A Systematic Review and Meta-Analysis of the Associations between Immigration Status and Stroke Incidence and Mortality

Abstract

Background and Objectives. Increasing global migration to Western Europe, North America, and other high-income countries makes a study of stroke risk in the immigrant population important. This study is aimed at evaluating the associations between immigration status and stroke risks and determining the risk factors for stroke in immigrant groups. Methods. We thoroughly searched PubMed, Embase, and MEDLINE databases for the literature on stroke risk for immigrants and host populations by January 2022. Fourteen relevant cohort studies from eight countries met the inclusion criteria, and their data were included in this meta-analysis. Heterogeneity and publication bias were assessed. Results. The results showed that the immigrant groups suffered from a lower incidence rate of stroke compared with the host populations ( $\text{HR}=0.81$ , 95% CI 0.71–0.91, $P=0.001$ ), but there was nonsignificant higher mortality of stroke in immigrants ( $\text{HR}=1.07$ ; 95% CI 0.84–1.36). However, the pooled adjusted incidence HR reduced to 0.67 (95% CI 0.60–0.75) after adjustment for publication bias. Immigrants had a lower stroke incidence compared to long-term residents, but the association varied with the country of origin, socioeconomic status, residence (urban vs. rural), and comorbid conditions. Discussion. The present systematic review and meta-analysis implicated that stroke risks are different for immigrants and the host populations; therefore, this knowledge may be useful for developing targeted stroke prevention strategies.