Jiangxi Center for Disease Control and Prevention Institute of Chronic Non-communicable Diseases, Nanchang, China.
Jiangxi Province Key Laboratory of Preventive Medicine, School of Public Health, Nanchang University, Nanchang, Jiangxi, China.
Front Public Health. 2022 Aug 19;10:815579. doi: 10.3389/fpubh.2022.815579. eCollection 2022.
To reveal the impact of eleven risk factors on stroke and provide estimates of the prevention potential.
We completed a multicenter case-control study in Jiangxi, China, a middle-income area. Neuroimaging examination was performed in all cases. Controls were stroke-free adults recruited from the community in the case concentration area. Conditional logistic regression and unconditional logistic regression were used for subgroup analysis of stroke type, and other groups (sex, age and urban-rural area), respectively. Odds ratios (ORs) and their population attributable risks (PARs) were calculated, with 95% confidence intervals.
A total of 43,615 participants (11,735 cases and 31,880 controls) were recruited from February to September 2018, of whom we enrolled 11,729 case-control pairs. Physical inactivity [PAR 69.5% (66.9-71.9%)] and hypertension [53.4% (49.8-56.8%)] were two major risk factors for stroke, followed by high salt intake [23.9% (20.5-27.3%)], dyslipidemia [20.5% (17.1-24.0%)], meat-based diet [17.5% (14.9-20.4%)], diabetes [7.7% (5.9-9.7%)], cardiac causes [5.3% (4.0-6.7%)], alcohol intake [4.7% (0.2-10.0%)], and high homocysteine [4.3% (1.4-7.4%)]. Nine of these factors were associated with ischemic stroke, and five were associated with intracerebral hemorrhage. Collectively, eleven risk factors accounted for 59.9% of the PAR for all stroke (ischemic stroke: 61.0%; intracerebral hemorrhage: 46.5%), and were consistent across sex (men: 65.5%; women: 62.3%), age (≤55: 65.2%; >55: 63.5%), and urban-rural areas (city: 62.2%; county: 65.7%).
The 11 risk factors associated with stroke identified will provide an important reference for evidence-based planning for stroke prevention in middle-income areas. There is an urgent need to improve awareness, management and control of behavioral and metabolic risk factors, particularly to promote physical activity and reduce blood pressure.
揭示 11 种危险因素对卒中的影响，并评估其预防潜力。
我们在中国中部地区的江西省开展了一项多中心病例对照研究。所有病例均进行神经影像学检查。对照组为在病例集中区社区招募的无卒中的成年人。采用条件 logistic 回归和非条件 logistic 回归分别对卒中类型和其他组（性别、年龄和城乡地区）进行亚组分析。计算比值比（OR）及其人群归因风险（PAR），置信区间为 95%。
2018 年 2 月至 9 月期间共招募了 43615 名参与者（11735 例病例和 31880 名对照），其中纳入了 11729 对病例对照。体力活动不足（PAR69.5%（66.9-71.9%））和高血压（53.4%（49.8-56.8%））是卒中的两个主要危险因素，其次是高盐饮食（23.9%（20.5-27.3%））、血脂异常（20.5%（17.1-24.0%））、肉食为主的饮食（17.5%（14.9-20.4%））、糖尿病（7.7%（5.9-9.7%））、心源性病因（5.3%（4.0-6.7%））、饮酒（4.7%（0.2-10.0%））和高同型半胱氨酸血症（4.3%（1.4-7.4%））。其中有 9 个因素与缺血性卒中相关，5 个因素与脑出血相关。这 11 个危险因素共同导致所有卒中的 PAR 占 59.9%（缺血性卒中：61.0%；脑出血：46.5%），且在性别（男性：65.5%；女性：62.3%）、年龄（≤55 岁：65.2%；>55 岁：63.5%）和城乡地区（城市：62.2%；县：65.7%）方面一致。
确定的 11 个与卒中相关的危险因素将为中低收入地区基于证据的卒中预防规划提供重要参考。迫切需要提高对行为和代谢危险因素的认识、管理和控制，特别是要促进体力活动和降低血压。
