Kaur Paramdeep, Verma Shweta J, Singh Gagandeep, Bansal Rajinder, Paul Birinder S, Singla Monika, Singh Shavinder, Samuel Clarence J, Sharma Meenakshi, Pandian Jeyaraj D
Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, Canada.
Stroke Unit, Department of Neurology, Christian Medical College, Ludhiana, India.
Eur Stroke J. 2017 Dec;2(4):377-384. doi: 10.1177/2396987317724052. Epub 2017 Jul 27.
The objective of this study is to compare the clinical profile, risk factors, type and outcome of stroke patients in urban and rural areas of Punjab, India.
The primary data source was from the Ludhiana urban population-based stroke registry. The data of first-ever stroke patients with age ≥18 years were collected using WHO stepwise approach from all hospitals, general practitioners, physiotherapy and scan centres between 26 March 2011 and 25 March 2013.
A total of 4989 patients were included and out of 4989 patients, 3469 (69%) were from urban areas. Haemorrhagic stroke was seen more in rural as compared to urban regions (urban 1104 (32%) versus rural 552 (36%); p = 0.01). There were significant differences seen in stroke risk factors; hypertension (urban 1923 (84%) versus rural 926 (89%); p = 0.001) and hyperlipidaemia (urban 397 (18%) versus rural 234 (23%); p = 0.001) between two groups. In the multivariable analysis the rural patients were more likely to be younger (age < 40 years) (OR: 1.82; 95% CI: 1.24-2.68; p = 0.002), Sikhs (OR: 2.57; 95% CI: 1.26-5.22; p = 0.009), farmers (OR: 9.41; 95% CI: 5.36-16.50; p < 0.001), housewives (OR: 2.71; 95% CI: 1.45-5.06; p = 0.002), and consumed alcohol (OR: 1.57; 95% CI: 1.19-2.06; p = 0.001) as compared to urban patients. In addition, use of imaging was higher in rural patients (OR: 1.99; 95% CI: 1.06-3.74; p = 0.03) as compared to urban patients.
In this large cohort of patients, rural and urban differences were seen in risk factors and type of stroke. Stroke prevention strategies need to take into consideration these factors including regional sociocultural practices.
本研究的目的是比较印度旁遮普邦城乡地区中风患者的临床特征、危险因素、类型及预后。
主要数据来源是卢迪亚纳基于城市人口的中风登记处。采用世界卫生组织逐步调查法，收集了2011年3月26日至2013年3月25日期间，所有医院、全科医生、理疗中心及扫描中心年龄≥18岁的首次中风患者的数据。
共纳入4989例患者，其中3469例（69%）来自城市地区。与城市地区相比，农村地区出血性中风更为常见（城市1104例（32%），农村552例（36%）；p = 0.01）。两组中风危险因素存在显著差异；高血压（城市1923例（84%），农村926例（89%）；p = 0.001）和高脂血症（城市397例（18%），农村234例（23%）；p = 0.001）。多变量分析显示，与城市患者相比，农村患者更可能年龄较小（年龄<40岁）（比值比：1.82；95%置信区间：1.24 - 2.68；p = 0.002）、是锡克教徒（比值比：2.57；95%置信区间：1.26 - 5.22；p = 0.009）、是农民（比值比：9.41；95%置信区间：5.36 - 16.50；p < 0.001）、是家庭主妇（比值比：2.71；95%置信区间：1.45 - 5.06；p = 0.002），且饮酒（比值比：1.57；95%置信区间：1.19 - 2.06；p = 0.001）。此外，与城市患者相比，农村患者影像学检查的使用率更高（比值比：1.99；95%置信区间：1.06 - 3.74；p = 0.03）。
在这个大型患者队列中，中风的危险因素和类型存在城乡差异。中风预防策略需要考虑这些因素，包括地区社会文化习俗。
