The Critical Period Role Of Tobacco Exposure In The Risk Of Female Stroke

BackgroundStroke is one of the serious problems of global public health.With the change of disease spectrum and death spectrum,stroke has become the second leading cause of death in the world and the third major cause of loss of disability-adjusted life years(DALYs).At present,about 5,500,000 people died from stroke each year in the world,and 44 million people lose DALYs due to stroke.In China,residents died of'cerebrovascular disease in urban and rural areas were ranked third and first,respectively.In addition,the direct economic burden of stroke is 19.887 billion yuan-accounting for 3.79%of total cost of medical care,brought serious economic burden to the community and family.The incidence of stroke in women aged 45 to 54 was twice that of men in the same age,and the incidence of stroke was increased in middle age.Studies have shown that female stroke occurs older than men.and female stroke is more severe than men.At the same time,female stroke patients had a worse disease outcome than men,and their death and morbidity were significantly higher than men.So we should pay great attention on female stroke.Traditional epidemiological studies focused on the study of risk factors in adult period.Female stroke is a chronic disease which development is the result of a combination of many factors from birth to old,so we use life course epidemiology to discuss the occurrence and development of female stroke.In life course epidemiology models,the critical period model is the effect of exposure and activity on the structure and function of organs,tissues and body systems for a given period of time,it will not be affected by future life.The role of exposure in future life may still be a simple way to increase the risk of disease.Expectations of early or late life through these models add or interact with each other to increase the risk of disease in individuals or populations.The increase in the risk of stroke in women is associated with genetic factors such as hypertension,diabetes,atrial fibrillation and other risk factors.In addition,early life factors(such as birth weight,diet,socioeconomic status,etc.)and female-specific fertility-related factors also have an important impact on female stroke.Tobacco exposure includes active smoking and passive smoking.For some diseases(such as lung cancer,coronary heart disease),the active smoking for women was more harmful than men.Active smoking was a risk factor for both men and women,and active smoking was similar to the risk of stroke in both men and women.In the Western population,the risk of active smoking for female stroke was significantly higher than that of men.In addition,passive smoking also plays an important role in the increased risk of stroke in women.However,there is no research report on the critical role of tobacco exposure in the study of the incidence of stroke in women.Therefore,this study applies the theory of "pedigree theory" in the course of life epidemiology,assuming that tobacco exposure to female stroke the risk factors of the incidence of stroke were analyzed,and the critical role of tobacco exposure at the risk of stroke was analyzed.The interaction between risk factors and other influencing factors was also discussed.Thus.to providing a scientific basis for understanding the pathogenesis of stroke in women.ObjectiveTo explore the risk factors of stroke in female,the critical period role of tobacco exposure in the risk of female stroke were inferred,and the interaction between the critical risk factors and other risk factors were compared with those of female stroke,in order to further understand the pathogenesis of stroke in women to provide guidance guidance strategy basis.MethodsA case-control study was used.Female patients who was hospitalized during the period from August 2015 to October 2016 was selected as the study group.A hospitalized patient with a confirmed female stroke was selected as the case group and the non-stroke female hospitalized patients in control group.Through the questionnaire survey,collected information from hospitalization of female patient during August 2015 to October 2016.The general demographic characteristics,menstrual history,fertility history,contraceptive history,history of menopause,history of individual diseases,family history,childhood socioeconomic status and exposure history of major risk factors and blood pressure,height and weight of the subjects were entered by EXCEL software to summary informations,and established the database.SPSS 21.0 statistical software was used for statistical analysis.The difference between the case group and the control group was analyzed by chi-square test.Multivariate analysis was used to determine the risk factors associated with stroke in patients with logistic regression.A binary logistic regression model was used to analyze the factors of each factor.and the significant factors were included in the multivariate logistic model to analyze and adjust the influence of confounding factors The risk of various factors for female stroke was expressed as OR and 95%CI.]Three indicators are used to explore whether the interaction exists,including the attributable proportion of interaction(AP).the synergy index(S)and the relative excess risk of interaction(RERI).ResultsA total of 797 subjects were enrolled in the analysis of 800 female patients admitted to three hospitals in Jinan.Among them.399 subjects were diagnosed as stroke and were not included in the study group.398 cases into the control group.(P<0.01),BMI(P<0.01),marital status(P<0.01),and educational level(P = 0.03)were significantly different from the control group(P<0.01).1.Risk factors of stroke in female Multivariate logistic regression analysis showed that subjects with tobacco exposure increased risk of stroke 1.98(95%CI:1.28-3.08)compared with subjects without tobacco exposure.subjects with menopausal age<14 years old increased risk of stroke 7.44(95%CI:4.41-12.56)compared with subjects with menopausal age between 15-18 years old.Subjects with BMI>24 increased risk of stroke 3.48(95%CI:1.18-8.79)compared with subjects with BMI between 18.5-23.9.Subjects with the number of pregnancies>2 times increased risk of stroke 3.46(95%CI:2.06-5.28)compared with subjects with the number of pregnancies?1time.Subjects with first pregnancy age>26 years old increased risk of'stroke 3.11(95%CI:1.96-5.82)compared with subjects with first pregnancy age<25 years old.Subjects with the phenomenon of menopause increased risk of stroke 10.62(95%CI:2.40-46.99)compared with subjects without the phenomenon of menopause.Subjects with insomnia increased risk of stroke 1.82(95%CI:1.22-2.72)compared with subjects without insomnia.Subjects with diabetes increased risk of stroke 1.79(95%CI:1.17-2.73)compared with subjects without diabetes.Subjects with hypertension increased risk of stroke 3.72(95%CI:2.50-5.55)compared with subjects without hypertension.Subjects with IUD used increased risk of stroke 0.37(OR=0.37.95%CI:0.2380.581compared with subjects without IUD used.Subjects with family history of stroke increased risk of stroke 12.39(95%CI:5.76-26.65)compared with subjects without family history of stroke.Subjects with mother's education level is high school increased risk of stroke 0.07(95%CI:0.02-0.29)compared with subjects with mother never went to school.2.Critical period of tobacco exposure affect the risk of stroke in female Multivariate logistic regression analysis showed that subjects with tobacco exposure in childhood increased risk of stroke 1.66(95%CI:1.13-2.42.P<0.01)compared with subjects without tobacco exposure in childhood.Whereas adult tobacco exposure was not associated with female stroke(P = 0.13).There were a positive interaction between passive smoking in childhood and first pregnancy age>26 years old(S=7.09.AP=0.67.RERI=3.20),insomnia(S=2.15,AP=0.44.RERI=2.61).menarche age<14years old(S=4.68,AP=0.75,RERI=20.55).Conclusions1.tobacco exposure,menarche age?14 years old.the number of pregnancy?2 times,the first pregnancy age ? 26 years old.BMI ?24.the phenomenon of menopause,hypertension,diabetes,insomnia,family history of stroke will increase the incidence of stroke Risk,while IUD used,a higher degree of mother's education is protection factors to prevent female stroke.2.Childhood is a critical period in which tobacco exposure affects the onset of stroke.3.There were a positive interaction between passive smoking in childhood and first pregnancy age>26 years old,insomnia,menarche age<14years old to increased the risk of female stroke.The effect of additive interaction between passive smoking in childhood and menarche age?14years old to increased the risk of stroke was the strongest.And the interaction between childhood passive smoking and menarche age?14 years of age had strongest impact on on the incidence of female stroke.