Risk Factors for Incident Stroke and Its Subtypes in China: A Prospective Study

Abstract

Background Managing risk factors is crucial to prevent stroke. However, few cohort studies have evaluated socioeconomic factors together with conventional factors affecting incident stroke and its subtypes in China. Methods and Results A 2014 to 2016 prospective study from the China National Stroke Screening and Intervention Program comprised 437 318 adults aged ≥40 years without stroke at baseline. There were 2429 cases of first-ever stroke during a median follow-up period of 2.1 years, including 2206 ischemic strokes and 237 hemorrhagic strokes. The multivariable Cox regression analysis indicated that age 50 to 59 years (versus 40-49 years), primary school or no formal education (versus middle school), having >1 child (versus 1 child), living in Northeast, Central, East, or North China (versus Southwest China), physical inactivity, hypertension, diabetes mellitus, and obesity were positively associated with the risk of total and ischemic stroke, whereas age 60 to 69 years and living with spouse or children (versus living alone) were negatively associated with the risk of total and ischemic stroke. Men, vegetable-based diet, underweight, physical inactivity, hypertension, living in a high-income region, having Urban Resident Basic Medical Insurance, and New Rural Cooperative Medical System were positively associated with the risk of hemorrhagic stroke, whereas age 60 to 69 years was negatively associated with the risk of hemorrhagic stroke. Conclusions We identified socioeconomic factors that complement traditional risk factors for incident stroke and its subtypes, allowing targeting these factors to reduce stroke burden.

Keywords: primary prevention; prospective study; risk factors; socioeconomic status; stroke.

Figure 1. Multivariable‐adjusted hazard ratioss (95% CIs) for incident first‐ever total stroke by risk factors.

BMI indicates body mass index; and HR, hazard ratio.

Figure 2. Multivariable‐adjusted hazard ratios (95% CIs) for incident first‐ever ischemic stroke by risk factors.

BMI indicates body mass index; and HR, hazard ratio.

Figure 3. Multivariable‐adjusted hazard ratios (95% CIs) for incident first‐ever hemorrhagic stroke by risk factors.

BMI indicates body mass index; HR, hazard ratio; NRCMS, New Rural Cooperative Medical Scheme; UEBMI, Urban Employee Basic Medical Insurance; and URBMI, Urban Resident Basic Medical Insurance.