| ObjectivesThe aim of the study is to analysis the influence factors of ischemic stroke onset based on case-control study,and mainly discuss the effect of different SES indicators on incidence of ischemic stroke,in order to provide some targeted prevention and control strategies of stroke for populations in different socioeconomic status groups,decline the incidence of stroke,and reduce heavy economic burden from ischemic stroke in China.MethodsA case-control study was carried out in Guangdong No.2 People's Hospital from September 2016 to October 2017,including 500 cases of hospitalized patients with ischemic stroke and 500 cases controls.Patients with non-ischemic stroke in control group were hospitalized in Orthopedics,general surgery,urology at the same time.All subjects were eligible to inclusion criteria and agreed to participate in research.Data were collected using designed questionnaire by trained investigators.Information on sociodemographic characteristics,socioeconomic status,life behaviors,history of disease and clinical factors were collected.EpiData Version 3.1 software was used to establish databases,and the data were independently inputted bytwo researchers for check consistency.Using SPSS version 22.0 software for data analysis,test of significance level is defined as ?=0.05,a double side with P value <0.05 was statistically significant.For quantitative data,t test was used between the two groups if normal distribution of data,and analysis of variance was compared among more groups.Rank sum test was performed if abnormal distribution of data.For counting data,chi-square test or rank sum test was used.The gender,age,and the significance variables(P<0.05)in single factor analysis were conducted by gradually forward multivariate unconditioned Logistic regression analysis with maximum likelihood.The effect of SES on ischemic stroke was analyzed by Logistic regression.Logistic regression correction model variables were used according to the gender,age,and the significant factors in single factor analysis.Setting model1 was unadjusted any factor,model 2 was sociodemographic characteristics,model 3 added life behavior,model 4 added disease history,model 5 added clinical indicator.Results1.The analysis of baseline characteristics.There was a significant difference between case group and control group on birth place and present residence(P<0.05).The difference of education level,family average per capita monthly income,occupational status was statistically significant(P<0.05).The difference on smoking,exercise,high-salt,high-fat,high-sugar was significant,similar to excessive meat,eggs,fish,fruit,whole grains and tea drinking(P<0.05).The difference between two groups on hypertension,diabetes,hyperlipidemia,coronary heart disease,atrial fibrillation,stroke history was statistically significant(P<0.05).There was a significant difference between two groups on WBC,Fib,FPG,TC,TG,HDL-C,LDL-C,SBP,DBP,BMI(P< 0.05).2.Multivariate analysis on risk of ischemic stroke onset.In sociodemographic characteristics,compared with >60 years old,people with ?60 years old had a higher risk of ischemic stroke,OR values were 2.36(95%CI 1.39~4.00).Now living in the city could increase the risk of ischemic stroke,a value of OR was 1.70(95%CI 1.03 ~ 2.80).In SES,compared with primary school education level,OR of ischemic stroke in middle school,high school/vocational/technical secondary school,college or above were 2.16(95%CI 1.29~3.61),3.28(95%CI 1.82~5.91),3.46(95%CI1.49~8.04),respectively;compared with non-manual,OR of ischemic stroke with the manual labor,unemployed,retirement were 3.06(95%CI 1.58~5.93),1.51(95%CI 0.76 ~ 3.02),2.38(95%CI 1.18 ~ 4.78),respectively.In life behavior,smoking,high-salt,high-fat,excessive eggs consumption increased the risk of ischemic stroke,OR values were 1.82(95%CI 1.11~2.98),2.87(95%CI 1.88~4.38),2.27(95%CI 1.43~3.60),and 2.54(95%CI 1.59~4.06),respectively.Exercise could reduce the risk of ischemic stroke,the OR value was 0.22(95%CI 0.14 ~ 0.33).Tea drinking also could reduce the risk of ischemic stroke,the OR value of 0.37(95%CI 0.14~0.97)for black tea,0.32(95%CI 0.16~0.67)for green tea,and 0.57(95%CI 0.36~0.89)for black and green tea.In history of disease,the OR value of hypertension,atrial fibrillation,stroke history was 2.93(95%CI 1.89~4.53),12.42(95%CI 2.91~52.97),and10.39(95%CI 5.43~19.86),respectively.In clinical factors,the OR value of TC,TG,SBP,BMI was 1.44(95%CI 1.20~1.72),1.45(95%CI 1.15~1.82),1.03(95%CI 1.02~1.04),and 1.10(95%CI 1.03~1.16),respectively.HDL-C was protective factors of ischemic stroke,and OR value was 0.26(95%CI0.14~0.50).3.Effect of SES on ischemic stroke onset.(1)The risk of ischemic stroke onset with high education was 1.41(95%CI 1.09 ~ 1.82)compared with low education.After adjusting for sociodemographic characteristics,the odds ratio of ischemic stroke with high education was 2.22(95%CI 1.59~3.09);further adjusted for life behaviors,disease history and clinical indicators,the odds ratio of ischemic stroke with high education was 2.12(95%CI 1.44~3.12),2.10(95%CI 1.38~3.20)and2.52(95%CI 1.59~3.99),respectively.In sex subgroup analysis,no matter what factors were adjusted,men with high education had a higher risk of ischemic stroke;further adjusted for life behavior,Women with high education increased the risk of ischemic stroke.In age subgroup analysis,for populations over 60 years old,an increased risk of ischemic stroke onset with higher education was observed after adjusting all factors.(2)The risk of ischemic stroke onset with high income was 2.00(95%CI1.50~2.67)compared with low income.After adjusting the sociodemographic characteristics,the odds ratio of ischemic stroke with high income was 1.72(95%CI 1.24~2.39).In sex group analysis,adjustment for sociodemographic characteristics,high income was related to the higher risk of ischemic stroke for men and women.In age group analysis,no matter what factors were adjusted,it was found that people under 60 years old with high income had an increased risk of ischemic stroke onset.(3)There was no association between occupation and ischemic stroke onset.However,after adjusted for disease history and clinical factors,manual labor had an increased risk of ischemic stroke,OR values were 1.72(95%CI1.08~2.74),1.94(95%CI 1.14~3.30),respectively.In sex group analysis,women with manual labor had a higher risk of ischemic stroke.Further adjusted for sociodemographic characteristics,life behavior,and disease history,manual labor all increase the risk of ischemic stroke in women.In age subgroup analysis,further adjusted for disease history and clinical factors,manual labor increased the risk of ischemic stroke in women and under 60 years old.Conclusion1.Compared with non-ischemic stroke,life behavior of people with ischemic stroke was poorer,percentage of disease history was higher,the abnormal clinical index was more significant.2.Age,present living place,smoking,high-salt diet,high-fat diet,excessive consumption of eggs,education level,occupational status,hypertension,atrial fibrillation,history of stroke,TC,TG,SBP,BMI were risk factors of ischemic stroke onset.Physical activity,drinking tea,HDL-C were protective factors of ischemic stroke onset.3.The high education level,high income,and manual labor increased risk of ischemic stroke onset.In addition,the difference of relationship between SES and incidence of ischemic stroke on gender and age was observed.4.Sociodemographic characteristics,life behavior,history of disease and clinical factors could be partly explained the relationship between SES and ischemic stroke onset. |
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