Abstract Details

Title Incidence of Stroke by Immigration Status: A Retrospective Study of 8 Million Adults

Topic Health Care Disparities

Presentation(s) Health Care Disparities Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 012

Background As the proportion of immigrants in high-income countries increases, it is important to understand the association between immigration status and stroke incidence.

Objective To ascertain the association between immigration status and stroke incidence using population-based cohort study in Ontario, Canada.

Design/Methods We followed 8 million adults with no history of prior stroke or transient ischemic attack (TIA) from 2003 to 2018 to identify incident stroke or TIA, defined as hospitalization or emergency room visit with a corresponding ICD-10 code. We calculated adjusted hazard ratios (HR) of stroke [ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage] or TIA using cause-specific hazard models comparing immigrants, born outside Canada and migrated after 1985, to long-term residents, adjusting for demographics and comorbidities. We evaluated whether the observed association varied with age, stroke subtype, and country of origin of immigrants.

Results

During 109 million person-years follow-up, we observed 235,336 incident stroke or TIA. Compared to long-term residents, immigrants were younger at the time of event (median age: 67 vs. 74 years) and had a lower rate of stroke or TIA (10.9 vs. 23.4 per 10,000-person-years, adjusted hazard ratio [HR] 0.67; 95% confidence interval, 0.66-0.68). This association varied by age, with a lower rate in immigrants compared to long-term residents in all age groups, except those under 30 years (HR 0.87, 0.70-1.07); by stroke subtype, HR for ischemic stroke 0.71 (0.69-0.72), intracerebral hemorrhage 0.89 (0.85-0.93), subarachnoid hemorrhage 0.85 (0.81-0.91), and TIA 0.53 (0.51-0.54); and by country of origin, HR in immigrants from the Caribbean 0.95 (0.91-1.00), Latin America 0.85 (0.82-0.91), and Africa 0.80 (0.74-0.85).

Conclusions

Immigrants have a lower rate of stroke or TIA than long-term residents, although the magnitude of this association varies by age, stroke subtype, and country of origin of immigrants. This knowledge can be used to develop targeted stroke prevention strategies.

Authors/Disclosures
Manav Vyas, MD (MV VYAS MEDICINE PROFESSIONAL CORPORATION) PRESENTER	The institution of Dr. Vyas has received research support from Heart and Stroke Foundation of Canada . The institution of Dr. Vyas has received research support from Canadian Institutes of Health Research . Dr. Vyas has received research support from Heart and Stroke Foundation of Canada .
	No disclosure on file
	No disclosure on file
	No disclosure on file
Frank L. Silver, MD (Univ Health Network, Toronto Western Hosp)	Dr. Silver has nothing to disclose.
Moira Kapral, MD (Toronto General Hospital)	The institution of Moira Kapral, MD has received research support from Heart and Stroke Foundation of Canada, Canadian Institutes of Health Research.