July 1, 2015

Stroke Disparities: Disaggregating Native Hawaiians from other Pacific Islanders

Kazuma Nakagawa M.D., Pippa R. MacDonald B.A., Susan M. Asai M.S.N.

Ethnicity & Disease

Objectives—To compare the clinical characteristics of Native Hawaiians (NH) and other Pacific Islanders (PI) who are hospitalized with ischemic stroke.

Design—Retrospective, cross-sectional analysis of medical records.

Setting—Tertiary, Primary Stroke Center in Honolulu, Hawaii.

Patients—Consecutive patients with race/ethnicity identified as NH or PI who were hospitalized for ischemic stroke between January 2006 and December 2012.

Outcome Measures—Age, sex, cardiovascular risk factors, intravenous tissue plasminogen activator (IV-tPA) utilization rate and hospital length of stay.

Results—A total of 561 patients (57% NH and 43% PI) were studied. PI were younger (59 ± 13 years vs 62 ± 14 years, ,P=.002), had higher prevalence of diabetes mellitus (58% vs 41%, P<. 0001) and prosthetic valve (6% vs 2%, P=.007), lower prevalence of smoking (14% vs 21%, P=.03), lower HDL cholesterol (38 ± 11 mg/dL vs 41 ± 13 mg/dL, P=.004), and higher discharge diastolic blood pressure (79 ± 15 vs 76 mm Hg ± 14 mm Hg, P=.04) compared to NH. No difference was seen in other cardiovascular risk factors. The IV-tPA utilization rate (5% vs 6%, P=.48) and the hospital length of stay (10 ± 17 days vs 10 ± 49 days, P=.86) were not different between the two groups.

Conclusion—Native Hawaiians and other Pacific Islanders with ischemic stroke have modestly different age of stroke presentation and burden of risk factors compared to each other. Disaggregating these two racial groups may be important to unmask any potential clinical differences in future studies.

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