Risk Factors of Incident Total Stroke and Ischemic Stroke in China

Abstract

Background: Stroke places a considerable burden on human beings. Managing risk factors is crucial to prevent stroke. However, few cohort studies have evaluated socioeconomic factors together with conventional factors affecting incident stroke, particularly ­in China. Methods: A 2014-2016 cohort of the China National Stroke Screening and Intervention Program was studied, comprised 437 318 adults aged 40 years or older without stroke at baseline from 31 provinces. Cox regression yielded adjusted hazard ratios for risk factors related to the incidence of first-ever stroke and ischemic stroke. Findings: There were 2 429 cases of first-ever stroke during a median follow-up period of 2·1 years, including 2 206 ischemic strokes and 237 hemorrhagic strokes. The multivariable Cox regression analysis indicated that age 50–59 years (vs. 40-49 years), primary school or no formal education (vs. middle school), having more than one child (vs. one child), and living in Northeast, Central, East, or North China (vs. Southwest China), fruit consumption ≤4 days/week (vs.≥5 days/week), vegetable-based diet (vs. balance portion of vegetables and meat), physical inactivity, smoking (former, current, and passive), heavy drinking, hypertension, diabetes, obesity, family history (stroke, coronary heart disease, and hypertension) were positively associated with the risk of total and ischemic stroke, whereas age 60-69 years (vs. 40-49 years), living with spouse or children (vs. living alone), and vegetable consumption 3-4 days/week (vs.≥5 days/week) were negatively associated with the risk of total and ischemic stroke. The population-attributable risk of hypertension for stroke was the highest among all modifiable risk factors, followed by physical inactivity and smoking. Interpretation: We identified socioeconomic factors that complement traditional risk factors associated with incident stroke and ischemic stroke, allowing targeting these factors to reduce stroke burden. Funding Statement: The National Natural Science Foundation of China (No. 71532014). Declaration of Interests: The authors stated: None. Ethics Approval Statement: The study was performed according to the Helsinki declaration and approved by the Ethics Committee of Xuanwu Hospital Institutional Review Board of Capital Medical University, located in Beijing, China. All participants were informed about the study and signed written informed consent.