金坛市乡镇人群脑卒中危险因素比例风险模型

A population-based prospective cohort study on risk factors of stroke in Jintan

目的 通过对金坛市两乡镇队列人群的监测和生存分析 ,寻找农村人群脑卒中发病和死亡的危险因素 ,为社区干预提供依据。方法 以 1984、1992年金坛市心血管病监测点社头、河头两乡镇的基线调查人群为队列 ,经过多年随访 ,采用Cox回归生存分析方法进行分析。结果 队列随访结果表明 ,脑卒中的发病率为 180 2 0 10万人年 ,其中男性发病率为 2 36 2 2 10万人年 ,女性发病率为133 99 10万人年 ;脑卒中的死亡率为 10 6 79 10万人年。全死因死亡率为 76 7 5 3 10万人年 ,其中男性为 10 18 6 8 10万人年 ,女性为 5 6 0 32 10万人年。结论 总的多因素Cox回归模型中 ,脑卒中发病与脑卒中史、母亲高血压史、收缩压、年龄有关 ;分性别Cox回归模型中 ,男性脑卒中发病与收缩压、年龄、家族史 (母亲患高血压 )、体重指数、吸烟史有关 ;女性脑卒中发病与收缩压、年龄、脑卒中史、高血压史、高密度脂蛋白胆固醇有关。

Objective Stroke is the holding cause of cardiovascular diseases (CVD) For identifying risk factors of disease and death, we performed a baseline survey to examine the random samples of men and women in two towns in Jintan city of Jiangsu Province in the MONICA study in 1984 and 1992 Method The subjects completed a questionnaire, underwent anthropometric and blood pressure measurements, and provided blood samples Then a follow up examination was performed in July 1997 An average follow up period of 9 28 years was available in 3 228 subjects (including 54 patients of stroke and 230 deaths of total causes) Univariate and multivariate estimates of hazard ratios were calculated according to the Cox proportional hazards analysis Results The mortality of stroke was 180 20 / 100 000 person year, and it showed a significant difference between males and females (RR= 1 76, P <0 04) Univariate Cox regression analysis (failure in stroke) showed that age (RR=1 14, P < 0.000 1 ), sex (RR=1 88, P < 0.000 1 ), baseline systolic blood pressure (SBP) (RR=1 04, P < 0.000 1 ), baseline diastolic blood pressure (DBP) (RR=1 08, P < 0.000 1 ), history of high blood pressure (RR=8 32, P < 0.000 1 ), family history of hypertension (RR=1 52, P < 0.000 1 ), history of stroke (RR=18 02, P < 0.000 1 ), history of smoking (RR=2 36, P <0 002) and drinking (RR=2 07, P < 0 01) were independently associated with deaths from stroke Hypertension was 1 27 fold (adjusted for age, P <0 003) the rate of deaths from stroke of normotension When entered the risk factors separately in the multivariate Cox regression model, it was found that SBP (RR=1 85, P < 0.000 1 ), age (RR=1 62, P < 0.000 1 ), family history of hypertension (RR=1 47, P <0 0002) and history of stroke (RR=14 09, P < 0 000 4) had significant effects on stroke risk A multivariate Cox regression model demonstrated that, however, only SBP, age, history of smoking had significant effects on the total death risks SBP (RR=1 23, P < 0.000 1 ), age (RR=1 55, P < 0.000 1 ), history of smoking was 1 56 fold (adjusted for age, P < 0.000 1 ) the rate of the total deaths of non smokers Conclusion Stroke is related to history of stroke, mother′s storke history, SBP and age