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CMAJ Open. 2017 Sep 11;5(3):E702-E709. doi: 10.9778/cmajo.20160147.

Secondary prevention treatment after acute stroke in older South Asian, Chinese and other Canadians: a retrospective data analysis.

Author information

1
Affiliations: Division of General Internal Medicine (Khan, Palepu), University of British Columbia; Centre for Health Evaluation & Outcomes Sciences (Khan, Palepu), Vancouver, BC; Division of General Internal Medicine (McAlister) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister), University of Alberta, Edmonton, Alta; Divisions of Clinical Epidemiology (Pilote) and General Internal Medicine (Pilote), Department of Medicine, McGill University; The Research Institute of the McGill University Health Centre (Pilote), Montréal, Que.; Departments of Community Health Sciences (Quan, Hill) and Clinical Neurosciences (Hill), University of Calgary, Calgary, Alta.; Institute for Clinical Evaluative Sciences (Fang, Kapral); Division of General Internal Medicine (Kapral), Department of Medicine, University of Toronto, Toronto, Ont.

Abstract

BACKGROUND:

Little is known about whether there are differences in medication use between older patients of Chinese descent, those of South Asian descent and other Canadian patients after acute ischemic or primary intracerebral hemorrhagic stroke. The aim of this population-based study was to evaluate potential ethnic differences in secondary prevention pharmacotherapy after acute stroke.

METHODS:

Using health administrative data, we conducted a retrospective analysis of all patients aged 66 years or more admitted to hospital with acute stroke in Ontario (1997-2011) and British Columbia (1997-2009). We compared prescriptions filled for statins, warfarin, any antihypertensive agent, the recommended combination of angiotensin-converting-enzyme (ACE) inhibitor and diuretic, and the combination of ACE inhibitor, diuretic and statin within 1 year after ischemic or primary intracerebral hemorrhagic stroke.

RESULTS:

There were 118 362 patients with acute stroke (3430 Chinese, 2075 South Asian and 112 857 other Canadians). Among those with ischemic stroke (n = 108 699), Chinese patients were less likely than other Canadian patients to fill prescriptions for the combination of ACE inhibitor, diuretic and statin (adjusted odds ratio [OR] 0.64 [95% confidence interval (CI) 0.55-0.74]) and, in those with atrial fibrillation, for warfarin (adjusted OR 0.75 [95% CI 0.59-0.95]). There were no differences in filling of prescriptions for antihypertensive therapy overall between the 3 groups. Among patients with intracerebral hemorrhagic stroke (n = 9663), Chinese patients were less likely than other Canadian patients to fill prescriptions for the combination of ACE inhibitor and diuretic (adjusted OR 0.51 [95% CI 0.38-0.69]), and South Asians were more likely than other Canadian patients to fill prescriptions for any antihypertensive agent (adjusted OR 1.73 [95% CI 1.21-2.49]).

INTERPRETATION:

We identified ethnic differences in filling of prescriptions for several secondary prevention medications after acute stroke. The reasons underlying these differences need to be investigated.

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