Incidence of Stroke in Indigenous Populations of Countries With a Very High Human Development Index: A Systematic Review

Anna H. Balabanski, Angela Dos Santos, John A. Woods, Chloe A. Mutimer, Amanda G. Thrift, Timothy J. Kleinig, Astrid M. Suchy-Dicey, Susanna Ragnhild A. Siri, Bernadette Boden-Albala, Rita V. Krishnamurthi, Valery L. Feigin, Dedra Buchwald, Annemarei Ranta, Christina S. Mienna, Carol Zavaleta-Cortijo, Leonid Churilov, Luke Burchill, Deborah Zion, W.T. Longstreth, David L. TirschwellSonia S. Anand, Mark W. Parsons, Alex Brown, Donald K. Warne, Matire Harwood, P. Alan Barber, Judith M. Katzenellenbogen

Research output: Contribution to journalReview articlepeer-review


BACKGROUND AND OBJECTIVES: Cardiovascular disease contributes significantly to disease burden among many Indigenous populations. However, data on stroke incidence in Indigenous populations are sparse. We aimed to investigate what is known of stroke incidence in Indigenous populations of countries with a very high Human Development Index (HDI), locating the research in the broader context of Indigenous health.

METHODS: We identified population-based stroke incidence studies published between 1990 and 2022 among Indigenous adult populations of developed countries using PubMed, Embase, and Global Health databases, without language restriction. We excluded non-peer-reviewed sources, studies with fewer than 10 Indigenous people, or not covering a 35- to 64-year minimum age range. Two reviewers independently screened titles, abstracts, and full-text articles and extracted data. We assessed quality using "gold standard" criteria for population-based stroke incidence studies, the Newcastle-Ottawa Scale for risk of bias, and CONSIDER criteria for reporting of Indigenous health research. An Indigenous Advisory Board provided oversight for the study.

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

DISCUSSION: In countries with a very high HDI, there are notable, albeit varying, disparities in stroke incidence between Indigenous and non-Indigenous populations, although there are gaps in data availability and quality. A greater understanding of stroke incidence is imperative for informing effective societal responses to socioeconomic and health disparities in these populations. Future studies into stroke incidence in Indigenous populations should be designed and conducted with Indigenous oversight and governance to facilitate improved outcomes and capacity building.


Original languageEnglish
Article numbere209138
Pages (from-to)1-15
Issue number5
Publication statusPublished - 12 Mar 2024


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