摘要：We conducted a systematic review of published studies on stroke epidemiology in American Indians and Alaska Natives (AI/ANs). We used MeSH terms and strict inclusion criteria to search PubMed, identifying a relevant sample of 57 refereed publications. We report a consensus view in which prevalent stroke is more common, and estimates of cerebrovascular risk factors are higher, among AI/ANs than among other US populations. Like other minority groups, AI/ANs suffer stroke at younger ages than do non-Hispanic Whites. However, data on AI/AN stroke mortality are significantly compromised by racial misclassification and nonrepresentative sampling. Studies correcting for these problems have found that stroke mortality rates among AI/ANs are among the highest of all US racial and ethnic groups. As with Black and non-Hispanic White stroke mortality, AI/AN stroke mortality varies by geographic region, with the highest rates in Alaska and the Northwest and the lowest in the Southwest. Our results underscore the need for a concerted national effort to collect accurate cross-sectional and longitudinal data on stroke in AI/ANs. American Indian and Alaska Native (AI/AN) people experience significant health and socioeconomic disparities relative to other US populations, including elevated rates of obesity, 1 diabetes, 2 alcohol abuse, 3 cigarette smoking, 3 and poverty, 4 as well as the second lowest rates of educational attainment in the nation, after Hispanics. 5 All-cause mortality among AI/ANs is approximately 50% higher than among non-Hispanic Whites (hereinafter Whites), 6 and life expectancy is shorter. 7 Given these harsh disparities, it is not surprising that Native people have the highest or second highest prevalence of risk factors for cerebrovascular disease among US populations, as several recent studies have confirmed. 8–14 Yet the extant literature on AI/AN health presents a remarkable paradox: alongside findings of high stroke risk are many studies, old and new, concluding that AI/AN people have low stroke mortality. 10,15–21 Because of the need for reliable data to inform public health priorities and community interventions, an accurate understanding of cerebrovascular health and illness in this population is essential. Therefore, we undertook a systematic literature review 22 to determine the current state of knowledge about the risk factors, incidence, prevalence, mortality, and outcomes of stroke among AI/ANs. In the process, we encountered widely recognized obstacles to obtaining epidemiological data on Native people.
