Comparative Rates of Acute Ischemic Stroke Incidence: Native Hawaiians or Pacific Islanders vs Other Races and Ethnic Groups in 4 US States

Background and ObjectivesThere are limited data on the incidence of acute ischemic stroke (AIS) among Native Hawaiian or Pacific Islander (NHOPI) individuals in the United States and on how their incidence compares with that of other racial and ethnic groups. We compared age and sex-specific incidence of AIS in NHOPI individuals with those of non-Hispanic White (NHW), non-Hispanic Black (NHB), Hispanic and Asian individuals residing in 4 states of the United States over the past decade.MethodsUsing a retrospective approach, we examined the State Ambulatory Surgery, Emergency, and Inpatient Databases of Florida (2005-2020), Georgia (2010-2020), Maryland (2012-2020), and New York (2005-2020). Based on available data, we applied a 6-year look-back period for Florida and New York and a 3-year look back period for Georgia and Maryland. Incident AIS cases among adults (≥18 years) were identified using International Classification of Diseases codes. Cases were combined with census data to compute incidence. Random-effects Poisson regression models were used to compare incidence between various race and ethnicity groups.ResultsWe identified 799,150 incident cases of AIS among residents of all 4 states. The median age of these cases was 70.0 years, and 50.1% were female individuals. The age and sex-standardized incidence of AIS in NHOPI was 591.4 (95% CI 559.3-623.5), whereas that in NHW individuals was 179.7 (95% CI 179.2-180.3). After multivariable adjustment, the incidence in NHOPI was >3 times that of NHW individuals (adjusted incidence rate ratio [aIRR] 3.30, 95% CI 1.70-6.42). Incidence was also higher in NHOPI compared with Hispanic (aIRR 3.91, 95% CI 2.13-7.19) and Asian individuals (aIRR 5.66, 95% CI 3.27-9.80), whereas the NHOPI incidence in comparison with that of NHB individuals showed a trend toward significance (aIRR 1.94, 95% CI 0.99-3.77, p = 0.052). After further stratification by age, the incidence gap between NHOPI and NHW individuals was present in most age groups but was most marked in adults age ≥80 years (aIRR 4.24, 95% CI 2.46-7.33).DiscussionOver the period 2011-2020, incidence of AIS among NHOPI individuals residing in Florida, Georgia, Maryland, and New York was higher than among individuals from other major race and ethnicity groups. Additional studies are needed to see whether the findings in these 4 states are occurring nationally.