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Hmong Americans more likely to suffer stroke at younger age, new study says

Hmong American adults tend to suffer a stroke at a younger age than their white counterparts, reports a new retrospective study published in the Journal of the American Heart Association. They may also be more likely to suffer a rarer, deadlier stroke known as an intracerebral hemorrhage and have higher blood sugar levels compared to white patients suffering the same type of stroke.

While previous research has shown that cardiovascular risks are greater among refugee—including Hmong—populations, this is the first study to focus specifically on the incidence of strokes among Hmong communities in the U.S.

“What we typically see in a lot of data is the clustering of Asian populations together under these labels of Asian American, Asian and Pacific Islander,” Lan Ðoàn, an assistant professor in the department of population health at New York University Grossman School of Medicine, told American Heart Association News. Ðoàn was not a part of the study.

“This generalization and use of this large Asian American label really has inhibited our ability as researchers, as health professionals to understand the true prevalence of health conditions across the diversity of Asian ethnicities,” she continued.

The data for this study was collected from the American Heart Association’s Get With The Guidelines database, and Hmong patients were identified through clan name and primary language. Researchers were able to gather samples of 128 Hmong and 3,084 white stroke patients treated at Regions Hospital in St. Paul, Minn., between 2010 and 2019. St. Paul has the largest metropolitan Hmong population in the country, according to Pew Research Center.

While most patients had an ischemic stroke (caused by a clot blocking blood flow to the brain), the rarer and more dangerous hemorrhagic stroke (caused by bleeding in the brain) occurred twice as often in Hmong than white patients: 31 percent compared to 15 percent. This high rate is comparable to that of other Asian ethnic groups, according to American Heart Association News.

For both types of stroke, Hmong people were much younger on average at the time of their strokes. The average age of Hmong patients who suffered ischemic strokes was 60 compared to the average age of white patients at 70, and the age gap was even greater for the hemorrhagic stroke, with an average age of 56 versus 70.

Beyond the differences in the type and age of onset of stroke, Hmong patients suffering from ischemic strokes arrived at the emergency room an average of four hours later than white patients. They were also less likely to arrive by ambulance.

For researchers, this disparity in response could be a result of insufficient educational outreach. According to lead author Dr. Haitham Hussein, the Hmong have no word for “stroke” in their language. “This was a surprise to us because for many years, our stroke education efforts assumed a common understanding that was not there, which raises questions about the effectiveness of such efforts,” he told American Heart Association News.

Despite the limitations of this study, which is retrospective and looks at a relatively small number of Hmong patients, researchers said their findings are still valuable.

“We must start soon and include the young generations,” Hussein said to American Heart Association News. “Without that foundation of knowledge early in life, we are intervening late. When people are in their 60s or in their 50s and already coming in with a brain hemorrhage, it’s too late.”

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