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Page 2 of 16 Santos et al. Vessel Plus 2021;5:21 https://dx.doi.org/10.20517/2574-1209.2020.69

Indigenous People.

Keywords: Stroke, Indigenous Peoples, first nations, incidence, risk factors, treatment, management

INTRODUCTION
It is estimated that 476 million Indigenous Peoples live in over 90 countries worldwide . The World Health
[1]
Organisation (WHO) defines Indigenous Peoples as “communities that live within, or are attached to,
geographically distinct traditional habitats or ancestral territories, and who identify themselves as being part
of a distinct cultural group, descended from groups present in the area before modern states were created
and current borders were defined. Usually, they are considered the original inhabitants of their lands (“First
Peoples”). They generally maintain cultural, economic, political and social identities separate from the
[2]
mainstream or dominant society or culture in which they live . There is great diversity between and within
Indigenous Peoples around the world. However, Indigenous Peoples typically share more holistic concepts
of health as well as the common experience of poorer health outcomes, particularly in relation to
cardiovascular diseases (including stroke), when compared with their non-Indigenous counterparts . These
[3]
health inequities relate to the ongoing socio-economic, cultural and environmental consequences of
colonisation and racism . These health inequities exist not only in low- and middle-income countries, but
[3-5]
also in high-income countries where the dominant society typically experience substantially higher quality
of life and life expectancy .
[6]

[7]
Stroke is the second leading cause of death and the third greatest cause of disability worldwide . Seventy
percent of those strokes and 87% of stroke-related deaths and disability-adjusted-life-years (DALYs) occur
in low- and middle-income countries [8-10] . Within those low- and middle-income countries, where stroke
typically affects patients at younger ages, there is typically a greater proportion of intracerebral haemorrhage
(ICH) compared with ischaemic stroke (IS), and greater mortality rates . These patterns of stroke incidence
[9]
and mortality are also seen in Indigenous populations around the world, even within high-income
countries .
[11]
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 in the same region. This narrative review
includes Indigenous Peoples where data have been published on the subject. We acknowledge that stroke
has not been studied in all Indigenous groups; hence, we were unable to provide data on these Indigenous
Peoples. Given the breadth of this topic, we will focus on Indigenous Peoples who represent a minority
group within their country, many of whom share a history of colonisation. We will not draw direct
comparisons between different Indigenous populations, due to inconsistencies in determining Indigenous
status, study design, data collection and standardisation .
[12]
Our objective is to understand the differences in stroke between Indigenous and non-Indigenous
populations leading to a discussion on potential solutions for improving stroke-related health outcomes for
Indigenous Peoples around the world. Specifically, we focused on peer-reviewed literature that discusses
stroke incidence, cardiovascular risk factors and treatment with thrombolysis or endovascular clot retrieval
in Indigenous populations in comparison to the non-Indigenous population in the same region.