Native Hawaiians in Hawaii at Higher Risk for Cerebral Hemmorhage: News

News from the International Stroke Conference in Honolulu this week! Based on an extensive retrospective chart survey at the Queen's Hospital in Honululu.

Astract WP303: Disparities among Native Hawaiians and Pacific Islanders with Intracerebral Hemorrhage: Effect of Methamphetamine Abuse

Kazuma Nakagawa1; Megan A Vento; Matthew A Koenig; Susan M Asai; Cherylee W Chang; Todd B Seto

Background and Purpose: Native Hawaiians and other Pacific Islanders (NHPI) with intracerebral hemorrhage (ICH) are younger and have a higher burden of cardiovascular risk factors compared to other racial groups in Hawaii. Furthermore, NHPI in Hawaii have a higher prevalence of methamphetamine abuse compared to other major racial-ethnic groups. Therefore, it is unclear whether younger age of NHPI with ICH is due to methamphetamine abuse or untreated risk factors.

Methods: We conducted a retrospective study on consecutive patients hospitalized for acute ICH at a single tertiary center on Oahu between 2006 and 2010. To determine the factors associated with young ICH (age<45), we performed unadjusted and multivariable logistic regressions, adjusting for methamphetamine abuse, untreated hypertension and whether they were transferred from another hospital to account for a potential referral bias. Non-Hispanic whites were the reference group.

Results: A total of 384 consecutive ICH patients (NHPI 19%, Asians 65% and non-Hispanic whites 16%) were studied. Compared to non-Hispanic whites, NHPI were younger (mean ages, NHPI 54±16 vs. whites 68±16, p < 0.0001), and had higher prevalence of diabetes (NHPI 36% vs. whites 19%, p = 0.03) and untreated hypertension (NHPI 32% vs. whites 15%, p = 0.02). Young ICH (age<45) was more common among NHPI (26%) than Asians (9%) and non-Hispanic whites (6%) (p <0.05). Methamphetamine abuse was slightly more common among NHPIs than whites and Asians (10% vs. 3% vs. 6%, p = NS for all comparison). After controlling for potential confounders, young ICH (age<45) was independently associated with NHPI race (OR 5.07, 95% CI 1.55 to 16.62), methamphetamine abuse (OR 4.17, 95% CI 1.56 to 11.20) and being transferred from another hospital (OR 3.37, 95% CI 1.66 to 6.84).

Conclusions: Native Hawaiian and other Pacific Islander race and methamphetamine abuse are independently associated with young ICH in Hawaii. Further studies are needed to determine factors other than methamphetamine abuse that are contributing to the young age of ICH presentation in this unique racial group.

Thanks, Kazuma, Matthew, and Cherylee, neurologists at Queens, as well as all those who contributed! Now we just have to learn what more to do for prevention, other than treat hypertension better in the kanaka maoli, and maybe there won't have to be so many transfers someday :).