Skip to main content

Advertisement

Log in

Large variations in stroke hospitalization rates across immigrant groups in Italy

  • Original Communication
  • Published:
Journal of Neurology Aims and scope Submit manuscript

    We’re sorry, something doesn't seem to be working properly.

    Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Abstract

A high mortality from cerebrovascular diseases has been reported among immigrants in Europe; however, data on stroke incidence in immigrants are sparse. Aim of the study is to assess hospitalization rates for stroke across different immigrant groups in the Veneto Region (Italy). The study population was represented by all residents aged 20–64 years. Admissions for stroke in 2008–2013 were extracted from hospital discharge records based on diagnosis codes. We computed age and gender specific rates separately for Italian and foreign residents. For each area of origin (Eastern Europe, North Africa, Sub-Saharan Africa, South Asia, other Asian countries, Central-South America, and industrialized countries) we calculated standardized hospitalization ratios (SHR) by means of indirect standardization, with rates observed in Italian residents as a reference. We identified 9740 hospitalization for stroke, 8.0 % of which occurred in immigrants. Overall stroke rates were higher in immigrants males (SHR 1.45, 95 % confidence interval 1.32–1.59) and females (SHR 1.21, 1.08–1.36) with respect to the Italian population. The highest risk was observed in Sub-Saharan Africans, in both genders (males SHR 3.15, 2.62–3.76; females SHR 3.15, 2.22–4.34), followed by immigrants from South Asia and other Asian countries. Our findings confirm the increased risk of stroke in immigrants, with wide variations by country of origin. Further studies are warranted to investigate associated risk factors in order to shape effective preventive strategies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Krishnamurthi RV, Feigin VL, Forouzanfar MH, Mensah GA, Connor M, Bennett DA et al (2013) Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990–2010: findings from the Global Burden of Disease Study 2010. Lancet Glob Health 1:e259–e281

    Article  PubMed  PubMed Central  Google Scholar 

  2. Wild SH, Fischbacher C, Brock A, Griffiths C, Bhopal R (2007) Mortality from all causes and circulatory disease by country of birth in England and Wales 2001–2003. J Public Health 29:191–198

    Article  CAS  Google Scholar 

  3. Boulogne R, Jougla E, Breem Y, Kunst AE, Rey G (2012) Mortality differences between the foreign-born and locally-born population in France (2004–2007). Soc Sci Med 74:1213–1223

    Article  PubMed  Google Scholar 

  4. Regidor E, Astasio P, Calle ME, Martínez D, Ortega P, Domínguez V (2009) The association between birthplace in different regions of the world and cardiovascular mortality among residents of Spain. Eur J Epidemiol 24:503–512

    Article  PubMed  Google Scholar 

  5. Bos V, Kunst AE, Keij-Deerenberg IM, Garssen J, Mackenbach JP (2004) Ethnic inequalities in age- and cause-specific mortality in The Netherlands. Int J Epidemiol 33:1112–1119

    Article  PubMed  Google Scholar 

  6. Fedeli U, Ferroni E, Pigato M, Avossa F, Saugo M (2015) Causes of mortality across different immigrant groups in Northeastern Italy. Peer J 3:e975

    Article  PubMed  PubMed Central  Google Scholar 

  7. Gezmu T, Schneider D, Demissie K, Lin Y, Gizzi MS (2014) Risk factors for acute stroke among South Asians compared to other racial/ethnic groups. PLoS One 9:e108901

    Article  PubMed  PubMed Central  Google Scholar 

  8. Dassanayake J, Gurrin L, Payne WR, Sundararajan V, Dharmage SC (2011) Cardiovascular disease risk in immigrants: what is the evidence and where are the gaps? Asia Pac J Public Health 23:882–895

    Article  PubMed  Google Scholar 

  9. Sohail QZ, Chu A, Rezai MR, Donovan LR, Ko DT, Tu JV (2015) The risk of ischemic heart disease and stroke among immigrant populations: a systematic review. Can J Cardiol 31:1160–1168

    Article  PubMed  Google Scholar 

  10. Fedeli U, Casotto V, Ferroni E, Saugo M, Targher G, Zoppini G (2015) Prevalence of diabetes across different immigrant groups in North-eastern Italy. Nutr Metab Cardiovasc Dis 25:924–930

    Article  CAS  PubMed  Google Scholar 

  11. Spolaore P, Brocco S, Fedeli U, Visentin C, Schievano E, Avossa F et al (2005) Measuring accuracy of discharge diagnoses for a region-wide surveillance of hospitalized strokes. Stroke 36:1031–1034

    Article  PubMed  Google Scholar 

  12. Pathak EB, Sloan MA (2009) Recent racial/ethnic disparities in stroke hospitalizations and outcomes for young adults in Florida, 2001–2006. Neuroepidemiology 32:302–311

    Article  PubMed  Google Scholar 

  13. Heuschmann PU, Grieve AP, Toschke AM, Rudd AG, Wolfe CD (2008) Ethnic group disparities in 10-year trends in stroke incidence and vascular risk factors: the South London Stroke Register (SLSR). Stroke 39:2204–2210

    Article  PubMed  Google Scholar 

  14. Bhopal RS, Bansal N, Fischbacher CM, Brown H, Capewell S, Scottish Health and Ethnic Linkage Study (2012) Ethnic variations in the incidence and mortality of stroke in the Scottish Health and Ethnicity Linkage Study of 4.65 million people. Eur J Prev Cardiol 19:1503–1508

    Article  CAS  PubMed  Google Scholar 

  15. Feigin V, Carter K, Hackett M, Barber PA, McNaughton H, Dyall L et al (2006) Ethnic disparities in incidence of stroke subtypes: Auckland Regional Community Stroke Study, 2002–2003. Lancet Neurol 5:130–139

    Article  PubMed  Google Scholar 

  16. Moon JR, Capistrant BD, Kawachi I, Avendaño M, Subramanian SV, Bates LM, Glymour MM (2012) Stroke incidence in older US Hispanics: is foreign birth protective? Stroke 43:1224–1229

    Article  PubMed  Google Scholar 

  17. Agyemang C, van Oeffelen AA, Norredam M, Kappelle LJ, Klijn CJ, Bots ML et al (2014) Ethnic disparities in ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage incidence in The Netherlands. Stroke 45:3236–3242

    Article  PubMed  Google Scholar 

  18. Khan FA, Zia E, Janzon L, Engstrom G (2004) Incidence of stroke and stroke subtypes in Malmö, Sweden, 1990–2000: marked differences between groups defined by birth country. Stroke 35:2054–2058

    Article  PubMed  Google Scholar 

  19. Saposnik G, Redelmeier DA, Lu H, Lonn E, Fuller-Thomson E, Ray JG (2010) Risk of premature stroke in recent immigrants (PRESARIO): population-based matched cohort study. Neurology 74:451–457

    Article  CAS  PubMed  Google Scholar 

  20. Muennig P, Jia H, Khan K (2004) Hospitalization for heart disease, stroke, and diabetes mellitus among Indian-born persons: a small area analysis. BMC Cardiovasc Disord 4:19

    Article  PubMed  PubMed Central  Google Scholar 

  21. Spallek J, Arnold M, Razum O, Juel K, Rey G, Deboosere P et al (2012) Cancer mortality patterns among Turkish immigrants in four European countries and in Turkey. Eur J Epidemiol 27:915–921

    Article  PubMed  Google Scholar 

  22. Fang J, Foo SH, Fung C, Wylie-Rosett J, Alderman MH (2006) Stroke risk among Chinese immigrants in New York city. J Immigr Minor Health 8:387–393

    Article  PubMed  Google Scholar 

  23. Gunarathne A, Patel JV, Gammon B, Gill PS, Hughes EA, Lip GY (2009) Ischemic stroke in South Asians: a review of the epidemiology, pathophysiology, and ethnicity-related clinical features. Stroke 40:e415–e423

    Article  PubMed  Google Scholar 

  24. Ramachandran A, Snehalatha C, Kapur A, Vijay V, Mohan V, Das AK et al (2001) High prevalence of diabetes and impaired glucose tolerance in India: the National Urban Diabetes Survey (NUDS). Diabetologia 44:1094–1101

    Article  CAS  PubMed  Google Scholar 

  25. Gentilucci UV, Picardi A, Manfrini S, Khazrai YM, Fioriti E, Altomare M et al (2008) Westernization of the Filipino population resident in Rome: obesity, diabetes and hypertension. Diabetes Metab Res Rev 24:364–370

    Article  CAS  PubMed  Google Scholar 

  26. Modesti PA, Bianchi S, Borghi C, Cameli M, Capasso G, Ceriello A et al (2014) Cardiovascular health in migrants: current status and issues for prevention. A collaborative multidisciplinary task force report. J Cardiovasc Med 15:683–692

    Article  Google Scholar 

  27. Modesti PA, Tamburini C, Hagi MI, Cecioni I, Migliorini A, Neri Serneri GG (1995) Twenty-four-hour blood pressure changes in young Somalian blacks after migration to Italy. Am J Hypertens 8:201–205

    Article  CAS  PubMed  Google Scholar 

  28. Dominguez LJ, Galioto A, Pineo A, Ferlisi A, Vernuccio L, Belvedere M et al (2008) Blood pressure and cardiovascular risk profiles of Africans who migrate to a Western country. Ethn Dis 18:512–518

    PubMed  Google Scholar 

  29. ESH/ESC Task Force for the Management of Arterial Hypertension (2013) 2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension. J Hypertens 31:1925–1938

    Article  Google Scholar 

  30. Agyemang C, Bindraban N, Mairuhu G, Gv Montfrans, Koopmans R, Stronks K et al (2005) Prevalence, awareness, treatment, and control of hypertension among Black Surinamese, South Asian Surinamese and White Dutch in Amsterdam, The Netherlands: the SUNSET study. J Hypertens 23(11):1971–1977

    Article  CAS  PubMed  Google Scholar 

  31. Agyemang C, Kieft S, Snijder MB, Beune EJ, van den Born BJ, Brewster LM et al (2015) Hypertension control in a large multi-ethnic cohort in Amsterdam, The Netherlands: the HELIUS study. Int J Cardiol 183:180–189

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ugo Fedeli.

Ethics declarations

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical standards

All analyses were carried out on previously anonymized records without any possibility of identification of individuals; therefore the study was exempt from institutional review board approval.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fedeli, U., Pigato, M., Avossa, F. et al. Large variations in stroke hospitalization rates across immigrant groups in Italy. J Neurol 263, 449–454 (2016). https://doi.org/10.1007/s00415-015-7995-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-015-7995-x

Keywords

Navigation