We aimed to characterize demographic and clinical characteristics of the Native American stroke population and identify predictors of in-patient mortality.

Stroke is a leading cause of morbidity and mortality in the United States. Native Americans constitute 1.5% of the population. Multiple studies have examined how stroke affects minority groups. However, existing data on stroke in Native Americans (NA)remains extremely limited. 

We evaluated claims data from California acute care hospitals between 2005-2011. California has the largest NA population in the US. Using validated ICD-9 codes, we identified primary ischemic (AIS) and hemorrhagic stroke (ICH) admissions and ascertained comorbidities and in-hospital complications.  We compared baseline characteristics across race/ethnic groups and identified independent predictors of hospital mortality using univariate and multivariate logistic regression. 

We identified 283,107  strokes in California between 2005 and 2011. (234,471 AIS [83%] and 48,636 ICH [17%]). Of these, 851 (0.3%) were NA (including AIS 698 [82%] and ICH 153[18%]). For AIS, NA had intermediate prevalence of vascular risk factors, including smoking history (15% vs 18% in Blacks and 11% in Whites, p<0.001) and diabetes (46% vs 48% in Hispanics and 26% in Whites, p<0.001). Native Americans with AIS were least likely to receive palliative care (1% vs 4% in Whites, p<0.001). In ICH, NA had the second highest proportion of chronic kidney disease (13% vs. 17.5% in Blacks and 8.1% in Whites, p<0.001) and the highest proportion of diabetes (41% vs. 37% in Hispanics and 21% in Whites, p<0.001). In-hospital mortality was similar among minorities (4% [AIS], 26%  [ICH], p>0.2). In both AIS and ICH, predictors of in-hospital mortality were similar to other minority groups including atrial fibrillation (p=0.002) in AIS and female sex (p=.005) in ICH. 

Native Americans constitute an important understudied minority population in stroke. NA have high prevalence of modifiable risk factors including diabetes and smoking.