Clinical characteristics and healthcare utilization of Hmong patients presenting with stroke [abstract]
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Objective: This study was conducted to describe ischemic stroke in the Hmong patients at our comprehensive stroke center. Background: Hmong people are originally from the mountainous areas of Southeastern China, Northern Vietnam, Laos, and Thailand. Large numbers have migrated to the USA. Design/Methods: Institutional GWTG database and charts for years 2010–2015 were reviewed. Hmong patients were identified by their last names (18 clans). Demographic, social, and clinical characteristics were compared to white patients in a univariate analysis, with focus on ischemic stroke. Results: There were 68 Hmong and 2034 White patients. Hmong had higher rate of intracerebral hemorrhage (ICH - 34% vs. 15%) and lower rate of ischemic stroke (IS - 60% vs. 77%). For patients diagnosed with IS, Hmong patients were significantly younger (60±2.16 vs. 70±0.39 years#), more frequently women (66% vs. 48%; p=0.03), less frequently covered by insurance (68% vs. 87%#) and less frequently brought by ambulance (44% vs. 54%#). Hmong patients had poorly controlled risk factors with mean A1C 11±0.9% in diabetics (n=13) and mean LDL 116±6.4 mg/dL in hyperlipidemics (n=16). The most common stroke mechanisms were small vessel (31%) and intracranial atherosclerotic diseases (27%). Based on imaging, 56% of Hmong patients had intracranial arterial calcification, 53% had microangiopathic disease, 46% had intracranial stenosis, and 18% extracranial stenosis. On echocardiogram, 68% of Hmong had left ventricular hypertrophy, one patient had hypokinesis, and none had low ejection fraction. The length of stay and the rate of independent ambulation on discharge were not different between Hmong and Whites, however, a larger proportion of Hmong were discharged home (59% vs. 46%; p=0.05). #p≤0.0005. Conclusions: In this study population, Hmong patients have more poorly controlled risk factors, higher incidence of ICH, small vessel and intracranial atherosclerosis, lower incidence of carotid disease and heart failure and utilized fewer resources than Whites.