Robert Murphy, Albertino Damasceno, Catriona Reddin, Graeme J Hankey, Helle K Iversen, Shahram Oveisgharan, Fernando Lanas, Anna Czlonkowska, Peter Langhorne, Adesola Ogunniyi, Mohammad Wasay, Zvonko Rumboldt, Conor Judge, Aytekin Oguz, Charles Mondo, Yaroslav Winter, Annika Rosengren, Nana Pogosova, Alvaro Avezum, Yongchai Nilanont, Ernesto Penaherrera, Denis Xavier, Patricio Lopez-Jaramillo, Xingyu Wang, Salim Yusuf, Martin O'Donnell
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We included 10,363 ischemic stroke cases and 10,333 community or hospital controls who were matched for age, sex, and center. Participants were grouped into high-income (HIC), upper-middle-income (subdivided into two groups-UMIC-1 and UMIC-2), and lower-middle-income (LMIC) countries, based on gross national income. We evaluated the risk factors for AF overall and by country income level, and evaluated the association of AF with ischemic stroke.</p><p><strong>Results: </strong>AF was documented in 11.9% (n = 1235) of cases and 3.2% (n = 328) of controls. Compared to HIC, the prevalence of AF was significantly lower in UMIC-2 (aOR 0.35, 95% CI 0.29-0.41) and LMIC (aOR 0.50, 95% CI 0.41-0.60) on multivariable analysis. Hypertension, female sex, valvular heart disease, and alcohol intake were stronger risk factors for AF in lower-income countries, and obesity a stronger risk factor in higher-income countries. The magnitude of association between AF and ischemic stroke was significantly higher in lower-income countries compared to higher-income countries. The population attributable fraction for AF and stroke varied by region and was 15.7% (95% CI 13.7-17.8) in HIC, 14.6% (95% CI 12.3-17.1) in UMIC-1, 5.7% (95% CI 4.9-6.7) in UMIC-2, and 6.3% (95% CI 5.3-7.3) in LMIC.</p><p><strong>Conclusion: </strong>Risk factors for AF vary by country income level. AF contributes to stroke burden to a greater extent in higher-income countries than in lower-income countries, due to a higher prevalence and despite a lower magnitude of odds ratio.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"559-568"},"PeriodicalIF":6.3000,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Variations in the prevalence of atrial fibrillation, and in the strength of its association with ischemic stroke, in countries with different income levels: INTERSTROKE case-control study.\",\"authors\":\"Robert Murphy, Albertino Damasceno, Catriona Reddin, Graeme J Hankey, Helle K Iversen, Shahram Oveisgharan, Fernando Lanas, Anna Czlonkowska, Peter Langhorne, Adesola Ogunniyi, Mohammad Wasay, Zvonko Rumboldt, Conor Judge, Aytekin Oguz, Charles Mondo, Yaroslav Winter, Annika Rosengren, Nana Pogosova, Alvaro Avezum, Yongchai Nilanont, Ernesto Penaherrera, Denis Xavier, Patricio Lopez-Jaramillo, Xingyu Wang, Salim Yusuf, Martin O'Donnell\",\"doi\":\"10.1177/17474930241227783\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The contribution of atrial fibrillation (AF) to the etiology and burden of stroke may vary by country income level.</p><p><strong>Aims: </strong>We examined differences in the prevalence of AF and described variations in the magnitude of the association between AF and ischemic stroke by country income level.</p><p><strong>Methods: </strong>In the INTERSTROKE case-control study, participants with acute first ischemic stroke were recruited across 32 countries. We included 10,363 ischemic stroke cases and 10,333 community or hospital controls who were matched for age, sex, and center. Participants were grouped into high-income (HIC), upper-middle-income (subdivided into two groups-UMIC-1 and UMIC-2), and lower-middle-income (LMIC) countries, based on gross national income. We evaluated the risk factors for AF overall and by country income level, and evaluated the association of AF with ischemic stroke.</p><p><strong>Results: </strong>AF was documented in 11.9% (n = 1235) of cases and 3.2% (n = 328) of controls. Compared to HIC, the prevalence of AF was significantly lower in UMIC-2 (aOR 0.35, 95% CI 0.29-0.41) and LMIC (aOR 0.50, 95% CI 0.41-0.60) on multivariable analysis. Hypertension, female sex, valvular heart disease, and alcohol intake were stronger risk factors for AF in lower-income countries, and obesity a stronger risk factor in higher-income countries. 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引用次数: 0
摘要
背景：目的：我们研究了心房颤动患病率的差异，并描述了不同国家收入水平的心房颤动与缺血性中风之间关联程度的差异：在 INTERSTROKE 病例对照研究中，我们在 32 个国家招募了急性首次缺血性中风患者。我们纳入了 10,363 例缺血性中风病例和 10,333 例社区或医院对照，这些病例在年龄、性别和中心方面均匹配。根据国民总收入，我们将参与者分为高收入国家（HIC）、中上收入国家（细分为 UMIC1 和 UMIC2 两组）和中低收入国家（LMIC）。我们评估了心房颤动的总体风险因素和不同国家收入水平的风险因素，并评估了心房颤动与缺血性中风的关联：11.9%的病例（n = 1235）和 3.2%的对照组（n = 328）有房颤记录。在多变量分析中，与高收入国家相比，房颤患病率在 UMIC-2 （aOR 0.35，95% CI 0.29 - 0.41）和低收入国家（aOR 0.50，95% CI 0.41 - 0.60）明显较低。在低收入国家，高血压、女性、瓣膜性心脏病和酒精摄入量是心房颤动的更高风险因素，而在高收入国家，肥胖则是更高风险因素。与高收入国家相比，低收入国家心房颤动与缺血性中风之间的关联程度明显更高。心房颤动和中风的人群可归因比例因地区而异，高收入国家为 15.7% (95% CI 13.7% - 17.8%)，UMIC-1 国家为 14.6% (95% CI 12.3 - 17.1)，UMIC-2 国家为 5.7% (95% CI 4.9% - 6.7%) ，低收入国家为 6.3% (95% CI 5.3% - 7.3%)：房颤的风险因素因国家收入水平而异。结论：心房颤动的风险因素因国家收入水平而异，高收入国家的心房颤动对中风负担的影响程度高于低收入国家，这是因为高收入国家的心房颤动发病率更高，尽管几率比较低。
Variations in the prevalence of atrial fibrillation, and in the strength of its association with ischemic stroke, in countries with different income levels: INTERSTROKE case-control study.
Background: The contribution of atrial fibrillation (AF) to the etiology and burden of stroke may vary by country income level.
Aims: We examined differences in the prevalence of AF and described variations in the magnitude of the association between AF and ischemic stroke by country income level.
Methods: In the INTERSTROKE case-control study, participants with acute first ischemic stroke were recruited across 32 countries. We included 10,363 ischemic stroke cases and 10,333 community or hospital controls who were matched for age, sex, and center. Participants were grouped into high-income (HIC), upper-middle-income (subdivided into two groups-UMIC-1 and UMIC-2), and lower-middle-income (LMIC) countries, based on gross national income. We evaluated the risk factors for AF overall and by country income level, and evaluated the association of AF with ischemic stroke.
Results: AF was documented in 11.9% (n = 1235) of cases and 3.2% (n = 328) of controls. Compared to HIC, the prevalence of AF was significantly lower in UMIC-2 (aOR 0.35, 95% CI 0.29-0.41) and LMIC (aOR 0.50, 95% CI 0.41-0.60) on multivariable analysis. Hypertension, female sex, valvular heart disease, and alcohol intake were stronger risk factors for AF in lower-income countries, and obesity a stronger risk factor in higher-income countries. The magnitude of association between AF and ischemic stroke was significantly higher in lower-income countries compared to higher-income countries. The population attributable fraction for AF and stroke varied by region and was 15.7% (95% CI 13.7-17.8) in HIC, 14.6% (95% CI 12.3-17.1) in UMIC-1, 5.7% (95% CI 4.9-6.7) in UMIC-2, and 6.3% (95% CI 5.3-7.3) in LMIC.
Conclusion: Risk factors for AF vary by country income level. AF contributes to stroke burden to a greater extent in higher-income countries than in lower-income countries, due to a higher prevalence and despite a lower magnitude of odds ratio.
期刊介绍：
The International Journal of Stroke is a welcome addition to the international stroke journal landscape in that it concentrates on the clinical aspects of stroke with basic science contributions in areas of clinical interest. Reviews of current topics are broadly based to encompass not only recent advances of global interest but also those which may be more important in certain regions and the journal regularly features items of news interest from all parts of the world. To facilitate the international nature of the journal, our Associate Editors from Europe, Asia, North America and South America coordinate segments of the journal.
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