Ethnic Differences in Access to Stroke Reperfusion Therapy in Northern New Zealand

2020 ◽  
Vol 54 (5) ◽  
pp. 427-432
Author(s):  
Isaac Samuels ◽  
Michael T.M. Wang ◽  
Kar Po Chong ◽  
Alan Davis ◽  
Annemarei Ranta ◽  
...  
Keyword(s):  
New Zealand ◽  
Acute Stroke ◽  
Ethnic Groups ◽  
Ethnic Differences ◽  
Intravenous Thrombolysis ◽  
Reperfusion Therapy ◽  
Northern Region ◽  
Incidence Rates ◽  
Stroke Incidence ◽  
Pacific People

<b><i>Background:</i></b> In New Zealand, Māori and Pacific people have higher age-adjusted stroke incidence rates, younger age at first stroke, and higher mortality at 12 months than other ethnic groups. We aimed to determine if access to acute stroke reperfusion therapy with intravenous thrombolysis (IVT) or endovascular thrombectomy (EVT) is equitable among ethnic groups. <b><i>Methods:</i></b> Data were obtained from the Northern Region component of the New Zealand Stroke Registry over the 21 months between January 1, 2018 and September 30, 2019. Data recorded included demographic details, self-identified ethnicity, treatment times, and clinical outcomes. National hospital discharge coding of patients admitted with ischemic stroke and stroke unspecified was used to determine the proportion of patients treated by ethnic group. <b><i>Results:</i></b> There were 537 patients normally resident in the Northern Region who received reperfusion therapy: 281 received IVT alone, 123 received EVT after bridging IVT, and 133 received EVT alone. Of the 537 patients treated with IVT or EVT, there were 81 (15.1%) Māori, 78 (14.5%) Pacific, 57 (10.6%) Asian, and 341 (63.5%) NZ European/other ethnicity patients. There were no ethnic differences in treatment process times. When compared with NZ European/others, Māori and Pacific people were younger, and Māori had worse neurological impairment at admission. A higher proportion of Māori were treated with EVT with a trend to higher proportion treated with IVT. Day 90 modified Rankin Scale (mRS) for EVT-treated patients was similar apart from Asian patients who had worse outcome when compared with NZ European/others (mRS 3 vs. 2; <i>p</i> = 0.03). <b><i>Conclusions:</i></b> This study has shown equitable access to acute stroke reperfusion therapies and largely similar outcomes in different ethnic groups in northern New Zealand.

Burden of Stroke in Maori and Pacific Peoples of New Zealand

2007 ◽  
Vol 2 (3) ◽  
pp. 208-210 ◽  
Author(s):  
Valery L. Feigin ◽  
Harry McNaughton ◽  
Lorna Dyall
Keyword(s):  
Health Care ◽  
New Zealand ◽  
Health Care Providers ◽  
Population Based ◽  
Care Providers ◽  
Health Care Planning ◽  
Stroke Incidence ◽  
Pacific People ◽  
Incidence Studies ◽  
Stroke Epidemiology

Studying ethnic particularities of stroke epidemiology may not only provide a clue to the causes of the observed racial/ethnic differences in stroke mortality but is also important for appropriate, culturally specific health care planning, prevention in stroke and improved health outcomes. This overview of published population-based stroke incidence studies and other relevant research in the multi-ethnic New Zealand population demonstrates an obvious ethnic disparity in stroke in New Zealand, with the greatest and increasing burden of stroke being imposed on Maori, who are indigenous, and Pacific people, who have migrated and settled in this country. These data warrant urgent and effective measures to be undertaken by health policy makers and health care providers to reverse the unfavourable trends in stroke and improve Maori and Pacific people's health.

Abstract WP36: Post-ischemic Hyperperfusion After Reperfusion Therapy Predicts Hemorrhagic Transformation

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Shuhei Okazaki ◽  
Takeshi Yoshimoto ◽  
Hiroshi Yamagami ◽  
Katsufumi Kajimoto ◽  
Mikito Hayakawa ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Three Dimensional ◽  
Intravenous Thrombolysis ◽  
Reperfusion Therapy ◽  
Hemorrhagic Transformation ◽  
Regional Cerebral Blood ◽  
Stroke Patients ◽  
Mca Occlusion ◽  
Blood Flow Ratio ◽  
The Relationship

Background and Purpose: Post-ischemic hyperperfusion has been considered as a risk factor of hemorrhagic transformation and poor prognosis. To date, however, there is a lack of data about the pathological significance of hyperperfusion after reperfusion therapy. In this study, we evaluated the relationship between hemorrhagic transformation and post-ischemic hyperperfusion after reperfusion therapy by using arterial spin labeled perfusion MRI (ASL) and 123 I IMP-SPECT. Methods: We retrospectively collected data of acute stroke patients with middle cerebral artery (MCA) occlusion who received intravenous thrombolysis and/or endovascular therapy, and underwent pulsed ASL using Q2TIPS-FAIR with 3D-TGSE readout and 123 I IMP-SPECT using dual-table ARG method within 14 days of stroke onset from November 2015 to June 2016. Ipsilateral-contralateral regional cerebral blood flow ratio (IC ratio) was calculated by using three-dimensional stereotactic ROI template (3DSRT) software. Results: Among 47 consecutive acute stroke patients with the MCA occlusion who received reperfusion therapy, 21 underwent only ASL and 10 underwent both ASL and SPECT after reperfusion therapy. The IC ratio of ASL was well correlated with that of SPECT in the MCA territory (r=0.65, p <0.001). Hemorrhagic transformation was observed in 7 patients. IC ratio was higher in patients with hemorrhagic transformation after reperfusion therapy than those without hemorrhagic transformation (2.19±0.35 vs 0.99±0.19, p=0.005). Focal post-ischemic hyperperfusion (IC ratio >1.5) was detected in 7 of 31 patients (23%). The presence of post-ischemic hyperperfusion was significantly associated with hemorrhagic transformation after reperfusion therapy (odds ratio 9.3, 95% confidence interval 1.4 to 64.0, p=0.03). Conclusions: Post-ischemic hyperperfusion detected by ASL predicts hemorrhagic transformation after reperfusion therapy. ASL hyperperfusion may indicate the disruption of blood brain barrier after reperfusion therapy.

Time trends in incidence rates of atrial fibrillation-related strokes in Norway 2001–2014: a nationwide analysis using data from the cardiovascular disease in Norway (CVDNOR) project

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
I Ariansen ◽  
J Igland ◽  
M Anjum ◽  
L.J Kjerpeseth ◽  
R Selmer ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiovascular Disease ◽  
Acute Stroke ◽  
Time Trends ◽  
Incidence Rates ◽  
Horizontal Line ◽  
Funding Source ◽  
Stroke Incidence ◽  
The Past ◽  
Hospital Deaths

Abstract Background Stroke incidence rates declined in Norway during 2001 to 2014. Atrial fibrillation (AF) incidence rates were stable in the same period. Purpose We aimed to study time trends in incidence (first time) of acute stroke hospitalizations and stroke deaths associated with AF in Norway in the period 2001–2014. Methods Nationwide hospital discharge diagnoses in the Cardiovascular Disease in Norway (CVDNOR) database and in the National Patient Registry were linked to the National Cause of Death Registry. All hospitalizations with acute stroke (including ischemic stroke, intracerebral bleeding and unspecified stroke) and out-of-hospital deaths with stroke as underlying cause in individuals 25 years and older were obtained during 1994–2014. Incident stroke was defined as the first hospitalization or out-of-hospital death due to stroke with no hospitalization for acute stroke or stroke sequela the past 7 years. Stroke was defined as AF-related if AF was registered during a hospitalization the past 7 years, or as underlying or contributing cause of death up to 28 days after the stroke hospitalization. Age-standardized incidence rates with 95% confidence intervals (CIs) were calculated using direct standardization to the age-distribution in the Norwegian population per 2001. Age-adjusted average yearly incidence rate ratios (IRR) with 95% CIs were estimated by negative binomial regression analyses. Results From 2001 to 2014 we identified 157 580 incident stroke cases of which 38 317 were AF-related. The proportion of incident strokes that were related to AF increased from 20.6% in 2001 to 26.3% in 2014. Age-standardized incidence rates of AF-related strokes per 100,000 person years were stable at 88 (85, 92) in 2001 and 79 (76, 83) in 2014, corresponding to a 0% average yearly change, IRR 1.00 (0.99, 1.00). The age-standardized incidence rates of non-AF-related strokes per 100,000 person years decreased from 334 (328, 341) in 2001 to 214 (209, 219) in 2014, corresponding to a 3% average yearly decrease, IRR 0.97 (0.97, 0.97). Conclusion The favourable trend in total stroke incidence rates from 2001 to 2014 does not include AF-related strokes. This may suggest that AF has become accountable for a higher proportion of incident strokes or that AF detection improved over this period. Figure 1. Age-standardized incidence rates of stroke hospitalizations or out-of-hospital deaths per 100,000 person years (py) by year, illustrated as all strokes (blue horizontal line) and AF-related strokes (red horizontal line/height of red area). The height of the blue area illustrates the rate for non-AF related strokes. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Vestre Viken Hospital Trust (public hospital research fund)

scholarly journals Does one shoe fit all? Impacts of gambling among four ethnic groups in New Zealand

2011 ◽  
pp. 69 ◽  
Author(s):  
En-Yi J Lin ◽  
Sally Casswell ◽  
Taisia Huckle ◽  
Ru Quan You ◽  
Lanuola Asiasiga
Keyword(s):  
New Zealand ◽  
Ethnic Groups ◽  
Telephone Interview ◽  
Life Domains ◽  
Pacific People ◽  
Korean People ◽  
Gambling Participation ◽  
Domains Of Life ◽  
Gaming Machines

The aim of the current study is to examine the impacts of gambling among four different ethnic groups within New Zealand (i.e., Maori, Pakeha, Pacific peoples, and Chinese and Korean peoples). Four thousand and sixty-eight Pakeha, 1,162 Maori, 1,031 Pacific people, and 984 Chinese and Korean people took part in a telephone interview that assessed their gambling participation and their quality of life. Results showed a number of differences between ethnic groups. For the Maori and Pacific samples, there were significant associations between gambling participation (especially time spent on electronic gaming machines) and lower ratings in a number of life domains. In contrast to the findings for the Maori and Pacific peoples, which showed predominantly negative associations between gambling modes and people's self ratings of their domains of life, the findings for Pakeha and for Chinese and Korean peoples were more mixed and the associations predominantly positive.

scholarly journals Favorable revascularization therapy in patients with ASPECTS ≤ 5 on DWI in anterior circulation stroke

2017 ◽  
Vol 10 (1) ◽  
pp. 5-9 ◽  
Author(s):  
Isabelle Mourand ◽  
Eitan Abergel ◽  
Daniel Mantilla ◽  
Xavier Ayrignac ◽  
Tzvika Sacagiu ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Acute Stroke ◽  
Intravenous Thrombolysis ◽  
Reperfusion Therapy ◽  
Control Group ◽  
Anterior Circulation ◽  
Malignant Infarction ◽  
Baseline Characteristics ◽  
Revascularization Therapy ◽  
Favorable Clinical Outcome

BackgroundA low baseline Alberta Stroke Programme Early CT Score (ASPECTS) is strongly associated with low rates of favorable outcome in patients with acute stroke.ObjectiveTo evaluate the efficacy and safety of revascularization therapy in patient with ASPECTS ≤5 in anterior circulation infarct.MethodsWe retrospectively analyzed 108 consecutive patients presenting low ASPECTS on diffusion-weighted imaging. Sixty patients were treated by mechanical thrombectomy, including 34 patients who received simultaneously intravenous thrombolysis. A control group of 48 patients not eligible for reperfusion therapy gave us a perspective on the natural history. Clinical outcome was evaluated at 90 days using the modified Rankin Scale (mRS) score. Hemicraniectomy after malignant infarction, mortality, and symptomatic intracranial haemorrhage (sICH) were also reported.ResultsThrombolysis in Cerebral Infarction 2b–3 was assessed in 75% of treated patients. Reperfusion therapy led to significantly reduced disability (mRS score 0–2) at 90 days compared with the control group (30% vs 2.1%, p<0.001), hemicraniectomy (3.3% vs 22.9%, p=0.002), and death at 90 days (25% vs 47.9%, p=0.01). The sICH level was similar in treated patients and in the control group (p=0.78). Patients aged ≤70 years in the thrombectomy group had a significantly better clinical outcome than older patients (37.5% vs 10%, p=0.02), regardless of baseline characteristics or recanalization rate.ConclusionsIn patients with acute stroke in the anterior circulation and ASPECTS ≤5 revascularization therapy contributes to a favorable clinical outcome at 90 days, especially in patients younger than 70 years.

scholarly journals Incidence and Association of Reperfusion Therapies With Poststroke Seizures

Stroke ◽  
2020 ◽  
Vol 51 (9) ◽  
pp. 2715-2723 ◽  
Author(s):  
Alain Lekoubou ◽  
Jonah Fox ◽  
Paddy Ssentongo
Keyword(s):  
Primary Outcome ◽  
Mechanical Thrombectomy ◽  
Meta Analysis ◽  
Intravenous Thrombolysis ◽  
Reperfusion Therapy ◽  
Incidence Rates ◽  
Tissue Type ◽  
Cochrane Library ◽  
Stroke Patients ◽  
Type Plasminogen Activator

Background and Purpose: We performed a systematic review and meta-analysis to assess the incidence and risk of seizures following acute stroke reperfusion therapy (intravenous thrombolysis [IVT] with r-tPA [recombinant tissue-type plasminogen activator], mechanical thrombectomy or both). Methods: We searched major databases (MEDLINE, SCOPUS, and Cochrane Library) for articles published between 1995 and October 28, 2019. The primary outcome was the overall and treatment specific pooled incidence of poststroke seizures (PSS) following acute reperfusion therapy. We also computed the pooled incidence of early poststroke seizures and late poststroke seizures separately for all studies. We derived the risk of PSS associated with IVT in the pooled cohort of patients who received only IVT. The small number of studies (<3) that reported on the risk of PSS associated with mechanical thrombectomy alone or in combination with IVT did not allow us to compute an estimate of the risk of seizures associated with this therapy. Results: We identified 13 753 patients with stroke, of which 592 had seizures. The pooled incidence of PSS was 5.9 % (95% CI, 4.2%–8.2%). PSS incidence rates among patients with stroke treated with IVT, mechanical thrombectomy, and both were respectively 6.1% (95% CI, 3.6%–10.2%), 5.9% (95% CI, 4.1%–8.4%), and 5.8 % (95% CI, 3.0%–10.9%). The incidence of late PSS was 6.7% (95% CI, 4.01%–11.02%) and that of early PSS was 3.14% (95% CI, 2.05%–4.76%). The pooled odds ratio for the association between IVT and PSS was 1.24 (95% CI, 0.75–2.05). Conclusions: The findings of this meta-analysis suggest that about one in 15 ischemic stroke patients treated with IVT, mechanical thrombectomy, or both develop seizures independently of the specific reperfusion treatment that they received.

Ethnic differences in perceptions of body size in middle-aged European, Maori and Pacific People living in New Zealand

2000 ◽  
Vol 24 (5) ◽  
pp. 593-599 ◽  
Author(s):  
PA Metcalf ◽  
RKR Scragg ◽  
P Willoughby ◽  
S Finau ◽  
D Tipene-Leach
Keyword(s):  
Body Size ◽  
New Zealand ◽  
Ethnic Differences ◽  
Middle Aged ◽  
Pacific People

scholarly journals Factors contributing to high immunisation coverage among New Zealand Asians

2014 ◽  
Vol 6 (4) ◽  
pp. 304 ◽  
Author(s):  
Moneeta Pal ◽  
Felicity Goodyear-Smith ◽  
Daniel Exeter
Keyword(s):  
New Zealand ◽  
Ethnic Groups ◽  
Parental Attitudes ◽  
Immunisation Coverage ◽  
Structured Interviews ◽  
Pacific People ◽  
Coverage Rates ◽  
Asian People ◽  
Child Culture ◽  
Group Child

INTRODUCTION: While New Zealand (NZ) immunisation coverage has improved steadily over the years, there is inequity between ethnic groups, with rates lower in Maori and Pacific people and highest in Asian people. This qualitative study aimed to identify attitudes and behaviours of NZ Asian parents of children under the age of five years that might contribute to their seeking immunisation for their children. METHODS: In-depth, semi-structured interviews were conducted to explore attitudes, values, experiences, knowledge, behaviour and perceived barriers regarding childhood immunisation. Transcripts were analysed using a general inductive approach. FINDINGS: Key themes identified were a general positive attitude towards immunisation, being well-informed and aware of the value of immunisation, accepting governmental encouragement to use immunisation services, and perceiving minimal barriers to immunisation services access. CONCLUSION: The findings of this study suggest that high immunisation coverage rates among NZ Asians may be primarily due to parental attitudes, rather than the quality and accessibility of immunisation services in NZ. KEYWORDS: Asian continental ancestry group; child; culture; ethnic groups; immunisation; qualitative research

scholarly journals Eighteen months of depression: examining the chronic care management of depression with particular reference to Pacific people

2014 ◽  
Vol 6 (1) ◽  
pp. 31
Author(s):  
Susan Tutty ◽  
Felicity Goodyear-Smith
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
New Zealand ◽  
Ethnic Groups ◽  
Care Management ◽  
Chronic Care ◽  
Dropout Rate ◽  
Pacific People ◽  
Cook Island ◽  
Chronic Care Management

INTRODUCTION: Primary care is responsible for the 17% of the population with mild to moderately severe mental illness. Total Healthcare Otara (THO), with 49% of its patients of Pacific ethnicity, presents an opportunity to study the primary care management of depression, inclusive of Pacific people. While it had been assumed that Pacific people in New Zealand suffer less mental illness, Te Rau Hinengaro: The New Zealand Mental Health Survey showed this is not the case. AIM: The aim of the study was to examine a Chronic Care Management (CCM) programme for depression in a predominantly Pacific practice. METHODS: A clinical audit of the CCM depression programme used by THO between 31 March 2009 and 30 September 2010. Participants were patients aged 18–64 years who scored =15 on the Patient Health Questionnaire-9 (PHQ-9). Computer templates completed for each consultation, including serial PHQ-9s, were analysed over time and across different ethnic groups. RESULTS: Cook Island Maori patients participated in the CCM depression programme in proportionally greater numbers than their enrolment in THO, while Samoan and Tongan patients participated significantly less. The mean PHQ-9 score fell rapidly over the first few visits and then levelled off, without reaching the normal range. Dropout rate was 60% after the third consultation irrespective of ethnicity or gender. DISCUSSION: There is a need for ethnic-specific research into depression in Pacific ethnic groups. A significant immediate improvement in PHQ-9 on entering the CCM depression programme suggests enrolment is therapeutic. However, further research into the CCM depression programme is needed, particularly the reasons for non-attendance. KEYWORDS: Case management; depression; oceanic ancestry group; Pacific Islands; primary health care

scholarly journals 165Ethnic differences in type 2 diabetes mortality and hospitalisation rates in a New Zealand population1994-2018

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Dahai Yu ◽  
Levi Osuagwu ◽  
Karen Pickering ◽  
John Baker ◽  
Richard Cutfield ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
New Zealand ◽  
Absolute Risk ◽  
Economic Status ◽  
Temporal Trends ◽  
Support Service ◽  
Incidence Rates ◽  
Pacific People

Abstract Background Type 2 Diabetes (T2DM) affects different populations disproportionately including in New Zealand (NZ), where long-term temporal trends in cause-specific clinical outcomes between Māori, European and Pacific people remain unclear. Methods Data from patients with T2DM, aged 35-84 years enrolled 1994-2018 in a NZ primary care audit programme (the Diabetes Care Support Service) were linked with national death registration, hospitalisation, pharmaceutical claims and primary care databases. Cause-specific death and hospitalisation rates were adjusted for gender, age, smoking, obesity, social-economic status and time periods by age-period-cohort models. Results Overall, 79,912 (50.6% female, mean-age 56±15 years, median follow-up 9.7 years) patients with T2DM were enrolled. For Europeans vs Māori, adjusted incidence rates ratio (IRR) and absolute risk difference /1000 person-years were 1.96 (95% CI: 1.80- 2.14) and 22.85 (19.93-25.77) for all-cause mortality, 1.93 (1.63-2.29) and 6.97 (5.14-8.80) for cardiovascular (CVD) mortality, 1.64 (1.40-1.93) and 3.08 (2.25-3.92) for cancer mortality, 1.26 (1.25-1.28) and 42.70 (41.32-44.08) for CVD hospitalisation, 1.31 (1.28-1.34) and 44.76 (42.37-47.15) for cancer hospitalisation, 2.05 (1.96-2.14) and 31.44 (29.67-33.21) for end-stage renal disease (ESRD) hospitalisation. Pacific rates were significantly less than Māori, but higher than Europeans for ESRD (IRR:1.59 (1.52-1.67)) and CVD (1.09 (1.07-1.10)) hospitalisation. Conclusions Poorer health outcomes have persisted among Māori and Pacific people with T2DM for &gt;20 years. New policies supporting more intensive management of T2DM are urgently needed. Differences in outcomes between Māori and Pacific people warrant further research. Key messages Outcome disparities have persisted among Māori and Pacific people with T2DM for &gt;20 years.

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