Neurology
Volume 74, Issue 6, 2010, Pages 451-457

Risk of premature stroke in recent immigrants (PRESARIO): Population-based matched cohort study (Article)

Saposnik G.* , Redelmeier D.A. , Lu H. , Lonn E. , Fuller-Thomson E. , Ray J.G.
  • a Division of Neurology, Department of Medicine, Canada, Department of Health Policy Management and Evaluation, Canada, Institute of Clinical Evaluative Sciences, Canada
  • b Division of Neurology, Department of Medicine, Canada, Department of Health Policy Management and Evaluation, Canada, Institute of Clinical Evaluative Sciences, Canada, St. Michael's Hospital, Sunnybrook and Women's College, Health Sciences Centre, Canada
  • c Institute of Clinical Evaluative Sciences, Canada
  • d Department of Medicine, Population Health Research Institute, McMaster University, Hamilton, ON, Canada
  • e Faculty of Social Work, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
  • f Division of Neurology, Department of Medicine, Canada, Department of Health Policy Management and Evaluation, Canada, Institute of Clinical Evaluative Sciences, Canada, Department of Obstetrics and Gynecology

Abstract

Background: New immigrants to North America, most of whom are under age 50 years, exhibit fewer risk factors for cardiovascular disease than their native-born counterparts, yet the stress of resettlement may conceivably place them at higher risk of stroke. We determined the risk of acute stroke associated with recency of immigration. Methods: We completed a population-based matched cohort study in Ontario, the largest province in Canada, from April 1, 1995, to March 31, 2007. Overall, 965,829 new immigrants were matched to 3,272,393 long-term residents by year of birth, sex, and location. New immigrants were identified as new recipients of universally available public health insurance, and long-term residents were those insured for 5 years or longer. Results: The mean age of the participants at study entry was about 34 years and the total number of observed strokes was 6,216 after a median duration of follow-up of about 6 years. The incidence rate of acute stroke was 1.69 per 10,000 person-years among new immigrants and 2.56 per 10,000 person-years among long-term residents (crude hazard ratio [HR] 0.66, 95% confidence interval [CI] 0.62-0.71). After adjusting for age, income quintile, urban vs rural residence, history of hypertension, diabetes mellitus and smoking, and number of health insurance claims, the HR for stroke was 0.69 (95% CI 0.64-0.74). Similar risk estimates were seen for both ischemic and hemorrhagic stroke subtypes. Conclusion: New immigrants appear to be at lower risk of premature acute stroke than long-term residents. This finding does not appear to be explained by the availability of health care services or income level. © 2010 by AAN Enterprises, Inc.

Author Keywords

[No Keywords available]

Index Keywords

urban area rural area institutionalization immigrant Stroke health insurance follow up human immigration risk assessment diabetes mellitus controlled study Cigarette Smoking priority journal hypertension acute disease morbidity income Adolescent male Canada female population research Article major clinical study adult premature stroke age distribution cohort analysis mortality
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-76649133020&doi=10.1212%2fWNL.0b013e3181cf6e9e&partnerID=40&md5=83c68fd10b30b70ba004195f56a1c4b2
DOI: 10.1212/WNL.0b013e3181cf6e9e
ISSN: 00283878
Cited by: 20
Original Language: English