Prevalence Of Tobacco Exposure And Smoking Related Stroke Among Bai Ethnic Minority In Yunnan Province And Its Economic Impact On Household

Objectives:The aim of this study was to understand the current situation of tobacco exposure,including smoking and exposure to secondhand smoke(SHS)and stroke among Bai ethnic minority in Yunnan province,further to analyze the relationship between stroke and smoking/secondhand smoke(SHS)exposure among Bai ethnic minority in Yunnan province,and calculate the population attributable risk to estimate the harm of stroke attributable to smoking/SHS.Further to analyze the economic impact of stroke on household among Bai ethnic minority in Yunnan Province.So as to provide scientific basis for reduce the harm of tobacco exposure,prevention and control of stroke and reduce the financial burden of stroke-family.Methods:This study is a cross-sectional field survey.Multistage stratified random sampling method was used to select a representative sample of 2700 Bai ethnic minority aged 35 years and over from Jian Chuan county of Da Li prefecture from April to May 2018.Each participant received face to face questionnaire interview and physical examinations.The questionnaire survey included relevant sociodemographic characteristics,family economic status,the current situation of smoking and SHS,the prevalence of stroke,family history,medical expenses due to stroke,and so on.Physical examination includes measuring the subject’s height,weight,waist circumference,hip circumference.The direct cost of stroke was measured by direct method,whereas the indirect cost of stroke was measured by the human capital method.The incidence of catastrophic health expenditure and poverty due to illness were used to assess the economic impact of stroke on household.Results:A total of 2,700 questionnaires were sent out in this survey,and 2,501 valid questionnaires were returned.The effective response rate was 92.61%.Among 2,501 Bai ethic minority residents≥35 years old in yunnan province,the smok ing rate is 30.5%.Among current smokers,Filtered cigarette smoking was the most popular form of smoking tobacco,comprising 84.5%of all forms of tobacco consumed.Tobacco users initiated smoking and regularly smoked occurred mostly at age 18 years and over(65.6%and 78.1%).52.0%of smokers smoke in public places,68.4%have never tried to quit,and 88.1%smoked≥10 cigarettes per day.And the SHS rate was 21.1%.The prevalence of stroke was 6.2%.Multivariate unconditional logistic regression analysis showed that,family history of stroke,older age,smokers and passive smokers had higher risk of stroke.The risk of stroke in Bai residents with family history of stroke was 2.071 times that of Bai residents without family history of stroke(OR=2.071,95%CI=1.083～5.081).The older the Bai residents,the higher the risk of stroke(OR=1.063,95%CI=1.046～1.081),current smokers and persons who exposed to SHS had 3.596 times(OR=3.596,95%CI=2.468～5.238)and 3.361 times(OR=3.361,95%CI=2.266～4.938)higher risk of suffering from stroke than their counterparts.After the elimination of smoking and exposed to SHS,the prevalence of stroke could be reduced by 44.19%and 33.25%,respectively.The sex comparison found that the proportion of stroke attributed to smoking was significantly higher in men than in women,while the proportion of stroke attributed to exposed to SHS was higher in women than in men.The per capita direct and indirect cost of stroke was 8,720.33 Yuan and 152.28 Yuan,of which the direct cost of man is higher than that of women(t=2.288,P=0.027).The results of multivariate unconditional logistic regression analysis show that the poor population have 1.676 times(OR=1.676,95%CI=1.079～2.602)and 3.278 times(OR=3.278,95%CI=2.3 11～4.648)the risk of catastrophic health expenditure and poverty due to illness compared with their counterparts.The risk of catastrophic health expenditure and poverty due to illness that people suffered from stroke among Bai residents was 4.511 times(OR=4.511,95%CI=3.005～6.770)and 1.851 times(OR=1.851,95%CI=1.131～3.029)for non-stroke;The average yearly income>5700 yuan for Bai residents is 0.430 times(OR=0.430,95%CI=0.314～0.588)and 0.035 times(OR=0.035,95%CI=0.020～0.062).for the risk of catastrophic health expenditures and poverty due to illness of who average yearly income ≤5700yuan.Before compensation for the new rural cooperative medical care system,the incidence of catastrophic health expenditure and poverty due to illness in 155 families with stroke patients was 25.16%and 18.71%,and was 21.94%and 9.67%after compensation,presenting a declining rate of 12.80%and 48.32%,respectively.Conclusions:Bai ethic minority residents in yunnan province have a high smoking rate and a low SHS rate.Both smoking and SHS can increase the risk of stroke.It is necessary to strengthen the health education about the harm of tobacco for Bai ethnic minority in Yunnan province,Taking effective measures to change smoking behaviors and reduce the harm of the exposure to SHS of local residents so as to further reduce prevalence of stroke.Stroke has significant economic impact on household among Bai ethnic minority in Yunnan province.It should enhance medical and economic support for poor and low-income households.