What is the clinical evidence from this study?

Study design: Cohort. Population: Stroke (n=13793). Intervention: Hypertension vs. General population without hypertension. Primary outcome: Stroke (OR 3.56, 95% CI 2.55-4.97, p=<0.001).

March 31, 2017Open Access

Population Attributable Fraction of Stroke Risk Factors in Thailand: Utilization of Non-communicable Disease Surveillance Systems

Q: What are the key findings of this study?

Hypertension increased the risk of stroke with an odds ratio of 3.56 and accounted for a population attributable fraction of 41.6% in the Thai population.

DADarin AreechokchaiMinistry of Public Health KVKamolthip VijitsoonthornkulMinistry of Public Health SPSarinya PongpanMinistry of Public Health

Key Result

Hypertension increased the risk of stroke with an odds ratio of 3.56 and accounted for a population attributable fraction of 41.6% in the Thai population.

Study Design

Type

Cohort (n=13,793)

Multicenter

Yes

Structured PICO

Population

13,793 Thai residents aged 15-79 years old from 12 provinces, comprising 3,041 stroke patients from the national health information system and 10,752 individuals from the general population behavioral risk factor surveillance system.

Outcome

Population attributable fraction (PAF) of stroke for behavioral risk factors and underlying diseases

Hypertension is the leading attributable risk factor for stroke in the general Thai population, while smoking is the primary attributable risk factor among young adults.

Main Result

Effect estimate: OR 3.56 (95% CI 2.55-4.97)

Absolute Event Rate: 57.8% vs 16.9%

p-value: p=<0.001

Limitations

BRFSS was conducted in purposively selected provinces, potentially affecting national representativeness.
Selection bias due to use of secondary NHIS data, missing stroke patients who did not visit hospitals.
Selection bias in BRFSS as it only recruited living individuals, potentially underestimating risk factor prevalence.
Lack of data on other risk factors like dyslipidemia, obesity, and physical inactivity in the NHIS database.

Abstract

In Thailand, stroke is the third leading cause of death. The objective of this study was to measure the impacts of behavioral risk and underlying disease factors on stroke. The study design was a case-cohort study comparing prevalence of demographic characteristics and risk factors between stroke patients and general population. We obtained data of stroke patients and risk factors in general population of 12 provinces from two non-communicable disease surveillance systems to calculate population-attributable fraction: the national health information system for morbidity and mortality surveillance, and the behavioral risk factor surveillance system. Multiple logistic regression, based on weighted data and adjusted for clustering effect in each province, was carried out. It was found that approximately 41.6% (95% CI = 35.1-46.2) of stroke in Thai population was related to hypertension. From an age group-specific model, among those aged 15-34 years, smoking carried the highest population attributable fraction of stroke, 32.7% (95% CI = 3.9-40.4). This study demonstrates that impact measurement of stroke risk factors could help devise stroke prevention and control strategies to tackle influential factors. In Thailand, hypertension control program should be a priority in middle and old age groups whereas smoking prevention should be emphasized in young people.

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