Table_1_The impact of potentially modifiable risk factors for stroke in a middle-income area of China: A case-control study.DOCX

AimsTo reveal the impact of eleven risk factors on stroke and provide estimates of the prevention potential.
MethodsWe 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.
ResultsA 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%).
ConclusionThe 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.

研究目的：揭示11项危险因素对脑卒中（stroke）的影响，并评估其预防潜力。研究方法：本研究在中国江西省这一中等收入地区开展多中心病例对照研究。所有病例均接受神经影像学检查。对照人群为从病例集中区域的社区招募的无脑卒中病史成年人。分别采用条件logistic回归（conditional logistic regression）与非条件logistic回归（unconditional logistic regression），针对脑卒中亚型及其他分组（性别、年龄、城乡区域）进行亚组分析。计算比值比（Odds Ratio, OR）及其人群归因风险（Population Attributable Risk, PAR），并给出95%置信区间。研究结果：2018年2月至9月，共招募43615名参与者（11735例病例、31880例对照），最终纳入11729对病例对照。缺乏体力活动[PAR 69.5%（66.9~71.9%）]与高血压[53.4%（49.8~56.8%）]是脑卒中的两大主要危险因素，其次依次为高盐饮食[23.9%（20.5~27.3%）]、血脂异常[20.5%（17.1~24.0%）]、肉食型饮食[17.5%（14.9~20.4%）]、糖尿病[7.7%（5.9~9.7%）]、心脏源性病因[5.3%（4.0~6.7%）]、饮酒[4.7%（0.2~10.0%）]及高同型半胱氨酸血症[4.3%（1.4~7.4%）]。其中9项危险因素与缺血性脑卒中相关，5项与脑出血相关。综上，11项危险因素合计占所有脑卒中人群归因风险的59.9%（缺血性脑卒中：61.0%；脑出血：46.5%），且在不同性别（男性：65.5%；女性：62.3%）、年龄（≤55岁：65.2%；>55岁：63.5%）及城乡区域（城市：62.2%；县城：65.7%）中结果一致。研究结论：本研究鉴定出的11项脑卒中相关危险因素，可为中等收入地区脑卒中预防的循证规划提供重要参考。当前亟需提升行为与代谢类危险因素的知晓率、管理与控制水平，尤其应推广体力活动并调控血压水平。