Trends and survival between ethnic groups after stroke: the South London Stroke Register

Abstract

Background and purpose: To identify trends and differences between ethnic groups in survival after first-ever stroke and examine factors influencing survival.

Methods: Population-based stroke register of first in a lifetime strokes between 1995 and 2010. Baseline data were collection of sociodemographic factors, stroke subtype, case mix, risk factors before stroke, and receipt of effective acute stroke processes. Survival curves were estimated with Kaplan-Meier methods, and survival analyses were undertaken using Cox Proportional-hazards models.

Results: Survival improved significantly over this 16-year period (P<0.0001). Black Caribbean and black African had a reduced risk of all-cause mortality compared with white patients (hazard ratio, 0.85 [95% confidence interval, 0.74-0.98] and 0.61 [0.49-0.77], respectively) after adjustment for confounders. This survival advantage of black Caribbean/black African over white mainly existed in older patients (over 65). Recent stroke, being black Caribbean/black African, and stroke unit admission were associated with better survival.

Conclusions: Survival has improved in a multiethnic population over time. The independent survival advantage of black Caribbean and black African over White group in those aged over 65 may be a healthy migrant effect of first generation migrants. The increase in admission to a stroke unit may contribute to the improvement in survival after stroke.