Predictors for the Recurrence and Prognosis of Stroke patients within a Multi-Ethnic Asian Population

Objective There is a paucity of studies investigating the risk profile, and outcomes amongst young versus old stroke patients in Asian populations. Singapore is uniquely placed to contribute to the understanding of these risk factors, given our multi-ethnic population. Therefore, the aim of this study was to identify predictors of recurrence and outcome in stroke, comparing the young and the older stroke patients in Singapore. Methods This cohort study adhered to STROBE guidelines. Data were obtained from the Singapore Stroke Registry (SSR) from 2005 to 2016, to compare outcomes after first stroke among young (18-49 years) and among old stroke (≥50 years) patients. Outcome measures included recurrent stroke, acute myocardial infarction (AMI) and death from the above. Cox proportional hazards models were performed to determine risk factors for time to each outcome after first stroke, which included demographic and comorbidity variables. Results A total of 64,915 patients (6,705 young, and 58,210 old) were included in our analysis. After adjusting for gender, ethnicity, and comorbidities, old stroke patients have a greater hazard for recurrent stroke (HR = 1.20, 95%CI: 1.11-1.29), AMI (HR = 1.72, 95%CI: 1.52-1.94), and for recurrent stroke/AMI (HR = 1.36, 95%CI: 1.27-1.45). The old stroke patients were also more likely to die than younger stroke patients (HR = 2.62, 95%CI: 2.48-2.78). Amongst young stroke patients, males were at greater hazards for recurrent stroke (HR = 1.18, 95%CI: 1.00-1.38), AMI (HR = 1.40, 95%CI: 1.07-1.82), recurrent stroke/AMI (HR = 1.17, 95%CI: 1.02-1.36). However, males were at reduced hazards for death (HR = 0.87, 95%CI: 0.77-0.98). When analysing specifically young stroke patients, compared with the Chinese ethnicity, the Malay ethnicity was predisposed to recurrent stroke (HR = 1.36, 95%CI: 1.14-1.64). Compared with the Chinese ethnicity, both the Malay and Indian ethnicities were predisposed to AMI. The Malay ethnicity was at greater hazards for death (HR = 1.45, 95%CI: 1.27-1.66). Conclusions Non-Chinese ethnicities, especially Malay and Indian ethnicities experience poorer outcomes after first stroke. Further optimisation of risk factors targeting these high-priority populations are needed to achieve high quality care. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement No funding was received. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Data were obtained from the Singapore Stroke Registry. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data are available upon request from the corresponding author.