The prevalence of most vascular risk factors increased significantly among Native American patients with ischemic stroke from 2000 to 2016, according to a study in the Journal of Stroke and Cerebrovascular Diseases.

Researchers analyzed trends in the prevalence of vascular risk factors among Native American patients with ischemic stroke and compared them with other race and ethnic groups between 2000 and 2016. They used the National Inpatient Sample and the Nationwide Inpatient Sample (NIS) database from the Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Eligible participants were adult patients with an inpatient hospital discharge for ischemic stroke.

Crude and age- and sex-standardized prevalence estimates were calculated for each risk factor across all years by race and ethnicity. The results were then stratified for the periods 2000-2002, 2003-2005, 2006-2008, 2009-2011, 2012-2014, and 2015-2016.

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Race and ethnicity information was available for 83.3% patients, with 6,183,757 weighted hospitalizations. Native American patients accounted for 5472 hospitalizations (female weighted frequency, 52.25%).

The crude prevalence of vascular risk factors among Native American patients increased from 2000 to 2016 for hypertension (slope=1.51, P =.003), smoking (slope=3.04, P <.001), hyperlipidemia (slope=7.54, P <.001), alcohol (slope=0.51, P =.022), atrial fibrillation or flutter (slope=0.87, P =.011), and diabetes (slope=1.93, P =.005). The prevalence of coronary artery disease and heart failure was unchanged.

The age- and sex-standardized prevalence of hypertension significantly increased from 47.96% to 64.32 % and diabetes from 44.16% to 51.79% among Native American patients from 2000 to 2016, stratified by the 6 time periods. The prevalence of hyperlipidemia, atrial fibrillation, and heart failure more than doubled, with estimates increasing from 23.71% to 53.22%, 3.77% to 8.67%, and 4.42% to 11.50%, respectively. Smoking prevalence increased from 21.62% to 40.69%.

The age- and sex-standardized prevalence increased for most vascular risk factors in all the race and ethnic groups. Native American patients had a significantly steeper trend in hypertension increase (slope=2.24, P <.0001) vs Black patients, Hispanic patients, and Asian and Pacific Islander patients.

Native American patients had a significant uptrend in smoking and alcohol use, with increases from 21.62% to 40.69% (slope=3.65, P <.001) and 5.16% to 8.61% (slope=0.60, P =.019), respectively. The adjusted prevalence among Native Americans was the highest of all the race and ethnic groups in these 2 categories by 2016, although their upward trend was only significantly steeper vs Hispanic patients and Asian and Pacific Islander patients.

By 2015 and 2016, Native American patients had the highest adjusted prevalence of diabetes (64.3%), smoking (40.69%), coronary artery disease (16.37%), and alcohol use (8.61%) among all race and ethnic groups and were in the highest tertiles regarding hyperlipidemia, heart failure, and hypertension.

The researchers noted that the NIS only tracks discharges and not individual patients and that interhospital transfers after hospitalization also may lead to duplicate registrations. In addition, the category of Native American patients (and Alaskan Native patients) is generalized, and the data are not stratified by different tribes or geographical location.

“These results highlight the need for stroke prevention by aggressive stroke risk factor management and by targeting individual cerebrovascular risk factors in minorities like the Native American [patients], Black [patients], and Asian/Pacific Islander [patients],” the study authors wrote.


Jillella DV, Crawford S, Lopez R, Zafar A, Tang AS, Uchino K. Vascular risk factor prevalence and trends in Native Americans with ischemic stroke. J Stroke Cerebrovasc Dis. Published online April 6, 2022. doi: 10.1016/j.jstrokecerebrovasdis.2022.106467