The contemporary incidence of stroke in indigenous populations of developed nations: A systematic review.

Background And Aims: An estimated 370 million indigenous people live across 90 nations worldwide. Despite the known substantial health and socioeconomic disadvantage experienced by Indigenous populations of developed nations, comparative data on the incidence of stroke in these populations are sparse. We aim to undertake a systematic review of the incidence of stroke in Indigenous populations of developed nations, with comparisons between Indigenous and non-Indigenous populations, and between different Indigenous populations. Method(s): Using PubMed, EMBASE and CINAHL-Plus databases, we will examine whole-of-population incidence studies of stroke in Indigenous populations of developed nations published 2000-2019, without language restriction. Non-peer-reviewed sources, studies having <10 Indigenous people, or with insufficient data to determine incidence, will be excluded. Two reviewers will independently validate the search strategies, screen titles and abstracts, and record reasons for rejection. Relevant articles will undergo full-text screening, using the Newcastle-Ottawa Scale to assess risk of bias, and standard data extracted for all studies included. Result(s): Primary outcomes include crude, age-specific and/or age-standardised incidence of stroke. Secondary outcomes include stroke attack rates, incidence rate ratio and case-fatality. Results will be synthesized in figures and tables, describing data sources, populations, methodology, and findings. Due to anticipated heterogeneity of data, results will be reported narratively. Conclusion(s): We will report the first systematic review undertaken to explicitly assess inequities in stroke incidence in Indigenous populations of developed nations. We predict that stroke incidence in Indigenous populations are substantially greater than in non-Indigenous populations, with significant variation in Indigenous rates and rate-ratios between different countries.