Incident Stroke in the United States and Foreign Born Black Individuals

OBJECTIVES: There is a paucity of information about the association between nativity and stroke prevalence among Black individuals in the United States. METHODS: We assessed stroke prevalence among individuals who identified as Black in the 2000-2018 National Health Interview Survey. Respondents were stratified by age (25-55 or 56-74 years) and location of birth (United States; Caribbean, South, and Central America [CSCA]; and Africa). Factors associated with stroke prevalence were assessed using logistic regression, adjusting for sociodemographic and medical characteristics. RESULTS: Among 64,717 respondents who identified as Black, 88.3% were born in the United States, 8.0% were born in CSCA, and 3.7% were born in Africa. Prevalence of stroke was 4.3%, 1.5% and 0.8%, respectively. Foreign born individuals had lower odds of stroke (adjusted OR 0.44, 0.34-0.57 for CSCA and 0.39, 0.23-0.63 for Africa). The odds of stroke were lowest for those who had recently immigrated at the time of the survey (adjusted OR < 15 years 0.27, 95% CI 0.15-0.47). DISCUSSION: Among individuals who identify as Black, there may be a healthy immigrant effect. Homogenizing racial and ethnic groups may mask key epidemiologic trends and limit targeted interventions.