Predictors for the Recurrence and Prognosis of Stroke patients within a Multi-Ethnic Asian Population

Abstract

AbstractObjectiveThere is a paucity of studies investigating the risk profile, and outcomes amongst young versus old stroke patients in Asian populations. Singapore is uniquely placed to contribute to the understanding of these risk factors, given our multi-ethnic population. Therefore, the aim of this study was to identify predictors of recurrence and outcome in stroke, comparing the young and the older stroke patients in Singapore.MethodsThis cohort study adhered to STROBE guidelines. Data were obtained from the Singapore Stroke Registry (SSR) from 2005 to 2016, to compare outcomes after first stroke among young (18-49 years) and among old stroke (≥50 years) patients. Outcome measures included recurrent stroke, acute myocardial infarction (AMI) and death from the above. Cox proportional hazards models were performed to determine risk factors for time to each outcome after first stroke, which included demographic and comorbidity variables.ResultsA total of 64,915 patients (6,705 young, and 58,210 old) were included in our analysis. After adjusting for gender, ethnicity, and comorbidities, old stroke patients have a greater hazard for recurrent stroke (HR = 1.20, 95%CI: 1.11-1.29), AMI (HR = 1.72, 95%CI: 1.52-1.94), and for recurrent stroke/AMI (HR = 1.36, 95%CI: 1.27-1.45). The old stroke patients were also more likely to die than younger stroke patients (HR = 2.62, 95%CI: 2.48-2.78). Amongst young stroke patients, males were at greater hazards for recurrent stroke (HR = 1.18, 95%CI: 1.00-1.38), AMI (HR = 1.40, 95%CI: 1.07-1.82), recurrent stroke/AMI (HR = 1.17, 95%CI: 1.02-1.36). However, males were at reduced hazards for death (HR = 0.87, 95%CI: 0.77-0.98). When analysing specifically young stroke patients, compared with the Chinese ethnicity, the Malay ethnicity was predisposed to recurrent stroke (HR = 1.36, 95%CI: 1.14-1.64). Compared with the Chinese ethnicity, both the Malay and Indian ethnicities were predisposed to AMI. The Malay ethnicity was at greater hazards for death (HR = 1.45, 95%CI: 1.27-1.66).ConclusionsNon-Chinese ethnicities, especially Malay and Indian ethnicities experience poorer outcomes after first stroke. Further optimisation of risk factors targeting these high-priority populations are needed to achieve high quality care.