Prevalence of stroke and stroke related risk factors: a population based cross sectional survey in southwestern China

Xingyang Yi, Hua Luo, Ju Zhou, Ming Yu, Xiaorong Chen, Lili Tan, Wei Wei, Jie Li, Xingyang Yi, Hua Luo, Ju Zhou, Ming Yu, Xiaorong Chen, Lili Tan, Wei Wei, Jie Li

Abstract

Background: Stroke and its risk factors epidemiological survey can help identify individuals at higher risk and therefore promote stroke prevention strategies. The aim of this study was to estimate the current prevalence of stroke and high risk stroke population, and evaluate stroke associated risk factors in southwestern China.

Methods: This was a multi-center, cross sectional survey in southwestern China from May 2015 to September 2015. The eight communities were selected at random, and 17,413 residents aged ≥40 years volunteered to participate in this survey. Data were collected through face-to-face survey using a structured questionnaire. Five hundred twenty-one participants with incomplete questionnaires on stroke history or risk factors records were excluded.

Results: A total of 16,892 people included in analysis. The overall prevalence of stroke was 3.1% (95% CI 2.6-3.9%), 17.1% of participants were the high risk stroke population. After full adjustments, hypertension, diabetes, dyslipidemia, overweight, lack of exercise and family history of stroke were significantly associated with overall stroke and ischemic stroke. The largest contributor was hypertension (population-attributable risk 23.6%), followed by dyslipidemia, physical inactivity, family history of stroke, diabetes, and overweight. However, only hypertension (OR = 3.66, 95% CI 1.82-8.23) was significantly associated with hemorrhagic stroke.

Conclusions: The prevalence of stroke and high risk stroke population was high among adults aged ≥40 years in southwestern China. Hypertension, dyslipidemia and lack of exercise were stronger contributors for stroke, these findings suggest that individual-level and population-level interventions for these leading risk factors are necessary to prevent stroke.

Keywords: Epidemiology; Health care; Risk factors; Stroke.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Data preparing and cleaning process in this survey

References

    1. Guan T, Ma J, Li M, Xue T, Lan Z, Guo J, et al. Rapid transitions in the epidemiology of stroke and its risk factors in China from 2002 to 2013. Neurology. 2017;89:53–61. doi: 10.1212/WNL.0000000000004056.
    1. Jiang B, Wang WZ, Chen H, Hong Z, Yang QD, Wu SP, et al. Incidence and trends of stroke and its subtypes in China: results from three large cities. Stroke. 2006;37:63–68. doi: 10.1161/01.STR.0000194955.34820.78.
    1. Liu L, Wang D, Wong KS, Wang Y. Stroke and stroke care in China: huge burden, significant workload, and a national priority. Stroke. 2011;42:3651–3654. doi: 10.1161/STROKEAHA.111.635755.
    1. Liu M, Wu B, Wang WZ, Lee LM, Zhang SH, Kong LZ. Stroke in China: epidemiology, prevention, and management strategies. Lancet Neurol. 2007;6:456–464. doi: 10.1016/S1474-4422(07)70004-2.
    1. Wang Y, Cui L, Ji X, Dong Q, Zeng J, Wang Y, et al. The China National Stroke Registry for patients with acute cerebrovascular events: design, rationale, and baseline patient characteristics. Int J Stroke. 2011;6:355–361. doi: 10.1111/j.1747-4949.2011.00584.x.
    1. Longde W, Ling Y, Yang H, Yi Z, Yongjun W, Xunming J, et al. Fixed-dose combination treatment after stroke for secondary prevention in China: a national community-based study. Stroke. 2015;46:1295–1300. doi: 10.1161/STROKEAHA.114.007384.
    1. Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, et al. Global and regional burden of stroke during 1990-2010: findings from the global burden of disease study 2010. Lancet. 2014;383:245–254. doi: 10.1016/S0140-6736(13)61953-4.
    1. GBD 2016 Lifetime Risk of Stroke Collaborators. Feigin VL, Nguyen G, Cercy K, Johnson CO, Alam T, Parmar PG, et al. Global, Regional, and Country-Specific Lifetime Risks of Stroke, 1990 and 2016. N Engl J Med. 2018;379:2429–2437. doi: 10.1056/NEJMoa1804492.
    1. Wu S, Wu B, Liu M, Chen Z, Wang W, Anderson CS, et al. Stroke in China: advances and challenges in epidemiology, prevention, and management. Lancet Neurol. 2019;18:394–405. doi: 10.1016/S1474-4422(18)30500-3.
    1. Wang W, Jiang B, Sun H, Ru X, Sun D, Wang L, et al. Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480687 adults. Circulation. 2017;135:759–771. doi: 10.1161/CIRCULATIONAHA.116.025250.
    1. Ru X, Wang W, Sun H, Sun D, Fu J, Ge S, et al. Geographical difference, rural-urban transition and trend in stroke prevalence in China: findings from a National Epidemiological Survey of stroke in China. Sci Rep. 2019;9(1):17330. doi: 10.1038/s41598-019-53848-1.
    1. GBD 2016 Healthcare Access and Quality Collaborators Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016. Lancet. 2018;391:2236–2271. doi: 10.1016/S0140-6736(18)30994-2.
    1. National Center for Stroke Control and Prevention, National Health and Family Planning Commission of the People’s Republic of China. The China National Stroke Screening Survey Guidelines [online, in Chinese]. Available at: . Accessed 18 Nov 2016.
    1. Krishnamurthi RV, Moran AE, Feigin VL, Barker-Collo S, Norrving B, Mensah GA, et al. Stroke prevalence, mortality and disability-adjusted life years in adults aged 20-64 years in 1990-2013: data from the global burden of disease 2013 study. Neuroepidemiology. 2015;45:190–202. doi: 10.1159/000441098.
    1. Asplund K, Tuomilehto J, Stegmayr B, Wester PO, Tunstall-Pedoe H. Diagnostic criteria and quality control of the registration of stroke events in the MONICA project. Acta Med Scand Suppl. 1988;728:26–39.
    1. James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. Evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the eighth joint National Committee (JNC 8) JAMA. 2014;311:507–520. doi: 10.1001/jama.2013.284427.
    1. American Diabetes Association Diagnosis and classification of diabetes mellitus. Diabetes Care. 2013;36:S67–S74. doi: 10.2337/dc13-S067.
    1. Yi X, Han Z, Zhou Q, Lin J, Liu P. 20-Hydroxyeicosatetraenoic acid as a predictor of neurological deterioration in acute minor ischemic stroke. Stroke. 2016;47:3045–3047. doi: 10.1161/STROKEAHA.116.015146.
    1. Rao Wenwang, Su Yingying, Yang Guang, Ma Yue, Liu Rui, Zhang Shangchao, Wang Shibin, Fu Yingli, Kou Changgui, Yu Yaqin, Yu Qiong. Cross-Sectional Associations between Body Mass Index and Hyperlipidemia among Adults in Northeastern China. International Journal of Environmental Research and Public Health. 2016;13(5):516. doi: 10.3390/ijerph13050516.
    1. Zhang FL, Guo ZN, Wu YH, Liu HY, Luo Y, Sun MS, et al. Prevalence of stroke and associated risk factors: a population based cross sectional studyfrom northeast China. BMJ Open. 2017;7(9):e015758. doi: 10.1136/bmjopen-2016-015758.
    1. Lyden PD, Lu M, Levine SR, Brott TG, Broderick J. A modified National Institutes of Health Stroke Scale for use in stroke clinical trials: preliminaryreliability and validity. Stroke. 2001;32:1310–1317. doi: 10.1161/01.STR.32.6.1310.
    1. Stroke Screening and Prevention Project Committee NHaFPCoC Technical specification of stroke screening and prevention in China. Chinese J Frontiers Med Sci. 2013;9:44–50.
    1. Bruzzi P, Green SB, Byar DP, Brinton LA, Schairer C. Estimating the population attributable risk for multiple risk factors using case-control data. Am J Epidemiol. 1985;122:904–914. doi: 10.1093/oxfordjournals.aje.a114174.
    1. Kooperberg C, Petitti DB. Using logistic regression to estimate the adjusted attributable risk of low birthweight in an unmatched case-control study. Epidemiology. 1991;2:363–366. doi: 10.1097/00001648-199109000-00009.
    1. Li SC, Schoenberg BS, Wang CC, Cheng XM, Bolis CL, Wang KJ. Cerebrovascular disease in the People's Republic of China: epidemiologic and clinical features. Neurology. 1985;35:1708–1713. doi: 10.1212/WNL.35.12.1708.
    1. Cheng XM, Ziegler DK, Lai YH, Li SC, Jiang GX, Du XL, et al. Stroke in China, 1986 through 1990. Stroke. 1995;26:1990–1994. doi: 10.1161/01.STR.26.11.1990.
    1. Zhou Maigeng, Wang Haidong, Zeng Xinying, Yin Peng, Zhu Jun, Chen Wanqing, Li Xiaohong, Wang Lijun, Wang Limin, Liu Yunning, Liu Jiangmei, Zhang Mei, Qi Jinlei, Yu Shicheng, Afshin Ashkan, Gakidou Emmanuela, Glenn Scott, Krish Varsha Sarah, Miller-Petrie Molly Katherine, Mountjoy-Venning W Cliff, Mullany Erin C, Redford Sofia Boston, Liu Hongyan, Naghavi Mohsen, Hay Simon I, Wang Linhong, Murray Christopher J L, Liang Xiaofeng. Mortality, morbidity, and risk factors in China and its provinces, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. 2019;394(10204):1145–1158. doi: 10.1016/S0140-6736(19)30427-1.
    1. O’Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, et al. Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet. 2010;376:112–123. doi: 10.1016/S0140-6736(10)60834-3.
    1. Mills KT, Bundy JD, Kelly TN, Reed JE, Kearney PM, Reynolds K, et al. Global disparities of hypertension prevalence and control clinical perspective. Circulation. 2016;134:441–450. doi: 10.1161/CIRCULATIONAHA.115.018912.
    1. Pan L, Yang Z, Wu Y, Yin RX, Liao Y, Wang J, et al. The prevalence, awareness, treatment and control of dyslipidemia among adults in China. Atherosclerosis. 2016;248:2–9. doi: 10.1016/j.atherosclerosis.2016.02.006.
    1. Wang S, Xu L, Jonas JB, You QS, Wang YX, Yang H. Prevalence and associated factors of dyslipidemia in the adult Chinese population. PLoS One. 2011;6:e17326. doi: 10.1371/journal.pone.0017326.
    1. Kesteloot H, Huang DX, Yang XS, Claes J, Rosseneu M, Geboers J, et al. Serum lipids in the People’s republic of China: comparison of western and eastern populations. Arteriosclerosis. 1985;5:427–433. doi: 10.1161/01.ATV.5.5.427.
    1. Ng SW, Howard AG, Wang HJ, Su C, Zhang B. The physical activity transition among adults in China: 1991-2011. Obes Rev. 2014;15:27–36. doi: 10.1111/obr.12127.
    1. Popkin BM. Synthesis and implications: China’s nutrition transition in the context of changes across other low- and middle-income countries. Obes Rev. 2014;15:60–67. doi: 10.1111/obr.12120.
    1. Ng M, Freeman MK, Fleming TD, Robinson M, Dwyer-Lindgren L, Thomson B, et al. Smoking prevalence and cigarette consumption in 187 countries, 1980–2012. JAMA. 2014;311:183–192. doi: 10.1001/jama.2013.284692.
    1. Feigin VL, Roth GA, Naghavi M, Parmar P, Krishnamurthi R, Chugh S, et al. Global burden of diseases, injuries and risk factors study 2013 and stroke experts writing group; global burden of stroke and risk factors in 188 countries, during 1990–2013: a systematic analysis for the global burden of disease study 2013. Lancet Neurol. 2016;15:913–924. doi: 10.1016/S1474-4422(16)30073-4.
    1. Sposato LA, Cipriano LE, Saposnik G, Ruíz Vargas E, Riccio PM, Hachinski V. Diagnosis of atrial fibrillation after stroke and transient ischaemic attack: a systematic review and meta-analysis. Lancet Neurol. 2015;14:377–387. doi: 10.1016/S1474-4422(15)70027-X.
    1. Koga M, Yoshimura S, Hasegawa Y, Shibuya S, Ito Y, Matsuoka H, et al. SAMURAI study investigators. Higher risk of ischemic events in secondary prevention for patients with persistent than those with paroxysmal atrial fibrillation. Stroke. 2016;47:2582–2588. doi: 10.1161/STROKEAHA.116.013746.

Source: PubMed

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