Background and Purpose- An excess incidence of strokes among blacks versus whites has been shown, but data on disparities related to Hispanic ethnicity remain limited. This study examines race/ethnic differences in stroke incidence in the multiethnic, largely Caribbean Hispanic, NOMAS (Northern Manhattan Study), and whether disparities vary by age. Methods- The study population included participants in the prospective population-based NOMAS, followed for a mean of 14±7 years. Multivariable-adjusted Cox proportional hazards models were constructed to estimate the association between race/ethnicity and incident stroke of any subtype and ischemic stroke, stratified by age. Results- Among 3298 participants (mean baseline age 69±10 years, 37% men, 24% black, 21% white, 52% Hispanic), 460 incident strokes accrued (400 ischemic, 43 intracerebral hemorrhage, 9 subarachnoid hemorrhage). The most common ischemic subtype was cardioembolic, followed by lacunar infarcts, then cryptogenic. The greatest incidence rate was observed in blacks (13/1000 person-years), followed by Hispanics (10/1000 person-years), and lowest in whites (9/1000 person-years), and this order was observed for crude incidence rates until age 75. By age 85, the greatest incidence rate was in Hispanics. Blacks had an increased risk of stroke versus whites overall in multivariable models that included sociodemographics (hazard ratio, 1.51 [95% CI, 1.13-2.02]), and stratified analyses showed that this disparity was driven by women of age ≥70. The increased rate of stroke among Hispanics (age/sex-adjusted hazard ratio, 1.48 [95% CI, 1.13-1.93]) was largely explained by education and insurance status (a proxy for socieoeconomic status; hazard ratio after further adjusting for these variables, 1.17 [95% CI, 0.85-1.62]) but remained significant for women age ≥70. Conclusions- This study provides novel data regarding the increased stroke risk among Caribbean Hispanics in this elderly population. Results highlight the need to create culturally tailored campaigns to reach black and Hispanic populations to reduce race/ethnic stroke disparities and support the important role of low socioeconomic status in driving an elevated risk among Caribbean Hispanics.

中文翻译：

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曼哈顿北部研究的卒中发生率中的种族和种族差异。

背景和目的-黑人与白人之间的中风发生率已经过高，但是与西班牙裔种族相关的差异数据仍然有限。这项研究调查了多种族（主要是加勒比裔西班牙裔），NOMAS（北曼哈顿研究）在中风发病方面的种族/种族差异，以及年龄之间的差异是否存在差异。方法-研究人群包括基于预期人群的NOMAS的参与者，平均随访时间为14±7年。构建了多变量调整的Cox比例风险模型，以估计种族/族裔与任何亚型的事件性卒中与缺血性卒中之间的关联（按年龄分层）。结果-在3298名参与者中（平均基线年龄69±10岁，男性37％，黑人24％，白人21％，西班牙裔52％），发生了460次中风（400次缺血，脑出血43例，蛛网膜下腔出血9例）。最常见的缺血性亚型是心脏栓塞，其次是腔隙性梗塞，然后是隐源性的。黑人的发病率最高（13/1000人年），其次是西班牙裔（10/1000人年），最低的白人（9/1000人年），并且对于粗发病率观察到该顺序到75岁为止的最高发病率。到85岁时，西班牙裔人的发病率最高。在包括社会人口统计学的多变量模型中，黑人与白人相比总体上具有更高的中风风险（危险比，1.51 [95％CI，1.13-2.02]），分层分析表明，这种差异是由70岁以上的女性造成的。西班牙裔中风的发生率上升（年龄/性别调整后的危险比为1.48 [95％CI，1.13-1。93]）在很大程度上由教育和保险地位（社会经济地位的代名词；进一步调整这些变量后的危险比，1.17 [95％CI，0.85-1.62]）解释，但对于70岁以上的女性仍然很重要。结论-这项研究提供了有关这一老年人口中加勒比裔西班牙裔中风风险增加的新颖数据。结果强调需要开展针对文化的运动，以覆盖黑人和西班牙裔人口，以减少种族/族裔中风差距，并支持低社会经济地位在推动加勒比裔西班牙裔中的风险增加方面发挥重要作用。结论-这项研究提供了有关该老年人中加勒比裔西班牙裔中风风险增加的新数据。结果强调需要开展针对文化的运动，以覆盖黑人和西班牙裔人口，以减少种族/族裔中风差距，并支持低社会经济地位在推动加勒比裔西班牙裔中的风险增加方面发挥重要作用。结论-这项研究提供了有关该老年人中加勒比裔西班牙裔中风风险增加的新数据。结果强调需要开展针对文化的运动，以覆盖黑人和西班牙裔人口，以减少种族/族裔中风差距，并支持低社会经济地位在推动加勒比西班牙裔人群中风险升高方面的重要作用。