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The following is a summary of “Incidence of Stroke in Indigenous Populations of Countries With a Very High Human Development Index A Systematic Review,” published in the February 2024 issue of Neurology by Balabanski et al.

Indigenous communities across the globe face disproportionate cardiovascular burdens, with stroke remaining poorly understood due to limited data.

Researchers conducted a retrospective study investigating the existing knowledge of stroke incidence within Indigenous populations of countries boasting a very high Human Development Index (HDI), situating the investigation within the broader landscape of Indigenous health disparities.

They searched PubMed, Embase, and Global Health databases for population-based stroke incidence studies published (1990 to 2022) among Indigenous adult populations in developed countries without language restrictions. Non-peer-reviewed sources were excluded, including studies with less than 10 Indigenous participants or not covering a minimum age range of 35 to 64 years. Two reviewers independently screened titles, abstracts, and full-text articles and extracted data. Quality assessment was conducted using the “gold standard” for population-based stroke incidence studies criteria, the Newcastle-Ottawa Scale for risk of bias, and CONSIDER criteria for reporting Indigenous health research. Oversight for the study was provided by an Indigenous Advisory Board.

The results showed 13,041 publications were screened, and 24 studies (19 full-text articles, 5 abstracts) from 7 countries met the inclusion criteria. Age-standardized stroke incidence rate ratios were higher in Aboriginal and Torres Strait Islander Australians (1.7–3.2),  Sámi of Sweden/Norway (1.08–2.14), American Indians (1.2), and Singaporean Malay (1.7–1.9), compared with respective non-Indigenous populations. Studies exhibited significant variation in design and risk of bias. Attack rates, male-female rate ratios, and time trends were reported where available. Indigenous stakeholder involvement was infrequently reported by investigators, with few studies meeting any of the CONSIDER criteria for research among Indigenous populations.

They concluded that high HDI nations noticed disparities in Indigenous stroke rates, highlighting data gaps and the need for research with Indigenous leadership to address these inequities.

Source: neurology.org/doi/10.1212/WNL.0000000000209138