학술논문
Population Attributable Fraction of Total Stroke Associated with Modifiable Risk Factors in the United States.
Document Type
Academic Journal
Author
Lee M; Minnesota Population Center, University of Minnesota, Minneapolis, MN.; Lakshminarayan K; Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN.; Sedaghat S; Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN.; Sabayan B; Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN.; Department of Neurology, HealthPartners Neuroscience Center, St. Paul, Minnesota.; Chen LY; Lillehei Heart Institute and Cardiovascular Division, University of Minnesota Medical School, Minneapolis, MN.; Johansen MC; Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, MD.; Gottesman RF; Stroke Branch, National Institute of Neurological Disorders and Stroke Intramural Research Program, NIH, Bethesda, MD.; Heckbert SR; Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA.; Misialek JR; Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN.; Szklo M; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.; Lutsey PL; Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN.
Source
Publisher: Oxford University Press Country of Publication: United States NLM ID: 7910653 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1476-6256 (Electronic) Linking ISSN: 00029262 NLM ISO Abbreviation: Am J Epidemiol Subsets: MEDLINE
Subject
Language
English
Abstract
Stroke is a leading cause of death in the United States across all race/ethnicity and sex groups, though disparities exist. We investigated the potential for primary prevention of total first stroke for Americans aged 20 and older, stratified by sex and race/ethnicity. Specifically, we calculated population attributable fractions (PAF) of first stroke for 7 potentially modifiable risk factors: smoking, physical inactivity, poor diet, obesity, hypertension, diabetes, and atrial fibrillation. PAFs are a function of (1) the relative risk of first stroke for people with the exposure and (2) the prevalence of the risk factor in the population. Relative risks came from recent meta-analyses and sex-race/ethnicity-specific prevalence estimates came from the 2015-2018 NHANES or Multi-Ethnic Study of Atherosclerosis (for atrial fibrillation only). Approximately 1/3 (35.7% [CI: 21.6%-49.0%]) for women, 32.7% [CI: 19.2%-45.1%] for men) of strokes were attributable to the 7 risk factors we considered. A 20% proportional reduction in stroke risk factors would result in approximately 37,000 fewer strokes annually in the United States. The estimated PAF was highest for non-Hispanic Black women (39.3% [CI: 24.8%-52.3%]) and lowest for non-Hispanic Asian men (25.5% [CI: 14.6%-36.2%]). For most groups, obesity and hypertension were the largest contributors to stroke rates.
(© The Author(s) 2024. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
(© The Author(s) 2024. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)