Wang Jing, Wen Xin, Li Wen, Li Xin, Wang Yuan, Lu Wenli
Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, Tianjin, China; Collaborative Innovation Center of Chronic Disease Prevention and Control, Tianjin Medical University, Tianjin, China.
Collaborative Innovation Center of Chronic Disease Prevention and Control, Tianjin Medical University, Tianjin, China.
J Stroke Cerebrovasc Dis. 2017 Mar;26(3):509-517. doi: 10.1016/j.jstrokecerebrovasdis.2016.12.002. Epub 2016 Dec 29.
Stroke is the leading cause of death in China. According to the Chinese Stroke Screening and Prevention Project, 8 main risk factors were assessed and individuals with 3 or more risk factors were identified as high-risk population of stroke. To explore the potential impropriety of counting the risk factors but ignoring the different strength of association of each risk factor, we performed this study.
Relevant databases were searched for case-control and cohort studies focusing on the risk factors of stroke. We systematically identified studies conducted between 1990 and 2015 that included data on the frequency of risk factors in Chinese Han populations. Pooled relative risks and odds ratios, with their 95% confidence intervals, were calculated for the cohort and case-control studies, respectively.
Fifteen cohort studies and 178 case-control studies were identified. Hypertension was the strongest independent risk factor for stroke (pooled odds ratio, 3.50; pooled relative risk, 2.68). Diabetes mellitus, heart disease, family history of stroke, hyperlipidemia, overweight, and smoking were also mildly predictive (pooled odd ratios, 1.82-2.68; pooled relative risks, 1.27-2.47). By contrast, physical exercise was a protective factor against stroke (pooled odd ratio, .49).
There was a measurable difference in the strength of association of the 8 risk factors with stroke; hypertension and diabetes were associated with the highest risks, indicating a need to focus resources on patients with these conditions. Giving risk factors equal weighting may not be an appropriate screening methodology.
中风是中国主要的死因。根据中国中风筛查与预防项目，评估了8个主要危险因素，有3个或更多危险因素的个体被确定为中风高危人群。为探究计算危险因素但忽略各危险因素不同关联强度的潜在不当之处，我们开展了本研究。
检索相关数据库，查找聚焦于中风危险因素的病例对照研究和队列研究。我们系统识别了1990年至2015年期间开展的、包含中国汉族人群危险因素频率数据的研究。分别为队列研究和病例对照研究计算合并相对风险和比值比及其95%置信区间。
识别出15项队列研究和178项病例对照研究。高血压是中风最强的独立危险因素（合并比值比，3.50；合并相对风险，2.68）。糖尿病、心脏病、中风家族史、高脂血症、超重和吸烟也有轻度预测作用（合并比值比，1.82 - 2.68；合并相对风险，1.27 - 2.47）。相比之下，体育锻炼是预防中风的保护因素（合并比值比，0.49）。
8个危险因素与中风的关联强度存在可测量的差异；高血压和糖尿病与最高风险相关，表明需要将资源集中于患有这些疾病的患者。对危险因素给予同等权重可能不是一种合适的筛查方法。
