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Santos et al. Vessel Plus 2021;5:21 Vessel Plus
DOI: 10.20517/2574-1209.2020.69

Review Open Access

A narrative review of stroke incidence, risk factors

and treatment in Indigenous Peoples of the world

6
5
Angela Dos Santos 1,2,3 , Anna H. Balabanski 2,3,4 , Judith M. Katzenellenbogen , Amanda G. Thrift , Luke
1
Burchill , Mark W. Parsons 1,2,7,8
1
Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria 3052, Australia.
2
Melbourne Brain Centre, University of Melbourne, Melbourne, Victoria 3052, Australia.
3
Department of Neurology, Alfred Health, Melbourne, Victoria 3004, Australia.
4
Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3800, Australia.
5
School of Population and Global Health, The University of Western Australia, Perth, Western Australia 6009, Australia.
6
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University,
Clayton, Victoria 3800, Australia.
7
University of New South Wales, South Western Sydney Clinical School, Department of Neurology, Liverpool Hospital, Ingham
Institute for Applied Medical Research, Liverpool, Hospital, New South Wales 2170, Australia.
8
School of Medicine and Public Health, Faculty of Medicine, University of Newcastle, New South Wales 2308, Australia.
Correspondence to: Dr. Angela Dos Santos, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, 300
Grattan St, Parkville, Victoria 3052, Australia. E-mail: adossantos@student.unimelb.edu.au
How to cite this article: Santos AD, Balabanski AH, Katzenellenbogen JM, Thrift AG, Burchill L, Parsons MW. A narrative review
of stroke incidence, risk factors and treatment in Indigenous Peoples of the world. Vessel Plus 2021;5:21.
https://dx.doi.org/10.20517/2574-1209.2020.69
Received: 9 Nov 2020 First Decision: 4 Jan 2021 Revised: 6 Feb 2021 Accepted: 24 Mar 2021 Available online: 23 Apr 2021
Academic Editor: Aaron S. Dumont Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
Stroke is the second leading cause of death and the third greatest cause of disability worldwide. In some countries,
stroke disproportionally affects Indigenous Peoples, with greater incidence and mortality at younger ages, higher
rates of conventional cardiovascular risk factors and lower treatment rates. Worldwide there are 470 million
Indigenous Peoples, residing in 90 countries. Analogous to the general health of all populations, the cause of stroke
and its outcomes are the result of complex interactions between factors that act at societal, service, and individual
levels. Colonisation, including the cultural and material losses associated with it, is a major indirect driver of
disparities in lifestyle, biological and other risk factors for stroke in Indigenous Peoples. In addition, structural
racism and the inability to access culturally safe education, employment and health care, further contribute to
stroke health inequities for Indigenous Peoples globally. In this narrative review we provide an outline of stroke
incidence rates, common risk factors for stroke, treatment rates with intravenous thrombolysis and endovascular
clot retrieval in adult Indigenous populations in comparison to the non-Indigenous population of the same region.
Our objective is to describe the differences that exist between the Indigenous and non-Indigenous populations with
stroke in a particular region and discuss potential solutions that support a “strengths-based” approach driven by

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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