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John Fink
The Auckland Regional Community Stroke (ARCOS) study provides important population-based data describing stroke in our community over a period of greater than 20 years. ARCOS consists of three high-quality stroke incidence and outcome studies conducted in 1981-1982, 1991-1992, and 2002-2003.1-4
The mantra that stroke is the third leading cause of death in New Zealand (after ischaemic heart disease and all forms of cancer combined) and that it is the single most important cause of adult disability should, by now, be a familiar one. But among the vast amount of data generated from these studies, it is the comparisons between ethnic groups which stand out as a stark reminder of the disparities that exist in New Zealand.
When data is age-standardised to the World Health Organization (WHO) world population, stroke incidence rates (first ever strokes) and stroke attack rates (any stroke event) are significantly higher among Maori, Pacific, and Asian/Other ethnic groups than for New Zealanders of European ethnicity.5,6 Indeed, the mean age of incidence of stroke is a full decade earlier for Pacific and Asian/Other ethnic groups than for those of European descent, and the mean age at stroke onset among Maori is a disturbingly young 60.7 years compared with 75.6 years among Europeans.5
Stroke at a young age creates additional burdens on family/whanau and support systems. Earning capacity is lost for patients and, often, carers. Worse still, the fact that funding for and access to rehabilitation services in New Zealand is much more restricted for patients under 65 years of age than those 65 years of age or greater means that there is institutionalised bias against Maori and Pacific Island Stroke patients in our public health system. This requires redress with urgency.
Stroke case...