Stroke risk factors in an incident population in urban and rural Tanzania: a prospective, community-based, case-control study
Identifieur interne : 002292 ( Main/Exploration ); précédent : 002291; suivant : 002293Stroke risk factors in an incident population in urban and rural Tanzania: a prospective, community-based, case-control study
Auteurs : Richard W. Walker [Royaume-Uni] ; Ahmed Jusabani [Tanzanie] ; Eric Aris [Tanzanie] ; William K. Gray [Royaume-Uni] ; Nigel Unwin [Barbade] ; Mark Swai [Tanzanie] ; George Alberti [Royaume-Uni] ; Ferdinand Mugusi [Tanzanie]Source :
- The Lancet Global Health [ 2214-109X ] ; 2013.
Abstract
The burden of stroke on health systems in low-income and middle-income countries is increasing. However, high-quality data for modifiable stroke risk factors in sub-Saharan Africa are scarce, with no community-based, case-control studies previously published. We aimed to identify risk factors for stroke in an incident population from rural and urban Tanzania.
Stroke cases from urban Dar-es-Salaam and the rural Hai district were recruited in a wider study of stroke incidence between June 15, 2003, and June 15, 2006. We included cases with first-ever and recurrent stroke. Community-acquired controls recruited from the background census populations of the two study regions were matched with cases for age and sex and were interviewed and assessed. Data relating to medical and social history were recorded and blood samples taken.
We included 200 stroke cases (69 from Dar-es-Salaam and 131 from Hai) and 398 controls (138 from Dar-es-Salaam and 260 from Hai). Risk factors were similar at both sites, with previous cardiac event (odds ratio [OR] 7·39, 95% CI 2·42–22·53; p<0·0001), HIV infection (5·61, 2·41–13·09; p<0·0001), a high ratio of total cholesterol to HDL cholesterol (4·54, 2·49–8·28; p<0·0001), smoking (2·72, 1·49–4·96; p=0·001), and hypertension (2·14, 1·09–4·17; p=0·026) identified as significant independent risk factors for stroke. In Hai, additional risk factors of diabetes (4·04, 1·29–12·64) and low HDL cholesterol (9·84, 4·06–23·84) were also significant.
We have identified many of the risk factors for stroke already reported for other world regions. HIV status was an independent risk factor for stroke within an antiretroviral-naive population. Clinicians should be aware of the increased risk of stroke in people with HIV, even in the absence of antiretroviral treatment.
The Wellcome Trust.
Url:
DOI: 10.1016/S2214-109X(13)70068-8
PubMed: 24748275
PubMed Central: 3986030
Affiliations:
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Walker</name><affiliation wicri:level="1"><nlm:aff id="aff1">North Tyneside General Hospital, North Shields, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>North Tyneside General Hospital, North Shields</wicri:regionArea><wicri:noRegion>North Shields</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2">Institute of Health and Society, Newcastle University, Newcastle-upon-Tyne, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Institute of Health and Society, Newcastle University, Newcastle-upon-Tyne</wicri:regionArea><wicri:noRegion>Newcastle-upon-Tyne</wicri:noRegion></affiliation></author><author><name sortKey="Jusabani, Ahmed" sort="Jusabani, Ahmed" uniqKey="Jusabani A" first="Ahmed" last="Jusabani">Ahmed Jusabani</name><affiliation wicri:level="1"><nlm:aff id="aff3">Kilimanjaro Christian Medical Centre, Moshi, Tanzania</nlm:aff><country xml:lang="fr">Tanzanie</country><wicri:regionArea>Kilimanjaro Christian Medical Centre, Moshi</wicri:regionArea><wicri:noRegion>Moshi</wicri:noRegion></affiliation></author><author><name sortKey="Aris, Eric" sort="Aris, Eric" uniqKey="Aris E" first="Eric" last="Aris">Eric Aris</name><affiliation wicri:level="1"><nlm:aff id="aff4">Department of Neurology, Muhimbili University Hospital, Dar-es-Salaam, Tanzania</nlm:aff><country xml:lang="fr">Tanzanie</country><wicri:regionArea>Department of Neurology, Muhimbili University Hospital, Dar-es-Salaam</wicri:regionArea><wicri:noRegion>Dar-es-Salaam</wicri:noRegion></affiliation></author><author><name sortKey="Gray, William K" sort="Gray, William K" uniqKey="Gray W" first="William K" last="Gray">William K. 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Walker</name><affiliation wicri:level="1"><nlm:aff id="aff1">North Tyneside General Hospital, North Shields, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>North Tyneside General Hospital, North Shields</wicri:regionArea><wicri:noRegion>North Shields</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2">Institute of Health and Society, Newcastle University, Newcastle-upon-Tyne, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Institute of Health and Society, Newcastle University, Newcastle-upon-Tyne</wicri:regionArea><wicri:noRegion>Newcastle-upon-Tyne</wicri:noRegion></affiliation></author><author><name sortKey="Jusabani, Ahmed" sort="Jusabani, Ahmed" uniqKey="Jusabani A" first="Ahmed" last="Jusabani">Ahmed Jusabani</name><affiliation wicri:level="1"><nlm:aff id="aff3">Kilimanjaro Christian Medical Centre, Moshi, Tanzania</nlm:aff><country xml:lang="fr">Tanzanie</country><wicri:regionArea>Kilimanjaro Christian Medical Centre, Moshi</wicri:regionArea><wicri:noRegion>Moshi</wicri:noRegion></affiliation></author><author><name sortKey="Aris, Eric" sort="Aris, Eric" uniqKey="Aris E" first="Eric" last="Aris">Eric Aris</name><affiliation wicri:level="1"><nlm:aff id="aff4">Department of Neurology, Muhimbili University Hospital, Dar-es-Salaam, Tanzania</nlm:aff><country xml:lang="fr">Tanzanie</country><wicri:regionArea>Department of Neurology, Muhimbili University Hospital, Dar-es-Salaam</wicri:regionArea><wicri:noRegion>Dar-es-Salaam</wicri:noRegion></affiliation></author><author><name sortKey="Gray, William K" sort="Gray, William K" uniqKey="Gray W" first="William K" last="Gray">William K. Gray</name><affiliation wicri:level="1"><nlm:aff id="aff1">North Tyneside General Hospital, North Shields, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>North Tyneside General Hospital, North Shields</wicri:regionArea><wicri:noRegion>North Shields</wicri:noRegion></affiliation></author><author><name sortKey="Unwin, Nigel" sort="Unwin, Nigel" uniqKey="Unwin N" first="Nigel" last="Unwin">Nigel Unwin</name><affiliation wicri:level="1"><nlm:aff id="aff5">Faculty of Medical Sciences, Cave Hill Campus, University of the West Indies, Barbados</nlm:aff><country xml:lang="fr">Barbade</country><wicri:regionArea>Faculty of Medical Sciences, Cave Hill Campus, University of the West Indies</wicri:regionArea><wicri:noRegion>University of the West Indies</wicri:noRegion></affiliation></author><author><name sortKey="Swai, Mark" sort="Swai, Mark" uniqKey="Swai M" first="Mark" last="Swai">Mark Swai</name><affiliation wicri:level="1"><nlm:aff id="aff3">Kilimanjaro Christian Medical Centre, Moshi, Tanzania</nlm:aff><country xml:lang="fr">Tanzanie</country><wicri:regionArea>Kilimanjaro Christian Medical Centre, Moshi</wicri:regionArea><wicri:noRegion>Moshi</wicri:noRegion></affiliation></author><author><name sortKey="Alberti, George" sort="Alberti, George" uniqKey="Alberti G" first="George" last="Alberti">George Alberti</name><affiliation wicri:level="3"><nlm:aff id="aff6">Department of Endocrinology and Metabolism, St Mary's Campus, Imperial College, London, UK</nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>Department of Endocrinology and Metabolism, St Mary's Campus, Imperial College, London</wicri:regionArea><placeName><settlement type="city">Londres</settlement><region type="country">Angleterre</region><region type="région" nuts="1">Grand Londres</region></placeName></affiliation></author><author><name sortKey="Mugusi, Ferdinand" sort="Mugusi, Ferdinand" uniqKey="Mugusi F" first="Ferdinand" last="Mugusi">Ferdinand Mugusi</name><affiliation wicri:level="1"><nlm:aff id="aff7">Department of Medicine, Muhimbili University College Hospital, Dar-es-Salaam, Tanzania</nlm:aff><country xml:lang="fr">Tanzanie</country><wicri:regionArea>Department of Medicine, Muhimbili University College Hospital, Dar-es-Salaam</wicri:regionArea><wicri:noRegion>Dar-es-Salaam</wicri:noRegion></affiliation></author></analytic><series><title level="j">The Lancet Global Health</title><idno type="eISSN">2214-109X</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>Summary</title><sec><title>Background</title><p>The burden of stroke on health systems in low-income and middle-income countries is increasing. However, high-quality data for modifiable stroke risk factors in sub-Saharan Africa are scarce, with no community-based, case-control studies previously published. We aimed to identify risk factors for stroke in an incident population from rural and urban Tanzania.</p></sec><sec><title>Methods</title><p>Stroke cases from urban Dar-es-Salaam and the rural Hai district were recruited in a wider study of stroke incidence between June 15, 2003, and June 15, 2006. We included cases with first-ever and recurrent stroke. Community-acquired controls recruited from the background census populations of the two study regions were matched with cases for age and sex and were interviewed and assessed. Data relating to medical and social history were recorded and blood samples taken.</p></sec><sec><title>Findings</title><p>We included 200 stroke cases (69 from Dar-es-Salaam and 131 from Hai) and 398 controls (138 from Dar-es-Salaam and 260 from Hai). Risk factors were similar at both sites, with previous cardiac event (odds ratio [OR] 7·39, 95% CI 2·42–22·53; p<0·0001), HIV infection (5·61, 2·41–13·09; p<0·0001), a high ratio of total cholesterol to HDL cholesterol (4·54, 2·49–8·28; p<0·0001), smoking (2·72, 1·49–4·96; p=0·001), and hypertension (2·14, 1·09–4·17; p=0·026) identified as significant independent risk factors for stroke. In Hai, additional risk factors of diabetes (4·04, 1·29–12·64) and low HDL cholesterol (9·84, 4·06–23·84) were also significant.</p></sec><sec><title>Interpretation</title><p>We have identified many of the risk factors for stroke already reported for other world regions. HIV status was an independent risk factor for stroke within an antiretroviral-naive population. Clinicians should be aware of the increased risk of stroke in people with HIV, even in the absence of antiretroviral treatment.</p></sec><sec><title>Funding</title><p>The Wellcome Trust.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Connor, Md" uniqKey="Connor M">MD Connor</name></author><author><name sortKey="Thorogood, M" uniqKey="Thorogood M">M Thorogood</name></author><author><name sortKey="Modi, G" uniqKey="Modi G">G Modi</name></author><author><name sortKey="Warlow, Cp" uniqKey="Warlow C">CP Warlow</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Murray, Cj" uniqKey="Murray C">CJ Murray</name></author><author><name sortKey="Vos, T" uniqKey="Vos T">T Vos</name></author><author><name sortKey="Lozano, R" uniqKey="Lozano R">R Lozano</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="O Donnell, Mj" uniqKey="O Donnell M">MJ 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uniqKey="Bill P">PLA Bill</name></author><author><name sortKey="Bhigjee, Ai" uniqKey="Bhigjee A">AI Bhigjee</name></author><author><name sortKey="Connolly, C" uniqKey="Connolly C">C Connolly</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hoffmann, M" uniqKey="Hoffmann M">M Hoffmann</name></author><author><name sortKey="Berger, Jr" uniqKey="Berger J">JR Berger</name></author><author><name sortKey="Nath, A" uniqKey="Nath A">A Nath</name></author><author><name sortKey="Rayens, M" uniqKey="Rayens M">M Rayens</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kargman, De" uniqKey="Kargman D">DE Kargman</name></author><author><name sortKey="Tuck, C" uniqKey="Tuck C">C Tuck</name></author><author><name sortKey="Berglund, L" uniqKey="Berglund L">L Berglund</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Barbade</li><li>Royaume-Uni</li><li>Tanzanie</li></country><region><li>Angleterre</li><li>Grand Londres</li></region><settlement><li>Londres</li></settlement></list><tree><country name="Royaume-Uni"><noRegion><name sortKey="Walker, Richard W" sort="Walker, Richard W" uniqKey="Walker R" first="Richard W" last="Walker">Richard W. Walker</name></noRegion><name sortKey="Alberti, George" sort="Alberti, George" uniqKey="Alberti G" first="George" last="Alberti">George Alberti</name><name sortKey="Gray, William K" sort="Gray, William K" uniqKey="Gray W" first="William K" last="Gray">William K. Gray</name><name sortKey="Walker, Richard W" sort="Walker, Richard W" uniqKey="Walker R" first="Richard W" last="Walker">Richard W. Walker</name></country><country name="Tanzanie"><noRegion><name sortKey="Jusabani, Ahmed" sort="Jusabani, Ahmed" uniqKey="Jusabani A" first="Ahmed" last="Jusabani">Ahmed Jusabani</name></noRegion><name sortKey="Aris, Eric" sort="Aris, Eric" uniqKey="Aris E" first="Eric" last="Aris">Eric Aris</name><name sortKey="Mugusi, Ferdinand" sort="Mugusi, Ferdinand" uniqKey="Mugusi F" first="Ferdinand" last="Mugusi">Ferdinand Mugusi</name><name sortKey="Swai, Mark" sort="Swai, Mark" uniqKey="Swai M" first="Mark" last="Swai">Mark Swai</name></country><country name="Barbade"><noRegion><name sortKey="Unwin, Nigel" sort="Unwin, Nigel" uniqKey="Unwin N" first="Nigel" last="Unwin">Nigel Unwin</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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