| Objective:1?To investigate the epidemiological characteristics of stroke and its risk factors in Chinese people aged 40 years and older.2?To investigate the epidemiological characteristics,prognosis and adherence to secondary prevention medicine of the stroke patients combined with different chronic diseases(hypertension,diabetes,dyslipidemia and atrial fibrillation).Meanwhile,we investigated the risk factors of stroke in people with different chronic diseases.3?To investigate the correlation of chronic diseases and other influence factors with the time interval between first ever and first rucurrent ischemic stroke.Methods:All the subjects in this study were recruited from the screening population of the China National Stroke Screening Survey(CNSSS)during the 2013-2015 screening period.The CNSSS is an ongoing,community-based surveillance project,with the objective of measuring the trend and epidemiological characteristics of stroke and its risk factors in all the 31 provincial administrative regions of mainland China.1?The epidemiological characteristics of stroke in China The cross-sectional study was used to describe the prevalence of stroke and the epidemiological characteristics of risk factors in general population,and in different sub-population which were defined according to different influence factors of stroke,as well as the contribution of risk factors to the risk of stroke.The prevalence of stroke was adjusted according to the ratio of age,sex and urban/rural of the China Population Census in 2010.All the subjects of our study and subjects of the China Population Census were divided into 36 groups respectively according to the ratio of age,sex and urban/rural.If subject A was in the i group whose number of group members was fi,and the corresponding number of group members in the same group in the China Population Census was Fi,the weight of subject A was Fi/fi?2?The epidemiological characteristics of stroke combined with chronic diseasesWe used cross-sectional study to investigate the ratio of hypertension,diabetes,dyslipidemia and atrial fibrillation in stroke patients,the epidemiological characteristics of stroke combined with chronic diseases in people with different demographic factors,and the contribution of risk factors to the risk of stroke combined with chronic diseases.3?The prognosis and the adherence to secondary prevention medicineWe used cross-sectional study to compare the prognosis situation between stroke patients with and without hypertension,diabetes,dyslipidemia,atrial fibrillation.The recurrence times and the score of mRs were used to evaluated the prognosis.The cross-sectional study was used to describe the coherence of antihypertensive agents,hypoglycemic agents,antilipemic agents,anticoagulant/antiplatelet agents in stroke patients with hypertension,diabetes,dyslipidemia or atrial fibrillation,as well as the ratio distribution in patients with different demographic factors.4?The risk factors of stroke in people with different chronic diseasesThe case-control studies were conducted separately in men and women.We only recruited first-ever stroke cases,which were diagnosed during the 2013-2015 screening period,in our study.Individuals with first-ever stroke in patients with hypertension,diabetes,dyslipidemia and atrial fibrillation composed the case group,respectively.Their controls(1:3 frequency-matched for age group and urban/rural ratio)were non-stroke subjects who were randomly selected from the patients with hypertension,diabetes,dyslipidemia and atrial fibrillation.5?The correlation of chronic diseases and other influence factors with the time interval between first ever and first rucurrent ischemic strokePatients with first recurrent ischemic stroke in 2013-2015 screening period were recruited in our study.According to the time interval between first-ever and first recurrent ischemic stroke,patients with TI<12 months,TI<24 months and TI<36 months were regarded as cases group.Their counterpart controls were patients without recurrent ischemic stroke in 12 months,24 months and 36 months.We conducted a subgroup analysis in different age groups,different sexes and different areas.Results:1?The epidemiological characteristics of stroke in China In 2013-2015,the prevalence of total stroke,ischemic stroke and hemorrhagic stroke was 2.48%,1.84%and 0.22%in people aged 40 years and older,respectively.The prevalence was significantly higher in women(P<0.0001)and in rural people(P<0.0001).The prevalence increased with age(P<0.0001)and decreased with educational level(P<0.0001).With full adjustment,the strongest risk factor of stroke was TIA(OR=5.45),followed by hypertension,family history of stroke,dyslipidemia,diabetes,smoking,atrial fibrillation,physical inactivity and overweight/obesity.Hypertension(PARP=53.41%)was the risk factor with the largest contrbutions to the risk of stroke,followed by dyslipidemia,family history of stroke,TIA,overweight/obesity,smoking,diabetes,physical inactivity and atrial fibrillation.2?The epidemiological characteristics of stroke combined with chronic diseases In the stroke patients,72.21%had hypertension,20.75%had diabetes,42.81%had dyslipidemia,and 12.00%had atrial fibrillation.In stroke patients with different chronic diseases,the ratio of women,urban people and people aged 60 years and older were significantly higher than that in stroke patients without corresponding chronic diseases.3?The prognosis and the adherence to secondary prevention medicine There were more patients with recurrence times ? 2 in stroke patients combined with hypertension,diabetes,dyslipidemia,atrial fibrillation.The score of mRs in stroke patients combined with hypertension,diabetes,dyslipidemia,atrial fibrillation were significantly higher than in that without corresponding chronic diseases.In stroke patients with hypertension,77.46%had taken antihypertensive agents.In stroke patients with diabetes,69.52%had taken hypoglycemic agents.In stroke patients with dyslipidemia,32.38%had taken antilipemic agents.In ischemic stroke patients with atrial fibrillation,2.21%had taken anticoagulant agents and 16.27%had taken antiplatelet agents.4?The risk factors of stroke in people with different chronic diseasesWith full adjustment,the risk factors of stroke in people with hypertension were TIA(OR=3.35),family history of stroke(OR=2.04),smoking(OR=1.28)and dyslipidemia(OR=1.14);the risk factors of stroke in people with diabetes were TIA(OR=3.22),family history of stroke(OR=2.65),atrial fibrillation(OR=1.59),hypertension(OR=1.34),physical inactivity(OR=1.33)and dyslipidemia(OR=1.25);the risk factors of stroke in people with dyslipidemia were TIA(OR=3.42),family history of stroke(OR=1.98),smoking(OR=1.57),diabetes(OR=1.27),hypertension(OR=1.24)and physical inactivity(OR=1.17);the risk factors of ischemic stroke in people with atrial fibrillation were family history of stroke(OR=3.30),hypertension(OR=1.85),physical inactivity(OR=1.59)and dyslipidemia(OR=1.44).The associations of risk factors with stroke risk between men and women were significantly different.5?The correlation of chronic diseases and other influence factors with the time interval between first ever and first rucurrent ischemic stroke Diabetes was significantly associated with increased risk of stroke recurrence in 12 months(OR=1.73),and 12-24 months(OR=2.39);coronary heart disease was significantly associated with increased risk of stroke recurrence in 12 months(OR=1.54);the mRs? 1 after the first ischemic stroke onset was significantly associated with increased risk of stroke recurrence in 12 months.Conclusions:1?There was a high prevalence in people aged aged 40 years and older in China.The prevalence of stroke in women and rural population was significantly higher than that in men and urban population.2?In China,there are a large number of stroke patients with chronic diseases.The stroke patients with chronic diseases are at high risk of recurrence and disability,as well as significantly undertreated with corresponding medicine.3?The risk factors of stroke in people with different chronic diseases were significantly different,and the associations between risk factors and stroke risk in men were different from that in women.4?The risk factors of first recurrent ischemic stroke were different among different time intervals,and the associations between risk factors and first recurrent stroke risk in subpopulation were different. |
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