Mark McAllister, MD

Agyeman C, van Oeffelen A, Norredam M, Kappelle LJ, Klijn C, Bots M, Stronks K, and Vaartjes I. Ethnic Disparities in Ischemic Stroke, Intracerebral Hemorrhage, and Subarachnoid Hemorrhage Incidence in The Netherlands. Stroke. 2014

Population based studies have demonstrated that the incidence of stroke is not equal across various races and ethnicities. Differences may be due to varying socioeconomic factors, genetic differences, or multifactorial elements. The extent to which this variability exists and the nature of the heterogeneity is not known for many countries. In this article, the authors investigated the incidence of stroke by ethnic background in the Netherlands using a nationwide database. 


Defining minorities as patients born abroad with at least one parent also born abroad and ethnic Dutch as those with both parents born in the Netherlands, the authors found differences in stroke subtype incidence by ethnic background. For ischemic stroke Surninamese, Turk, and Indonesian men had higher incidence than Dutch men – whereas Moroccan and Chinese men had fewer. For women there was a higher incidence of ischemic stroke in Surinamese and Indonesians compared to ethnic Dutch, and lower in Moroccans. For both intracerebral hemorrhage and subarachnoid hemorrhage Moroccan men and women had lower incidence compared to ethnic Dutch, whereas all other ethnic minorities had higher rates of ICH compared to ethnic Dutch.

While varying incidences of strokes and hemorrhage were found amongst ethnic minorities in the Netherlands in this study, the underlying causes are not known. As expected, the rates of ischemic stroke co-varied with cerebrovascular risk factors which also differ among minorities. Interestingly, this study did not find that ethnic minorities had a universally higher rate of stroke subtypes, particularly in the Moroccan population. Further study is needed to inform public health initiatives and to investigate the incidences in other countries.