc.contributor.authorCadilhac, Dominique
dc.contributor.authorLevack, William
dc.contributor.authorMcNaughton, Harry
dc.contributor.authorKim, Joosup
dc.contributor.authorFeigin, VL
dc.contributor.authorAbernethy, Virginia
dc.contributor.authorGirvan, Jackie
dc.contributor.authorWilson, Andrew
dc.contributor.authorRanta, Annemarei
dc.date.accessioned2023-10-13T03:53:17Z
dc.date.available2023-10-13T03:53:17Z
dc.date.issued2023-03-05
dc.description.abstractBACKGROUND: Ethnic differences in post-stroke outcomes have been largely attributed to biological and socioeconomic characteristics resulting in differential risk factor profiles and stroke sub-types, but evidence is mixed. AIMS: This study assessed ethnic differences in stroke outcome and service access in New Zealand (NZ) and explored underlying causes in addition to traditional risk factors. METHODS: This national cohort study used routinely collected health and social data to compare post-stroke outcomes between NZ Europeans, Māori, Pacific Peoples, and Asians, adjusting for differences in baseline characteristics, socioeconomic deprivation, and stroke characteristics. First and principal stroke public hospital admissions during November 2017-October 2018 were included (N=6,879). Post-stroke unfavourable outcome was defined as being dead, change in residence, or unemployed if working pre-stroke. RESULTS: In total, 5,394 NZ Europeans, 762 Māori, 369 Pacific Peoples and 354 Asians experienced a stroke during the study period. Median age was 65 years for Māori and Pacific Peoples, and 71 and 79 years for Asians and NZ Europeans, respectively. Compared with NZ Europeans, Māori were more likely to have an unfavourable outcome at all three time-points (OR=1.6 (95%CI=1.3-1.9); 1.4 (1.2-1.7); 1.4 (1.2-1.7), respectively). Māori also had increased odds of death at all time-points (1.7 (1.3-2.1); 1.5 (1.2-1.9); 1.7 (1.3-2.1)) and unemployment at twelve months (2.5 (1.2-5.2). There was evidence of differences in post-stroke secondary prevention medication by ethnicity. CONCLUSIONS: We found ethnic disparities in care and outcomes following stroke, independent of traditional risk factors raising concern for potential unconscious bias and institutional racism in stroke services.
dc.identifier.citationInternational Journal of Stroke, ISSN: 1747-4930 (Print); 1747-4949 (Online), SAGE Publications, 18(6), 663-671. doi: 10.1177/17474930231164024
dc.identifier.doi10.1177/17474930231164024
dc.identifier.issn1747-4930
dc.identifier.issn1747-4949
dc.identifier.urihttp://hdl.handle.net/10292/16772
dc.languageeng
dc.publisherSAGE Publications
dc.relation.urihttps://journals.sagepub.com/doi/10.1177/17474930231164024
dc.rights.accessrightsOpenAccess
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectData linkage
dc.subjectDisparities
dc.subjectEthnicity
dc.subjectIndigenous
dc.subjectStroke
dc.subjectStroke outcomes
dc.subjectDisparities
dc.subjectdata linkage
dc.subjectethnicity
dc.subjectindigenous
dc.subjectstroke
dc.subject4202 Epidemiology
dc.subject4206 Public Health
dc.subject42 Health Sciences
dc.subjectPrevention
dc.subjectAging
dc.subjectClinical Research
dc.subjectBrain Disorders
dc.subjectStroke
dc.subject2 Aetiology
dc.subject2.4 Surveillance and distribution
dc.subjectStroke
dc.subject1103 Clinical Sciences
dc.subject1109 Neurosciences
dc.subjectNeurology & Neurosurgery
dc.subject3202 Clinical sciences
dc.subject3209 Neurosciences
dc.subject4201 Allied health and rehabilitation science
dc.subject.meshAged
dc.subject.meshHumans
dc.subject.meshAsia
dc.subject.meshCohort Studies
dc.subject.meshEthnicity
dc.subject.meshEurope
dc.subject.meshMaori People
dc.subject.meshNew Zealand
dc.subject.meshPacific Island People
dc.subject.meshStroke
dc.subject.meshPatient Outcome Assessment
dc.subject.meshHumans
dc.subject.meshCohort Studies
dc.subject.meshAged
dc.subject.meshAsia
dc.subject.meshEurope
dc.subject.meshNew Zealand
dc.subject.meshStroke
dc.subject.meshPatient Outcome Assessment
dc.subject.meshEthnicity
dc.subject.meshPacific Island People
dc.subject.meshMaori People
dc.subject.meshAged
dc.subject.meshHumans
dc.subject.meshAsia
dc.subject.meshCohort Studies
dc.subject.meshEthnicity
dc.subject.meshEurope
dc.subject.meshMaori People
dc.subject.meshNew Zealand
dc.subject.meshPacific Island People
dc.subject.meshStroke
dc.subject.meshPatient Outcome Assessment
dc.titleEthnic Differences in Stroke Outcomes in Aotearoa New Zealand: A National Linkage Study
dc.typeJournal Article
pubs.elements-id495492
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NISAN - the National Institute for Stroke and Applied Neurosciences