| Part One Prevalence and incidence of stroke and associated risk factors:apopulation-based cross-sectional study in Dehui City of Jilin ProvinceBackgroud and objective:Data from the Global Burden of Diseases,Injuries,and Risk Factors Study 2016?GBD 2016?indicated that cardiovascular diseases?CVDs?were the leading cause of the global death,also the main cause of the years of life lost?YLLs?and disability-adjusted life-years?DALYs?.From a global perspective,China located in the high-risk belt of the global stroke maps,furthermore the Northeast China located in the high-risk stroke belt in China.The epidemiological investigations of stroke in Jilin Province were mostly carried out in the 1970s to 1990s.With the rapid development of economy and the improvement of people's living standards,we speculated that the epidemic situation of stroke in this area has undergone great changes.To get the latest scientifically reliable stroke epidemiological survey data in this area was imminent.The survey was based on the 2015-2016 and 2016-2017“High-risk Stroke Population Screening and Prevention Program”organized by National Health and Family Planning Commission Stroke Prevention Engineering Committee to achieve the following objectives:to obtain the latest data on the prevalence and incidence of stroke and the characteristics of high-risk populations,in order to provide scientific and reliable data for stroke prevention and control in the region.Participants and Methods:We used a multi-stage stratified randomized cluster sampling method to collect 4100 permanent residents aged 40 years or older who lived for more than 6 months in Dehui City of Jilin Province.The survey included two stages.Stage I:From January 1,2016 to March 31,2016,this period was the baseline data collection stage;the baseline demographic information,questionnaires,physical examinations,laboratory tests,and other baseline data information were obtained.Primary or secondary prevention guidance and recommendations were given to the surveyed population;this stage was conducted using a combination of centralized and household surveys.Stage II:From January 1st,2017 to March 31st,2017.This stage was the follow-up stage to obtain data on clinical events for new-onset or recurrent strokes during the 2016-2017 period in the baseline population.This stage was based on face-to-face and telephone follow-up combined.Results:The complex weighted prevalence of stroke among people aged 40 and over in Dehui City of Jilin Province was 7.2%?95%CI:6.3–8.2%?in 2015,and the prevalence of ischemic stroke was 6.7%?95%CI:5.9–7.7%?.Both of these showed an upward trend with age,and a downward trend with increasing education level.The complex weighted incidence of stroke was 1.1%?95%CI:0.8–1.6%?in 2016.In addition,the proportion of high-risk stroke population in the region was 57.3%?95%CI:55.4–59.1%?.Similarly,the composition ratio showed an upward trend with age and a downward trend with increasing education level.Among the common risk factors for stroke,the highest prevalence rates were dyslipidemia,smoking,and hypertension,with rates being 62.1%?95%CI:60.3–63.9%?,61.8%?95%CI:60.0–63.5%?,and 57.3%?95%CI:55.5–59.2%?,respectively.In addition,the survey also revealed for the first time that the prevalence of atrial fibrillation in the general population aged 40 years and over in this region was 0.7%?95%CI:0.5–1.1%?.Further logistic regression analysis found that hypertension was the most important metabolic risk factors both for ischemic stroke?OR=2.582,95%CI:1.720–3.877?and hemorrhagic stroke?OR=4.064,95%CI:1.358–12.160?.Conclusions:The study showed that the current situation of stroke in Dehui City of Jilin Province was very serious.The prevalence and incidence rates were both high and the burden of disease was heavy.In addition,the proportion of high-risk groups was relatively very large.We should focus on this group of people in the following-up management.Hypertension was the most important metabolic risk factors both for ischemic stroke and hemorrhagic stroke.Therefore,the effective control and management of hypertension should be paid more attention to reduce the burden of stroke in this region.Part Two Hypertension prevalence,awareness,treatment,and control in DehuiCity of Jilin Province:a population-based cross-sectional surveyBackgroud and objective:Data from GBD 2013 revealed that 90.5%of global stroke burden was attributed to controllable risk factors,among which metabolic risk factors accounted for 72.4%of DALYs losses caused by stroke.Among metabolic risk factors,hypertension was the most important risk factor for stroke.In China,as high as 94%of the stroke burden was attributed to controllable risk factors.Uncontrolled hypertension can account for approximately one-third of deaths caused by CVDs among people aged35–79 years?approximately half of deaths caused by CVDs among people aged 35–59years?.Although there have been some epidemiological studies of hypertension in Northeast China in recent years,these studies have not reported information on the factors influencing the awareness,treatment,and control of hypertension.Acquisition of this information was of vital importance for the hypertension prevention and control.The second part of this study was based on the relevant data on blood pressure collected in the“High-risk Stroke Population Screening and Prevention Program”in Dehui City of Jilin Province,and combined with the demographic sociology information of the region to achieve the following objectives:?1?Estimate the prevalence,awareness,treatment,and control of hypertension in Dehui City of Jilin Province in 2015 in the overall and subgroups based on the sociodemographic information;?2?Explore the influencing factors for prevalence,awareness,treatment and control of hypertension,in order to provide scientific data for hypertension prevention and control in the region.Participants:People participated in and completed the“High-risk Stroke Population Screening and Prevention Program”in Dehui City of Jilin Province,with complete history of hypertension,medication history,and complete blood pressure measurements in the survey.Results:The prevalence of hypertension among people aged 40 years and over in Dehui City of Jilin Province was 57.3%?95%CI:55.5–59.2%?in 2015.Among the controllable risk factors,obvious overweight or obesity?OR=2.320,95%CI:1.980–2.719?was the greatest risk factor for hypertension.In addition,people with dyslipidemia?OR=1.704,95%CI:1.476–1.968?or diabetes?OR=1.755,95%CI:1.367–2.253?were more likely to suffer from hypertension.The situation of comorbid diseases of metabolic diseases should be brought to the forefront.Of all hypertensive people,only 47.4%?95%CI:44.9–49.8%?knew they had high blood pressure.Men were more likely to ignore their status than women?OR=0.699,95%CI:0.584–0.836?.Among all hypertensive patients,37.3%?95%CI:35.0–39.7%?were treated with drug;among those who knew that they had hypertension,the proportion was 78.8%?95%CI:75.8–81.5%?.Compared with women,men were more likely to ignore the use of antihypertensive drugs to control their high blood pressure?OR=0.579,95%CI:0.436–0.769?.In addition,compared with rural populations,urban populations were more active in treating their hypertension?OR=1.758,95%CI:1.317–2.348?.Of the patients treated with antihypertensive drugs,only 9.2%?95%CI:7.2–11.8%?chose combination therapy,and only 10.2%?95%CI:8.1–12.7%?controlled their blood pressure within the normal range.People with dyslipidemia?OR=0.600,95%CI:0.375–0.960?were also less likely to achieve the target.In addition,hypertension patients who choose to use combination therapy were more likely to control their blood pressure,with an odds ratio of 2.924.Conclusions:The prevalence of hypertension was high among people aged 40 and over in Dehui City of Jilin Province.The awareness rate was low,and the known treatment rate was relatively high.However,the current situation of low control and treatment control rates was worrying.In the future,we will reduce the burden of hypertension in this region,apart from further raising the awareness rate of hypertension in the region,we should place greater emphasis on drug compliance,regularity,and scientific guidance and education for people with hypertension.Part Three Prevalence and risk factors for diabetes and impaired fastingglucose in Dehui City of Jilin Province:a population-based cross-sectional survey Backgroud and objective:Diabetes mellitus is an important and controllable metabolic risk factor leading to the onset and death of coronary heart disease and stroke.Some studies suggested that compared with non-diabetic people,diabetes increased the risk of death from any cause by 80%,and the risk of vascular disease-induced death increased by 1.32 times.Data from GBD 2016 showed that the absolute deaths and YLLs caused by diabetes have increased by 31.1%?95%UI 28.9–33.4%?and 25.3%?95%UI 23.2–27.7%?,respectively,from 2006 to 2016.A community-based and individual-based prospective cohort study from Sweden found that screening can bring forward an average of 4.6 years for diabetes diagnosis.And overall,patients with clinically diagnosed diabetes had a nearly 1-fold increased risk of all-cause mortality than those diagnosed through screening?HR=2.07,95%CI:1.63–2.62?.At the same time,all-cause mortality?HR=2.31,95%CI:1.82–2.94?of individuals diagnosed with diabetes who had not previously participated in screening was higher than those who had previously participated in screening,compared with individuals screened for testing.Clinically diagnosed patients?HR=1.70,95%CI:1.32–2.18?exhibited the same trends for the risk of CVD,kidney disease,and retinal diseases.Therefore,early detection and active intervention through screening was an important means to reduce the risk and burden of diabetes-related diseases.The third part of this study was based on the relevant data on blood glucose collected in the“High-risk Stroke Population Screening and Prevention Program”in Dehui City of Jilin Province,and combined with the demographic sociology information of the region to achieve the following two objectives:?1?Estimate the prevalence,awareness,treatment and control of diabetes and impaired fasting glucose in Dehui City of Jilin Province in the overall and subgroups based on the sociodemographic information in 2015;?2?Explore the influencing factors for prevalence,awareness,treatment and control of diabetes as well as the prevalence of impaired fasting glucose,in order to provide scientific reference data for prevention of diabetes and impaired fasting glucose in the region.Participants:People participated in and completed the“High-risk Screening and Intervention Project for Stroke Patients”in Dehui City of Jilin Province with complete information on the history of diabetes,and complete blood-glucose-related laboratory tests required on-site.Results:The overall prevalence of diabetes among people aged 40 years and over in Dehui City of Jilin Province was 11.2%?95%CI:10.1–12.4%?in 2015.In men,it was9.8%?95%CI:8.3–11.6%?,and 12.6%?95%CI:11.0–14.3%?for women;the prevalence of impaired fasting glucose was 6.9%?95%CI:6.0–8.0%?.Among the controllable risk factors,dyslipidemia?OR=2.387,95%CI:1.826–3.122?was the most important risk factor for diabetes.In addition,people with obvious overweight or obesity?OR=1.544,95%CI:1.211–1.969?,central obesity?OR=1.623,95%CI:1.240–2.124?,hypertension?OR=1.793,95%CI:1.400–2.297?were more likely to suffer from diabetes.In addition,people with obvious overweight or obesity?OR=1.542,95%CI:1.165–2.039?or dyslipidemia?OR=2.005,95%CI:1.464–2.747?were more likely to suffer from impaired fasting glucose.The total awareness of diabetes was 52.9%?95%CI:47.3–58.4%?:68.1%?95%CI:60.7–74.7%?in urban areas and 48.8%?95%CI:42.2–55.5%?in rural areas.People with family history of diabetes were more likely to be aware of their blood glucose status,with an odds ratio of 2.350.In addition,people with mild to moderate alcohol?OR=0.449,95%CI:0.207–0.974?or heavy drinking?OR=0.385,95%CI:0.182–0.814?were more likely to ignore their own blood status compared with those who never drinking alcohol.Among all diabetic patients,47.7%?95%CI:42.3–53.3%?were on antihyperglycemic drugs;90.2%?95%CI:85.1–93.8%?of those who knew they had diabetes were on antihyperglycemic drugs.Similarly,people with mild to moderate alcohol?OR=0.396,95%CI:0.184–0.850?or heavy drinking?OR=0.419,95%CI:0.203–0.865?were more likely to ignore treatment of diabetes than those who never used alcohol.Among those who received hypoglycemic drugs,75.9%?95%CI:68.2–82.3%?had their HbA1CC levels controlled below 7.0%:81.4%?95%CI:72.5–87.9%?in urban areas,73.9%?95%CI:63.7–82.0%?in rural areas.Patients with dyslipidemia?OR=0.209,95%CI:0.059–0.747?or lack of exercise?OR=0.360,95%CI:0.170–0.764?did not easily reach the target.Conclusions:The prevalence of diabetes among people aged 40 years and over in Dehui City of Jilin Province was approximately the same as the national level,while the awareness rate,treatment rate,known treatment rate,and treatment control rate have been greatly improved than before.However,the awareness and treatment rate of diabetes in Dehui City of Jilin Province were still far below from the developed countries and regions.In the future,there were still much room for improvement.Part Four The prevalence,awareness,treatment,and control of dyslipidemiain Dehui City of Jilin Province:a population-based cross-sectional surveyBackgroud and objective:Data analysis from GBD 2010 in China showed that deaths and life lost including YLLs,YLDs,and DALYs caused by hypercholesterolemia both in ischemic heart disease and ischemic stroke,no matter male or female,all showed a clear upward trend during the last 20 years from 1990 to 2010.Similarly,due to the difference of lifestyle and dietary habits,there were regional differences in the distribution of dyslipidemia.A recent survey from Jilin Province in 2012 showed that the awareness,treatment,and control rate of dyslipidemia among 18-79 years old population in the region were 11.6%,8.4%,and 34.8%,respectively,but the study did not report the prevalence of dyslipidemia and its'subtypes.Therefore,the fourth part of this study will further reveal the prevalence of dyslipidemia and its'subtypes,and further analyze the influencing factors affecting the prevalence,awareness,treatment and control of dyslipidemia,in order to provide scientific data for prevention of dyslipidemia in this area.Participants:People participated in and completed the“High-risk Screening and Intervention Project for Stroke Patients”in Dehui City of Jilin Province with a complete history of dyslipidemia and the lipid measurements in this survey.Results:In 2015,the total weighted prevalence of dyslipidemia among people aged 40years and older in Dehui City of Jilin Province was 62.1%?95%CI:60.3–63.9%?.The top two types of dyslipidemia were hypertriglyceridemia and hypercholesterolemia.Among the controllable risk factors,lack of exercise?OR=1.212,95%CI:1.021–1.439?,obvious overweight or obesity?OR=2.156,95%CI:1.836–2.533?,hypertension?OR=1.643,95%CI:1.425–1.893?and diabetes?OR=2.173,95%CI:1.661–2.844?all increased the risk of dyslipidemia.The awareness rate of dyslipidemia was only 14.4%?95%CI:12.9–16.0%?.Compared with those with primary or lower education level,the odds ratios for dyslipidemia awareness among people with high school/secondary school education,college education or above were 1.963 and 2.325,respectively.Among the metabolic risk factors,those with hypertension?OR=1.751,95%CI:1.339–2.289?or diabetes?OR=1.727,95%CI:1.305–2.286?were more likely to be aware of their dyslipidemia status.In all patients with dyslipidemia?self-report and on-site diagnosis?,4.9%?95%CI:4.0–6.0%?of patients treated with drug therapy,and 33.9%?95%CI:28.5–39.8%?of patients treated with drug therapy among those who were aware of their dyslipidemia status.People with history of stroke or coronary heart disease were more likely to use drugs to treat their dyslipidemia.In all patients with dyslipidemia?self-reported and on-site diagnosis?,the proportion of patients with controlled lipid levels was only 2.9%?95%CI:2.2–3.7%?;of the patients treated with lipid-lowering therapy,only 19.9%?95%CI:15.5–25.2%?had their blood lipid controlled within the normal range.Patients with obvious overweight or obesity?OR=0.404,95%CI:0.235–0.695?or lack of exercise?OR=0.423,95%CI:0.215–0.830?were not able to had their blood lipid controlled easily.Conclusions:The prevalence of dyslipidemia among people aged 40 years and over in Dehui City of Jilin Province was relatively high.What was even more worrying was the poor awareness,treatment and control rates.Obvious overweight or obesity and lack of exercise increased the risk of dyslipidemia,and they were also closely related to poor dyslipidemia control.Weight loss and increased physical activity may be the low cost way to reduce the prevalence of dyslipidemia and increase the control rate.Part Five Prevalence of cerebrovascular stenosis and associated risk factors: a population-based cross-sectional study in Dehui City of Jilin ProvinceBackground and objective:Intracranial and extracranial atherosclerosis was an important etiological factor and independent predictor of the occurrence and recurrence of transient ischemic attack and ischemic stroke around the world,and in the etiological classification of ischemic stroke in China,large artery atherosclerosis cerebral infarction was the main type.Understanding the prevalence of intracranial and extracranial atherosclerosis stenosis in the population can provide clues and evidence for the effective interventions for selected high-risk stroke populations.The investigation about the distribution of intracranial and extracranial atherosclerosis stenosis was mostly based on the results of people with ischemic stroke or transient ischemic attack in hospitals.At present,there was no data on the prevalence of intracranial and extracranial atherosclerosis stenosis in the general population in Jilin Province.Based on the“High-risk Screening and Intervention Project for Stroke Patients”in Dehui City of Jilin Province,our study will fill vacancy on the prevelence of intracranial and extracranial atherosclerosis stenosis in the general population in Jilin Province.Logistic regression analysis model was used to analysis the relevant influencing factors of intracranial and extracranial atherosclerosis stenosis.Participants:People participated in and completed the“High-risk Stroke Population Screening and Prevention Program”in Dehui City of Jilin Province with complete transcranial Doppler and cervical vascular ultrasound results.Results:The prevalence of total ICAS among people aged 40 years and over in Dehui City of Jilin Provincewas 16.3%?95%CI:14.9–17.9%?in 2015:the rate was 29.9%?95%CI:23.6–37.0%?among those with previous history of stroke,15.2%?95%CI:13.7–16.8%?among those without history of stroke.The prevalence of Only ICAS was14.5%?95%CI:13.1-16%?:the rate was 23.2%?95%CI:17.5-30.1%?among those with previous history of stroke,13.8%?95%CI:12.3–15.4%?among those without history of stroke.Hypertension was an important risk factor for Only ICAS.Compared with people without hypertension,hypertensive people had a 60%increased risk for Only ICAS?OR=1.603,95%CI:1.279–2.008?.The prevalence of total ECAS was 4.9%?95%CI:4.2–5.9%?:the rate was 13.8%?95%CI:9.7–19.2%?among those with previous history of stroke,4.2%?95%CI:3.4–5.1%?among those without history of stroke.The prevalence of Only ECAS was 3.1%?95%CI:2.5–3.9%?:the rate was 7.1%?95%CI:4.3–11.3%?among those with previous history of stroke,2.8%?95%CI:2.2–3.5%?among those without history of stroke.People with dyslipidemia had a higher risk having Only ECAS,and the odds ratio was 1.923.The prevalence of ICAS+ECAS was 1.8%?95%CI:1.4–2.4%?:the rate was 6.7%?95%CI:3.9–11.2%?among those with previous history of stroke,1.4%?95%CI:1.0–2.0%?among those without history of stroke.Our study also found that hypertension was also an independent risk factor for ICAS+ECAS.Conclusions:Our study revealed the prevalence of intracranial and extracranial atherosclerosis stenosis in this area for the first time.We found that hypertension was an important risk factor for Only ICAS,by contrast,people with dyslipidemia had higher risk for Only ECAS,and the odds ratio was 1.923.At the same time,our study also found that hypertension was an independent risk factor for ICAS+ECAS. |
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