Introduction: Native Americans have a higher incidence and prevalence of stroke and the highest stroke-related mortality among race-ethnic groups in the United States. We aimed to analyze trends in the prevalence of vascular risk factors among Native Americans with ischemic stroke over the last two decades along with a comparison to the other race-ethnic groups. Methods: National/Nationwide Inpatient Sample (NIS) database was used to explore the prevalence of risk factors among hospitalized ischemic stroke patients during 2000 - 2016. Ischemic stroke and risk factors of interest were identified using validated ICD-9/10 codes. The race-ethnic groups of interest were Native American, White, Black, Hispanic, Asian/Pacific Islanders, and others. Crude and age-and sex-standardized prevalence estimates were calculated for each risk factor within each race-ethnic group in 6 time periods: 2000-02, 2003-05, 2006-08, 2009-11, 2012-14, and 2015-16. We explored linear trends over the defined time periods using linear regression models, with differences in trends between the Native American group and each of the other race-ethnic groups assessed using interaction terms. The analysis accounted for the complex sampling design, including hospital clusters, NIS stratum, and trend weights for analyzing multiple years of NIS data. Results: Of the 1,278,784 ischemic stroke patients that were included in the analysis, Native Americans constituted 5472. The age-and-sex-standardized prevalence of hypertension (trend slope = 2.24, p < 0.001), hyperlipidemia (trend slope = 6.29, p < 0.001), diabetes (trend slope = 2.04, p = 0.005), atrial fibrillation/flutter (trend slope = 0.80, p = 0.011), heart failure (trend slope = 0.73, p = 0.036) smoking (trend slope = 3.65, p < 0.001), and alcohol (slope = 0.60, p = 0.019) increased during these time periods among Native Americans, while coronary artery disease prevalence remained unchanged. Similar upward trends of several risk factors were noted across other race-ethnic groups with Native Americans showing larger increases in hypertension prevalence compared to Blacks, Hispanics, and Asian/Pacific Islanders and in smoking prevalence compared to Hispanics and Asian/Pacific Islanders. By the year 2015-2016, Native Americans had the highest overall prevalence of diabetes, coronary artery disease, smoking, and alcohol among all the race-ethnic groups. Conclusion: The prevalence of most vascular risk factors among ischemic stroke patients has increased in Native Americans and other race-ethnic groups over the last two decades. Significantly larger increases in the prevalence of hypertension and smoking were seen in Native Americans compared to other groups along with them having the highest prevalence in multiple risk factors in recent years.

中文翻译：

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美洲原住民缺血性卒中的血管危险因素患病率和趋势-全国住院患者分析

简介：在美国的种族民族中，美洲原住民中风的发生率和患病率最高，与中风相关的死亡率最高。我们的目的是分析过去二十年来患有缺血性中风的美洲原住民中血管危险因素的流行趋势，并与其他种族的人群进行比较。方法：使用全国/全国住院患者样本（NIS）数据库调查2000-2016年住院缺血性中风患者的危险因素患病率。使用经过验证的ICD-9 / 10代码识别缺血性中风和相关危险因素。感兴趣的种族民族群体是美洲原住民，白人，黑人，西班牙裔，亚洲/太平洋岛民等。在6个时间段内，针对每个种族族群中的每个风险因素，计算了粗略，年龄和性别标准化的患病率估计：2000-02、2003-05、2006-08、2009-11、2012-14和2015- 16。我们使用线性回归模型探索了定义时间段内的线性趋势，并使用交互作用项评估了美国原住民群体与其他种族群体之间的趋势差异。该分析说明了复杂的抽样设计，包括医院群，NIS层次和用于分析多年NIS数据的趋势权重。结果：在分析中包括的1,278,784例缺血性中风患者中，美洲原住民占5472。年龄和性别标准化的高血压患病率（趋势斜率= 2.24，p <0.001），高脂血症（趋势斜率= 6.29，p） <0.001），糖尿病（趋势斜率= 2.04，p = 0.005），心房纤颤/颤动（趋势斜率= 0.80，p = 0.011），心力衰竭（趋势斜率= 0.73，p = 0.036）吸烟（趋势斜率= 3.65，p <0.001）在这些时间段内，美洲原住民中酒精度（坡度= 0.60，p = 0.019）增加，而冠状动脉疾病的患病率保持不变。在其他种族人群中，一些危险因素也有类似的上升趋势，与黑人，西班牙裔美国人和亚太岛民相比，美国原住民的高血压患病率上升幅度更大，与西班牙裔美国人和亚太岛民相比，吸烟率呈上升趋势。到2015-2016年，美洲印第安人在所有种族族裔中的糖尿病，冠状动脉疾病，吸烟和饮酒的总体患病率最高。结论：在过去的二十年中，缺血性中风患者中大多数血管危险因素的患病率呈上升趋势。与其他群体相比，美国土著人中高血压和吸烟的发生率显着增加，而近年来，他们在多种危险因素中的患病率最高。