Epidemiological Survey And Risk Prediction Study Of Stroke Based On Million Population In Hunan Province

Chapter 1: Epidemiological Study of Stroke in a million people in Hunan ProvinceObjective: To obtain the latest prevalence,incidence and mortality of stroke in Hunan Province through a large-scale stroke epidemiological survey,and to provide the latest data to support government departments in determining prevention and treatment priorities and priority areas for intervention.Methods: A multi-stage stratified whole-group sampling method was used to conduct a household survey of a sample of 152 survey sites in 28 districts and counties of 14 prefectures and cities in Hunan Province.All stroke survivors were considered as prevalent stroke cases at the prevalent time(December 31,2021).Firstever and death strokes that occurred during 1 year preceding the survey pointprevalent time were considered as incident and mortality cases.Results: 1.1,781,338 subjects aged 20 years or older were enrolled and 14,014 stroke patients were screened,including 10,778 cases of ischemic stroke and 3208 cases of hemorrhagic stroke.2.The age-standardized stroke prevalence rate in Hunan Province was 685.7/100,000(95%CI,674.3-697.3).thereinto,the age-standardized prevalence of ischemic stroke was 525.1/100,000(95% CI,515.2-535.2)and the age-standardized prevalence of hemorrhagic stroke was 159.2/100,000(95%CI,153.7-164.9).The highest stroke prevalence in Hunan Province was in Changsha,with a age-standardized prevalence of 1315.6/100,000(95%CI,1250.8-1383.4/100,000).The age-standardized prevalence of ischemic stroke was 1096.7/100,000(95%CI,1037.4-1159.1)and the age-standardized prevalence of hemorrhagic stroke was 215.8/100,000(95% CI,190.6-243.9),the lowest prevalence was in Shaoyang,with a age-standardized prevalence of 340.7/100,000(95% CI,313.2-370.6/100,000).3.The age-standardized incidence of stroke in Hunan Province was 102.1/100,000(95% CI,97.7-106.7).The age-standardized incidence of ischemic stroke was 72.3/100,000(95%CI,68.6-76.2)and the age-standardized incidence of hemorrhagic stroke was 29.7/100,000(95% CI,27.3-32.2).The highest stroke incidence rate was in Changsha,with a age-standardized incidence of 151.4/100,000(95%CI,130.3-172.5/100,000),of which 119.1/100,000(95%CI,100.4-137.9/100,000)and 32.3/100,000(95%CI,22.5-42.0/100,000)were for ischemic stroke and hemorrhagic stroke,respectively.The lowest incidence rate was 36.4/100,000(95%CI,25.4-47.4/100,000)in Chenzhou.4.The age-standardized stroke mortality rate in Hunan Province was30.4/100,000(95% CI,28.1-33.0/100,000).Of these,17.0/100,000(95%CI,15.3-18.9/100,000)and 13.3/100,000(11.8-15.0/100,000)were for ischemic stroke and hemorrhagic stroke,respectively.The region with the highest stroke mortality rate was Changsha,with a age-standardized mortality rate of 73.3/100,000(95%CI,58.6-88.0/100,000),and the age-standardized mortality rate for ischemic stroke was 51.1/100,000(95%CI,38.8-63.3/100,000)and for hemorrhagic stroke was22.2/100,000(95% CI,14.1-30.3/100,000).The area with the lowest stroke mortality rate was Chenzhou City,with a age-standardized mortality rate of 12.8/100,000(95% CI,6.3-19.4/100,000).Conclusions: 1.The latest stroke prevalence in Hunan Province was 735.0/100,000,morbidity was 102.1/100,000,and mortality was 30.4/100,000.2.There were regional differences in stroke prevalence,morbidity,and mortality in Hunan Province,with Changsha City having the highest stroke prevalence,morbidity,and mortality of 1315.6/100,000,151.4/100,000,and 73.3/100,000,respectively.Changsha has the highest stroke prevalence,incidence,and mortality rates in Hunan Province,with 1315.6/100,000,151.4/100,000,and 73.3/100,000 respectively.Chapter 2: Study of the distribution characteristics of factors influencing stroke in Hunan ProvinceObjective: To analyze the possible influencing factors of ischemic stroke and hemorrhagic stroke in different regions of Hunan Province through stroke patients and health control questionnaires obtained from the Stroke Current Survey,and to provide a scientific basis for targeted stroke interventions in different regional populations.Methods: A case-control study was conducted based on the Chapter 1 Epidemiological Survey of Stroke in Million People in Hunan Province,including 11,340 confirmed stroke cases(including 8,168 ischemic stroke cases and 3,172 hemorrhagic stroke cases)as the case group and 13,458 non-cardiovascular patients in the same survey area as healthy controls,applying dichotomous variable logistic regression analysis.The factors influencing ischemic stroke and hemorrhagic stroke in Hunan Province and each region were analyzed by applying dichotomous variable logistic regression.Results: 1.A total of 8168 cases of ischemic stroke,3172 cases of hemorrhagic stroke,and 13458 healthy controls were included in this study.The mean ages of the ischemic stroke group,hemorrhagic stroke group,and healthy controls were 70.7(±10.3),67.9(±11.6),and 63.5(±15.1)years,respectively.2.In the total survey population of Hunan province,male(OR=1.21),age(OR=1.03),smoking(OR=1.12),sleep snoring(OR=1.59),oily diet(OR=1.30),salty diet(OR=1.59),hypertension(OR=2.05),atrial fibrillation(OR=1.36),coronary artery disease(OR=1.49),hyperlipidemia(OR=1.63)and hyperglycemia(OR=1.67)were possible risk factors for ischemic stroke(P value for all of the above factors<0.001).3.In the total survey population of Hunan Province,men(OR=1.30),age(OR=1.01),alcohol consumption(OR=1.24),sleep snoring(OR=1.76),oily diet(OR=1.46),salty diet(OR=1.75),hypertension(OR=2.23),hyperlipidemia(OR=1.27),and hyperglycemia(OR=1.25)were possible risk factors for hemorrhagic stroke(p-values for the above factors were <0.01).4.Hypertension was a risk factor for ischemic stroke in Changsha(OR=3.59),Zhuzhou(OR=2.70),Yiyang(OR=2.71),Xiangtan(OR=2.70),Loudi(OR=2.97),Hengyang(OR=3.73),respectively(for all P values<0.001).Coronary heart disease was the first risk factor for ischemic stroke in Zhangjiajie(OR=2.73),Yongzhou(OR=3.00)and Shaoyang(OR=3.50)cities(all P values <0.01).Atrial fibrillation(OR=2.19),diabetes mellitus(OR=1.99)and hyperlipidemia(OR=2.72)were the most important risk factors for ischemic stroke in Xiangxi Tujia and Miao Autonomous Prefecture,Changde City,and Yueyang City,respectively(for all P values <0.01).Dietary oiliness(OR=3.04)and salty diet(OR=4.01)were the most important risk factors for ischemic stroke in Chenzhou City and Huaihua City,respectively(for all P values <0.001).5.Hypertension was the most likely risk factor for hemorrhagic stroke in Changsha(OR=3.95),Zhuzhou(OR=3.59),Zhangjiajie(OR=2.10),Yongzhou(OR=3.76),Yiyang(OR=2.51),Xiangtan(OR=3.12),Loudi(OR=2.93),Hengyang(OR=4.25)and Changde(OR=2.83).The risk factors for hemorrhagic stroke were the highest(P value <0.001).A salty diet was the first risk factor for hemorrhagic stroke in Huaihua(OR=3.23)and Chenzhou(OR=4.25)(for all P values <0.001).Hyperlipidemia was the most important risk factor for hemorrhagic stroke in Yueyang(OR=2.74)and Xiangxi Tujia and Miao Autonomous Prefecture(OR=2.53)(both P values <0.001).Atrial fibrillation(OR=3.20)was the most significant risk factor for hemorrhagic stroke in Shaoyang city(P=0.033).Conclusions: 1.The top three possible risk factors for ischemic stroke in the Hunan population were hypertension,hyperglycemia,and hyperlipidemia.2.The top three possible risk factors for hemorrhagic stroke were hypertension,a salty diet,and sleep snoring.3.The distribution patterns of factors affecting ischemic stroke and hemorrhagic stroke were different among regions in Hunan Province.Chapter 3: Risk prediction study of stroke onset based on the CKB-CVD modelObjective: To quantitatively assess the risk of stroke(ischemic stroke and hemorrhagic stroke)and its attributable risk by using the newly constructed CKB-CVD risk prediction model,and to provide a scientific basis for effective stratified stroke management and precise prevention and control.Methods: Based on the basic stroke database of Hunan Province and the RHR database of Hunan Province,we applied the CKB-CVD risk prediction model to evaluate the risk of ischemic stroke and hemorrhagic stroke in each subgroup in Hunan Province in the next 10 years.Results:1.8,356,317 study subjects from 28 districts and counties were finally included,of which 1,557,344 were used to assess the risk of stroke onset.The mean age of the total study population was 51.5 years(SD13.2),49.8% were female,95.9% were household residents,and 13.7% were hypertension or diabetes mellitus patients.2.The mean standardized risk of ischemic stroke was 7.9% and the mean standardized risk of hemorrhagic stroke was 4.2% for the 8,356,317 study subjects in 28 districts and counties in Hunan Province.In the next 10 years,656,538 new cases of ischemic stroke and 354,146 new cases of hemorrhagic stroke are expected to occur.Of these,41.4% of ischemic stroke cases and 42.4% of hemorrhagic stroke cases originated from non-hypertensive or non-diabetic patients aged <65 years;31.6% of ischemic stroke cases and 29.5% of hemorrhagic stroke cases originated from hypertensive or type 2 diabetes patients;27.0% of ischemic stroke cases and 28.1% of hemorrhagic stroke cases.3.The CKB-CVD model to assess the effects of different intervention scenarios for daily smoking,waist circumference,diabetes mellitus,and hypertension showed that the PAFs for intensive BP lowering,hypertension,diabetes mellitus,daily smoking,and high waist circumference in ischemic stroke were 11.0%,7.8%,4.9%,3.1%,and 0.6%,respectively.The PAFs for intensive BP lowering,hypertension,diabetes,daily smoking,and high waist circumference were 15.0%,8.6%,2.8%,1.4%,and-0.6%,respectively.4.8,356,317 study subjects would have 47,351 fewer ischemic strokes and 28,023 fewer new cases of hemorrhagic stroke over the next 10 years,assuming ideal control of hypertension alone.assuming ideal control of diabetes,30,758 fewer ischemic strokes and 9,603 fewer new cases of hemorrhagic strokes over the next 10 years;assuming ideal control of daily smoking,19,547 fewer ischemic strokes and 4,856 fewer new cases of hemorrhagic strokes over the next 10 years;Assume ideal control of waist circumference would result in 3,789 fewer ischemic strokes and 2,129 more hemorrhagic strokes over the next 10 years.Assuming tight control of blood pressure at 130/80 mm Hg,there would be an estimated reduction of 64,920 ischemic strokes and 46,278 new cases of hemorrhagic strokes.Assuming a combination of these factors,there would be an estimated reduction of 111,370 ischemic strokes and56,673 new cases of hemorrhagic strokes.Conclusions: 1.The average standardized risk of ischemic stroke and hemorrhagic stroke in 28 districts and counties in Hunan Province over the next 10 years is 7.9% and 4.2%,respectively;656,538 ischemic strokes and 354,146 new cases of hemorrhagic stroke are expected to occur over the next 10 years.2.Under ideal intervention of hypertension,diabetes,daily smoking and waist circumference,it is expected that 111,370 ischemic strokes and 56,673 new cases of hemorrhagic strokes can be minimized in the next 10 years.