Large Population Screening Identified the Main Risk Factors of Stroke in Shashi District of Jingzhou City

Objective: This paper aims to screen and analyze the current status of high-risk stroke patients in Shashi District of Jingzhou City and the exposure levels of related risk factors, and provides suggestions as the references for prevention and treatment of stroke. Methods: Using cluster sampling, on-site investigations were conducted on 1060 permanent residents aged 40 years and over at 3 townships and 2 communities in Shashi District of Jingzhou City from January 2018 to December 2018. Risk assessment of stroke is based on the stroke risk screening form. Statistical analysis was performed by using SPSS 22.0 software. Results: After making a stroke risk assessment, a total of 313 high-risk stroke patients were screened, and the detection rate was 29.53%. The exposure rate of risk factors from high to low was hypertension (70.93%), dyslipidemia (46.33%), less physical exercise (46.01%), diabetes (36.10%), overweight (33.55%), smoking (33.23%), family history of stroke (24.92%), atrial fibrillation or valvular heart disease (7.35%). There are statistically significant differences among all risk factors between the high-risk group and middle and low-risk groups (P < 0.05). There is a statistically significant difference in smoking between men and women (P < 0.05). Conclusion: The detection rate of high-risk stroke patients in Shashi District of Jingzhou City is high. Hypertension, dyslipidemia and less physical exercise are the main risk factors of stroke occurrence and recurrence in the region. The prevention and treatment of risk factors for stroke should be streng-thened to control the incidence and recurrence rate of stroke.


Introduction
Stroke is a neurological disease of cerebral blood circulation disorder caused by a combination of various factors, with high morbidity, high disability and high recurrence rate and is one of the major causes of disability and death worldwide [1]. Especially in recent years, the incidence of stroke in China has increased by 8.7% per year, and the mortality rate is 4 to 5 times that of developed countries in Europe and America [2]. With the aging and urbanization process accelerating, residents' unhealthy lifestyles are prevalent, and the incidence of strokes has risen sharply. It is speculated that the incidence of cerebrovascular disease in China will increase by about 50% in 2030 compared with 2010. The per capita cost of hospitalization for cerebral hemorrhage and cerebral infarction in China increased by 61.4% and 31.4% respectively compared with 2010, which brought heavy economic burden to families and society [3] [4]. Therefore, the prevention and treatment of stroke are extremely urgent.
The prevention and treatment of stroke began in the United States as early as 1950, and the American stroke mortality rate dropped by 34.8% between 1972 and 1985 [5]. The project has been carried out in Japan, Australia, Canada, New Zealand and other countries, and has achieved remarkable results, resulting in a significant reduction in stroke morbidity and mortality [6] [7] [8] [9]. At present, China has launched a stroke screening and prevention program in some cities. According to relevant research reported, the proportion of high-risk groups is between 13.45% -21.30% [10] [11] [12] [13]. About 1.6 million people died from stroke each year in China, which has become the primary cause of death among Chinese residents [14]. It shows that the burden of stroke in China is serious, and the prevention and treatment of stroke are extremely urgent. Studies have shown that among the risk factors that cause stroke, in addition to gender, age and genetic factors, the rest are closely related to people's daily habits and behaviors, and can be controlled by changing bad lifestyles and behaviors. Approximately 94% of stroke patients are caused by controlled risk factors, and early screening for risk factors and standardized treatment of stroke patients can effectively reduce stroke morbidity, recurrence rate, morbidity and mortality [15] [16].
This paper aims to screen and analyze the current status of high-risk stroke patients in Shashi District of Jingzhou City and the exposure levels of related risk factors, and provides suggestions as the references for prevention and treatment of stroke. The screening results are now reported as below.

Research Object
According to the screening standards of the National Health and Family Planning Commission's Stroke Screening and Prevention Engineering Committee, a cluster sampling method was adopted to screen the permanent residents of the three townships and two communities in Shashi District of Jingzhou City, aged 40 and above. A total of 1060 people were screened. Inclusion criteria: 1) The permanent residents who aged 40 and above in Shashi District of Jingzhou City; 2) A history of stroke or TIA, or patients with the following ≥ 3 risk factors: hypertension, hyperlipidemia, diabetes, atrial fibrillation or valvular heart disease, smoking, lack of exercise, overweight, family history of stroke. 3) Volunteer to participate in this study. Exclusion criteria: 1) Newly born stroke patients less than 6 months; 2) Patients who cannot be screened for severe physical illness; 3) Patients who are unable to communicate properly due to mental illness or cognitive impairment.

Investigation Method
The survey used a unified assessment form that included general information and stroke factors [17]. On-site questionnaires and physical examinations are conducted by qualified medical personnel who are trained and tested. The study was approved by the ethics committee and informed consent was obtained from the study subjects.

Diagnostic Criteria
Using the latest stroke risk screening assessment criteria by the Stroke Screening and Prevention Engineering Committee, high-risk stroke patients include a history of previous ischemic stroke or transient ischemic attack (TIA), or 3 of the following 8 risk factors Items and above: 1) Hypertension (≥140/90 mmHg, 1 mmHg = 0.133 kPa), or taking antihypertensive drugs; 2) Atrial fibrillation or valvular heart disease; 3) Smoking (evaluation criteria: ≥1 cigarette/day, duration more than 1 year); 4) Dyslipidemia or unknown; 5) Diabetes; 6) Less physical exercise (evaluation criteria: ≥3 times/week, ≥30 minutes/time, duration more than 1 year; those who are engaged in moderate or severe physical labor are regarded as regular physical exercise); 7) Obesity (BMI ≥ 26 kg/m 2 ); 8) Family history of stroke. There were fewer than 3 risk factors of stroke, but with one of the chronic diseases (hypertension, diabetes, atrial fibrillation, or valvular heart disease) was assessed as a middle-risk group. The risk factors of stroke were less than 3, and without chronic disease were assessed as a low-risk group.

Quality Control
All personnel involved in the stroke screening program must receive uniform training. During the development of the screening project, quality control personnel should be set up, all screening registration forms should be quality-controlled, and errors or missing items should be corrected in time to ensure the validity of the registration form. The data entry is double-checked and double entered to ensure the data is accurate.

Statistical Method
Data input and management were performed using Excel software, and data analysis was performed using SPSS 22.0 statistical software. Count data adoption rate and percentage description. Chi-square test was used to compare between groups. P < 0.05 was considered statistically significant.

Basic Situation of the Research Object
In this study, a total of 1060 subjects were screened. Finally, the data of 1060 patients were included in the study, and the effective rate was 100%. The general demographic characteristics of the study population are shown in Table 1.  Figure 1. Compared with the middle and low-risk groups, high-risk groups had statistically significant differences in hypertension, atrial fibrillation or valvular heart disease, smoking, dyslipidemia, diabetes, less physical exercise, overweight, and family history of stroke (P < 0.01), as shown in Table 2. There was a statistically significant difference in smoking between men and women (P < 0.05), as shown in Table 3.

Discussion
The results of this study show that the detection rate of high-risk stroke population in this region was relatively high, accounting for 29.53%, which was higher than the 15.32% of high-risk stroke population aged 40 and above reported by Yue [18]. In the high-risk group, the exposure rate of risk factors from high to low was hypertension (70.93%), dyslipidemia (46.33%), less physical exercise heavy. In addition, the risk factors of hypertension, dyslipidemia, less physical exercise, diabetes, overweight, smoking, family history of stroke, atrial fibrillation and valvular heart disease were statistically significant in the high-risk and middle and low-risk groups (P < 0.05). There is a statistically significant difference in smoking between men and women (P < 0.05).
Stroke is a multifactorial related disease, and its incidence trend is closely related to the exposure level of risk factors. Studies have shown that more than 80% of stroke cases can be controlled by improving people's unhealthy lifestyle and behaviors and strengthening self-health management [19] [20]. The results of this study found that the top three risk factors for high-risk stroke patients in this region were hypertension, dyslipidemia, and less physical exercise, which were controllable risk factors. Hypertension is the most important independent risk factor for stroke. 40% of cardiovascular and cerebrovascular diseases in China are attributed to hypertension. Among the many risk factors for stroke, hypertension is the first. With the increase of blood pressure, the risk of cardiovascular and cerebrovascular diseases increases gradually, and the risk of cardiovascular and cerebrovascular diseases increases by 1 time for every 20 mmHg of systolic blood pressure or 10 mmHg of diastolic blood pressure [21]. In a study by Goldstein [22], it is pointed out that maintaining proper exercise can reduce the incidence of stroke by 20%, multiple exercise can reduce the incidence of stroke by 27%, exercise can lower blood pressure, prevent atherosclerosis, and thus reduce the occurrence and recurrence of stroke. Some studies have P. P. Zheng et al. shown that targeted interventions for high-risk stroke patients can also effectively reduce the incidence of stroke. In the study of Ai, et al. [23], standardized drug treatment for people with high-risk factors such as hypertension, diabetes and dyslipidemia can control blood pressure, blood sugar and blood lipids within the normal range, thereby reducing the incidence of stroke. In the study of Li, et al. [24], targeted health education was conducted for cardiovascular patients with stroke risk factors, which mainly included early identification and control of stroke risk factors, guidance for patients to establish a good lifestyle to improve the knowledge of stroke prevention and treatment. Pan, et al. [25], for men and 2.7% for women). The proportion of dyslipidemia in the population has increased significantly, the overall male is higher than the female, and the urban is higher than the rural [27]. Diabetes epidemiological survey showed that the national diabetes awareness rate was 36.50%, the treatment rate was 32.20%, and the treatment control rate was 49.20% [28]. The prevention and treatment of stroke is a long-term and arduous task that requires multidisciplinary cooperation, continuous supervision and management, thereby improving the health of all citizens.

Conclusion
The detection rate of high-risk stroke patients in Shashi District of Jingzhou City is high. Hypertension, dyslipidemia, less physical exercise, diabetes, and overweight are the main risk factors of stroke occurrence and recurrence in the region. The prevention and treatment of risk factors for stroke should be strengthened to control the incidence and recurrence rate of stroke.