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Incidence of Stroke in Indigenous Populations of Countries With a Very High Human Development Index: A Systematic
Anna H Balabanski1, Angela Dos Santos1, John A Woods1
1From the Department of Medicine (A.H.B., A.G.T.), Monash University; Department of Medicine and Neurology (A.H.B., L.C.), University of Melbourne; Department of Stroke Medicine (A.H.B., C.A.M.), Alfred Health, Melbourne; South West Sydney Clinical School (A.D.S.), University of New South Wales, Liverpool; School of Allied Health (J.A.W.), The University of Western Australia, Perth; Department of Neurology (T.J.K.), Royal Adelaide Hospital, Australia; Elson S. Floyd College of Medicine (A.M.S.-D.); Institute for Research and Education to Advance Community Health (A.M.S.-D., D.B.), Washington State University, Spokane; Department of Community Medicine (S.R.A.S.), UiT The Arctic University of Norway, Tromso; Department of Health Society and Behavior (B.B.-A.); Department of Epidemiology and Biostatistics (B.B.-A.); Department of Neurology School of Medicine (B.B.-A.), University of California, Irvine; National Institute for Stroke and Applied Neurosciences (R.V.K., V.L.F.), Auckland University of Technology; Department of Medicine (A.R.), University of Otago, Wellington, New Zealand; Department of Odontology (C.S.M.); Várdduo - Centre for Sámi research (C.S.M.), Umeå University, Sweden; Unidad de Ciudadanía Intercultural y Salud Indígena (C.Z.-C.), Universidad Peruana Cayetano Heredia, Lima, Peru; Department of Medicine (L.B.), Royal Melbourne Hospital; Human Research Ethics Committee (D.Z.), Victoria University, Melbourne, Australia; Department of Neurology (W.T.L., D.L.T.); Department of Epidemiology (W.T.L.), University of Washington, Seattle; Department of Medicine (S.S.A.), McMaster University, Hamilton; Canada and Population Health Research Institute (S.S.A.), Hamilton Health Sciences; Department of Neurology (M.W.P.), Liverpool Hospital, Australia; Ingham Institute of Applied Medical Research (M.W.P.); National Centre for Indigenous Genomics (A.B.), Telethon Kids Institute and The Australian National University, Canberra; Bloomberg School of Public Health (D.K.W.), Johns Hopkins University, Baltimore, MD; Faculty of Medical and Health Sciences (M.H., P.A.B.), University of Auckland, New Zealand; and Cardiovascular Epidemiology Research Centre (J.M.K.), School of Population and Global Health, The University of Western Australia, Perth.
Background And Objectives:
Cardiovascular disease contributes significantly to disease burden among many Indigenous populations. However, data on stroke incidence in Indigenous populations are sparse. We aimed to investigate what is known of stroke incidence in Indigenous populations of countries with a very high Human Development Index (HDI), locating the research in the broader context of Indigenous health.
Methods:
We identified population-based stroke incidence studies published between 1990 and 2022 among Indigenous adult populations of developed countries using PubMed, Embase, and Global Health databases, without language restriction. We excluded non-peer-reviewed sources, studies with fewer than 10 Indigenous people, or not covering a 35- to 64-year minimum age range. Two reviewers independently screened titles, abstracts, and full-text articles and extracted data. We assessed quality using "gold standard" criteria for population-based stroke incidence studies, the Newcastle-Ottawa Scale for risk of bias, and CONSIDER criteria for reporting of Indigenous health research. An Indigenous Advisory Board provided oversight for the study.
Results:
From 13,041 publications screened, 24 studies (19 full-text articles, 5 abstracts) from 7 countries met the inclusion criteria. Age-standardized stroke incidence rate ratios were greater in Aboriginal and Torres Strait Islander Australians (1.7-3.2), American Indians (1.2), Sámi of Sweden/Norway (1.08-2.14), and Singaporean Malay (1.7-1.9), compared with respective non-Indigenous populations. Studies had substantial heterogeneity in design and risk of bias. Attack rates, male-female rate ratios, and time trends are reported where available. Few investigators reported Indigenous stakeholder involvement, with few studies meeting any of the CONSIDER criteria for research among Indigenous populations.
Discussion:
In countries with a very high HDI, there are notable, albeit varying, disparities in stroke incidence between Indigenous and non-Indigenous populations, although there are gaps in data availability and quality. A greater understanding of stroke incidence is imperative for informing effective societal responses to socioeconomic and health disparities in these populations. Future studies into stroke incidence in Indigenous populations should be designed and conducted with Indigenous oversight and governance to facilitate improved outcomes and capacity building.
Registration Information:
PROSPERO registration: CRD42021242367.
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