Publications by authors named "Xianjia Ning"

60 Publications

Sex Differences in the Association Between Obesity and Cognitive Impairment in a Low-Income Elderly Population in Rural China: A Population-Based Cross-Sectional Study.

Front Neurol 2021 9;12:669174. Epub 2021 Jul 9.

Department of General Medicine, Tianjin Medical University General Hospital, Tianjin, China.

Obesity is a potentially modifiable risk factor for cognitive impairment. However, sex-specific relationships between obesity and cognitive impairment in late life remain unclear. We aimed to assess sex differences in the association between various obesity parameters and cognitive impairment in a low-income elderly population in rural China. A population-based cross-sectional study was conducted to collect basic information from elderly residents aged 60 years and older from April 2014 to August 2014 in rural areas of Tianjin, China. Obesity parameters, including body mass index (BMI) and waist circumference (WC), and Mini Mental State Examination scores were measured, and the relationships between these variables were assessed. A total of 1,081 residents with a mean age of 67.70 years were enrolled in this study. After adjusting for age, educational attainment, smoking status, drinking status, physical exercise participation, and the presence of diabetes and hyperlipidemia, blood pressure group; a high BMI was found to be associated with an increased prevalence of cognitive impairment in elderly women. Each 1-unit increase in BMI was associated with a 5.9% increase in the prevalence of cognitive impairment. WC was related to the prevalence of cognitive impairment in elderly men, and each 1-cm increase in WC was associated with a 4.0% decrease in the prevalence of cognitive impairment. However, there were no significant associations between WC and cognitive function in women or between BMI and cognitive impairment in men. A greater WC was positively associated with better cognitive function in low-income elderly men in rural China, whereas a higher BMI was associated with an increased risk of cognitive impairment in elderly women, independent of sociodemographic, lifestyle, and health-related comorbid factors. Our results suggest weight management of elderly women in rural China may have cognitive benefits. However, randomized controlled trials would be needed to confirm causality.
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http://dx.doi.org/10.3389/fneur.2021.669174DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8299782PMC
July 2021

Sex -Specific Differences in the Association Between Metabolic Syndrome and Carotid Intima-Media Thickness Among a Low-Income Population in China: A Cross-Sectional Study.

Diabetes Metab Syndr Obes 2021 15;14:3263-3272. Epub 2021 Jul 15.

Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People's Republic of China.

Introduction: Carotid atherosclerosis is a well-established biomarker associated with future cardiovascular disease and stroke. We explored the influence of sex on the relationship between metabolic syndrome (MetS) and its components with carotid intima-media thickness (CIMT) among a low-income population in China, which has a high incidence of stroke.

Methods: This population-based study recruited participants aged ≥45 years from rural areas of Tianjin, China between April 2014 and January 2015. Anthropometric characteristics and biochemical profiles were measured. CIMT was assessed using ultrasonography. Diagnosis of MetS and its components was made using the modified International Diabetes Federation criteria for the Asian population. A multivariate linear regression model was used to evaluate the effects of sex on the relationship between the presence of MetS and its components and CIMT.

Results: A total of 3583 individuals (men, 41.4%; women, 58.6%) were included in the analyses. MetS was prevalent in 54.5% (men, 42.3%; women, 63.2%) of the participants. Mean CIMT was 0.57 ± 0.09 mm. In the multivariate analysis, for both sexes, CIMT increased significantly when MetS was present compared with when it was not (both P < 0.001). A common trend was observed in both sexes, in that CIMT increased as the number of MetS components increased, with β (95% confidence interval [CI]) = 0.021 (0.000, 0.042) for men and 0.014 (0.002, 0.026) for women (both P < 0.05). Of the five MetS components, elevated blood pressure was an independent risk factor for increased CIMT in both sexes (men: β = 0.013; 95% CI: 0.003, 0.023; P = 0.008; women: β = 0.024; 95% CI: 0.016, 0.033; P < 0.001). Moreover, abdominal obesity was also an independent risk factor for increased CIMT in men (β = 0.013; 95% CI: 0.003, 0.023; = 0.008) but not in women.

Conclusion: The presence and number of components of MetS were associated with CIMT in both men and women. Sex differences were found in the impact of individual components of MetS on CIMT. Early identification and management of MetS according to sex-specific risk of MetS should be considered to reduce the prevalence and burden of carotid atherosclerosis in rural China, which has a high incidence of stroke, a known consequence of carotid atherosclerosis.
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http://dx.doi.org/10.2147/DMSO.S313702DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8289329PMC
July 2021

Alcohol Consumption and Stroke Risk in Men: A Population-Based Cohort Study in Rural Tianjin, China.

Neuroepidemiology 2021 15;55(4):266-274. Epub 2021 Jun 15.

Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.

Background: Although the protective effects of alcohol consumption against future cardiovascular disease have been published, the effects of alcohol on stroke risk remain controversial.

Method: We assessed the effects of alcohol consumption on stroke risk in a poorly educated, low-income population in rural China. Between 1991 and 2018, a population-based cohort study was conducted in rural Tianjin, China, to examine stroke risk. All registered stroke events were clinically verified using available computed tomography or MRI scans. The stroke risk was analyzed, according to the extent of alcohol consumption, using Cox regression analyses.

Results: We identified 352 incident stroke events among male participants during the study period. The stroke incidences (per 100,000 person-years) were 965.3 overall, 575.9 for ischemic stroke events, 208.4 for hemorrhagic stroke events, and 181.0 for undefined stroke events. Overall, alcohol consumption provided a 32% reduction in the total stroke risk. Low-dose alcohol consumption (≤12 g/day) showed a negative association with total (hazard ratio [HR], 0.64; 95% confidence interval [CI], 0.46-0.88; p = 0.008) and ischemic (HR, 0.66; 95% CI, 0.44-0.98; p = 0.039) strokes. Alcohol consumption was not significantly associated with hemorrhagic strokes. After age stratification, alcohol consumption was protective against total and ischemic strokes in men aged ≥55 years old, with the risk of each stroke type decreasing by 46 and 49%, respectively. Low-dose alcohol consumption was inversely associated with both total and ischemic stroke risks, with the risks decreasing by 56 and 65%, respectively. Alcohol consumption was not significantly associated with strokes among men aged <55 years old.

Conclusions: These findings suggest that low-dose alcohol consumption may decrease the risk of ischemic strokes among men. Even so, the adverse effects of alcohol on the liver and pancreas cannot be ignored. Additionally, the effects of alcohol consumption on stroke risk vary with age, protecting against ischemic and total strokes among males ≥55 years old. Nevertheless, recommending light drinking and its potential health benefits should not be generalized to men of all ages.
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http://dx.doi.org/10.1159/000515036DOI Listing
June 2021

Association between kidney function and hearing impairment among middle-aged and elderly individuals: a cross-sectional population-based study.

Postgrad Med 2021 Jun 8:1-6. Epub 2021 Jun 8.

Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.

Objective: As age-related diseases, chronic kidney disease and hearing impairment (HI) cause a serious socioeconomic burden. Due to structural similarities, there is a certain connection between kidney function and hearing, but there has been no large-scale epidemiological study in China that further explored this connection. Thus, this study aimed to explore the association between indicator levels of kidney function and hearing impairment among middle-aged and elderly individuals in Tianjin, China.

Method: In 2020, 1539 participants aged 45 years or older from Tianjin, China, were recruited into this study. All participants completed questionnaire surveys and underwent physical examinations, laboratory examinations, and hearing tests. The estimated glomerular filtration rate (eGFR) was calculated from serum creatinine (Cre) levels. HI was measured using pure-tone audiometry, and audiologists determined the final diagnoses.

Result: The prevalence of HI was 49.97%. With each 1-mL/min/1.73 m increase in eGFR, the overall odds of HI increased by 1.3%; the risk increased by 2.4% and 1.6% for men and people aged 45-65 years, respectively. In contrast, in women, the odds of HI increased as Cre levels increased. Moreover, with each 1-mL/min/1.73 m increase in eGFR, the overall odds of a one-degree increase in hearing loss increased by 1.7%; the odds increased by 2.3% and 1.5% for men and people aged 45-65 years, respectively. However, in women and people aged ≥65 years, the odds of a one-grade increase in hearing loss increased by 2.1% and 1.5%, respectively, with each 1-µmol/L increase in Cre. In addition, there were no significant relationships between blood urea nitrogen and hearing loss in multivariate analysis (all P > 0.05).

Conclusions: These findings suggest that eGFR and serum Cre are effective predictors of hearing loss. Thus, to decrease the burden of HI, hearing should be carefully monitored for people aged ≥45 years with elevated serum Cre and eGFR.
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http://dx.doi.org/10.1080/00325481.2021.1933554DOI Listing
June 2021

Relationship Between Metabolic Syndrome and Cognitive Function: A Population-Based Study of Middle-Aged and Elderly Adults in Rural China.

Diabetes Metab Syndr Obes 2021 30;14:1927-1935. Epub 2021 Apr 30.

Department of Neurology, The Second People's Hospital of Wuhu, Wuhu, Anhui, People's Republic of China.

Introduction: To explore the relationship between metabolic syndrome (MetS) and cognitive impairment in a low-income and low-education population.

Methods: All residents aged ≥45 years in a low-income population in Tianjin, China, were eligible to participate in this study. The Mini-Mental State Examination (MMSE) scale was used to conduct a preliminary screening and assessment of the participants' cognitive statuses. The MMSE components are orientation, registration, attention and calculation, recall, and language.

Results: In this population, the prevalences of MetS and cognitive impairment were 54.1% and 44.5%, respectively. In the overall population, the registration score was 0.105 points lower in the elevated triglycerides (TG) group than in the normal TG group (β, -0.105; 95% confidence interval [CI]: -0.201, -0.010; P=0.030). In men, high TG was associated with registration scores that were 0.152 points lower than those in the normal TG group (95% CI: -0.281, -0.022; P=0.022), while larger WC and lower HDL-C had positive effects on cognitive scores (all P<0.05). However, in women, there were no significant differences between cognitive scores and MetS or its components.

Conclusion: In this population, first, TG had a great impact on cognition, even greater than the impact of MetS on cognition. Second, the impact of MetS components on cognition was more obvious in men, and not all of the effects were negative. Therefore, the effect of MetS on cognition may need to be analyzed separately for different populations, and it may be that the effect of a single component is greater than the overall effect. When formulating prevention strategies for cognitive impairments, population differences must also be taken into consideration.
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http://dx.doi.org/10.2147/DMSO.S308250DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8096414PMC
April 2021

Health care reform and stroke prognosis in low-income Chinese populations from 1992 to 2018.

J Glob Health 2021 Apr 17;11:08002. Epub 2021 Apr 17.

Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.

Background: To assess the impact of the health care reform on stroke prognoses among low-income Chinese residents.

Methods: Stroke events and all-cause deaths were registered during 1992-2018 in Tianjin, China. Trends in stroke management and prognoses were compared during the study periods1992-2008 and 2009-2018.

Results: A total of 1462 patients were diagnosed with first-ever stroke during the study periods. For patients aged ≥45 years, the rates of neuroimaging-based diagnoses and hospitalization were greater in 2009-2018 than in 1992-2008, regardless of patient sex or stroke type. Overall, the one-year case fatality rate was significantly lower in 2009-2018 than in the earlier period; the case fatality rate for women aged ≥65 years decreased by 30.0%. Between both periods, the stroke recurrence rate increased 1.9-fold, including a 2.5-fold increase in men (all  < 0.05). During the 2009-2018 period, the one-year case fatality rate was higher among elderly male patients not using medical insurance than among those using it (32.8% vs 20.7%;  = 0.050). After 2009, a significant decline in the recurrence rate ( = 0.001) and a significant increase in the hospitalization rate ( = 0.004) were observed in the interrupted time-series analysis.

Conclusions: These findings suggest that the implementation of universal medical insurance for residents in urban and rural China played a major role in improving the prognoses of low-income, rural, first-ever stroke patients, especially for elderly (≥65 years old) residents. However, elderly male patients not using medical insurance benefits had a high case fatality rate. Thus, restructuring of the government medical insurance policy to facilitate its use by low-income, rural residents is crucial for reducing the stroke burden in China.
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http://dx.doi.org/10.7189/jogh.11.08002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8053405PMC
April 2021

Sex Differences in the Prevalence of and Risk Factors for Abnormal Glucose Regulation in Adults Aged 50 Years or Older With Normal Fasting Plasma Glucose Levels.

Front Endocrinol (Lausanne) 2020 19;11:531796. Epub 2021 Feb 19.

Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital, Tianjin, China.

Aims: Abnormal glucose regulation, which can present as diabetes and prediabetes, has become one of the most common chronic conditions. However, sex differences in the prevalence of and factors associated with abnormal glucose regulation remain unclear. Thus, we aimed to explore sex differences in the prevalence of and factors associated with abnormal glucose regulation in low-income adults in China aged ≥50 years with normal fasting plasma glucose levels.

Materials And Methods: A total of 2,175 individuals aged ≥50 years with normal fasting plasma glucose levels were recruited into this study. After an overnight fast of at least 10 h, individuals underwent an oral glucose tolerance test. Fasting and 2-h plasma glucose levels were measured to determine the state of glucose regulation.

Results: Women were more likely than men to have isolated-impaired glucose tolerance (i-IGT) overall (24.7% vs 20.8%; P= 0.034), among individuals aged <65 years (21.7% vs 15.9%; P= 0.012). Among men, independent risk factors for i-IGT were an age of ≥65 years, hypertension, and high serum uric acid (SUA) and triglyceride levels; independent risk factors for diabetes mellitus (DM) were an age of ≥75 years and alcohol consumption. Among women, independent risk factors for i-IGT were central obesity and high levels of high-sensitivity C-reactive protein and SUA; independent risk factors for DM were low education and an elevated white blood cell count.

Conclusions: Our findings suggest that conventional cardiovascular disease risk factors (i.e., age, hypertension, and dyslipidemia) associated with high risk of developing DM in men, but poor life style (i.e., obesity) and low education attainment in women. It is necessary for delay or stopping the development of DM among low-income adults in China to implement the personalized scheme of prevention DM between men and women, especially highlight control the risk factors in young and middle aged women.
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http://dx.doi.org/10.3389/fendo.2020.531796DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7933576PMC
May 2021

A Sharp Decline in Burden of Stroke in Rural China During COVID-19 Pandemic.

Front Neurol 2020 25;11:596871. Epub 2021 Jan 25.

Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.

This study aimed to explore trends in the burden from stroke associated with home quarantine during the COVID-19 pandemic. Patients with a first-ever stroke registered between January 1 and April 20 from 2010 to 2020 were included in this study. We compared the incidence and the rates of mortality, hospitalization, and diagnosis by neuroimaging for first-ever stroke among a low-income population in rural China during the study periods. Overall, 377 first-ever stroke patients were analyzed in this study period; men accounted for 59.2%. Compared with 2019, the incidence of first-ever stroke was 73.5% lower in 2020 ( < 0.001). The incidence of first-ever stroke was lower by 64.18% in 2020 than in the previous 5 years ( = 0.002) and by 65.42% in 2020 than in the previous 10 years ( = 0.001). Mortality from first-ever stroke in 2020 was not significantly different from that in 2019, but it was noticeably lower than that for the previous 5 and 10 years. However, rates of hospitalization and diagnosis by neuroimaging remained stable across the study period. These findings suggest that the home quarantine helped reduce outdoor activities at low temperatures, restrict gatherings, reduce alcoholism and high-fat diet, and lower pollution caused by factories. These changes were advantageous for helping high-risk groups to reduce the burden of stroke.
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http://dx.doi.org/10.3389/fneur.2020.596871DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7868406PMC
January 2021

Hearing impairment prevalence and risk factors among adults in rural China: a population-based cross-sectional study.

Postgrad Med 2021 Apr 10;133(3):369-376. Epub 2020 Dec 10.

Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.

: Over the past few decades, the prevalence of hearing impairment (HI) has rapidly increased, making HI one of the most common causes of disability, globally. The burden of HI is particularly heavy in low socioeconomic status populations. Despite extensive research into the range of HI prevalence in low socioeconomic status populations, worldwide, population-based studies have been rare. Thus, we explored HI prevalence and risk factors among low-income, middle-aged and elderly individuals in Tianjin, China.: Between September and November 2013, 2351 rural residents in Tianjin, China were recruited into the study. All participants completed questionnaire surveys, physical examinations, laboratory examinations, and hearing tests. HI was measured using pure-tone audiometry, and audiologists determined the final diagnoses.: Among the 2351 participants, ≥45 years old, the prevalence of HI was 49.3%, including 54.3% among men and 46.0% among women. Slight HI accounted for the largest proportion of individuals (40.7%). The risk of HI among men was 32.9% higher than among women. Moreover, the risk of HI increased with increasing age. Compared with the 45-54-year-old group, the risk of HI in individuals in the 55-64-year-old, 65-74-year-old, and ≥75-year-old groups were 25.8%, 109.9%, and 373.7% higher, respectively. Moreover, increased with each 1-mmHg SBP, the risk of HI increase 0.7% (95%CI: 1.001-1.013; P = 0.017); while increased with each 1-mmHg DBP, the risk of HI decrease 1.7% (95%CI: 0.973-0.993; P = 0.001): The burden of HI in rural northern China is heavy, especially among elderly men and people with elevated systolic blood pressure (SBP). Addressing HI prevention is critical for reducing the HI burden and improving quality of life.
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http://dx.doi.org/10.1080/00325481.2020.1855852DOI Listing
April 2021

Association Between Pulse Pressure and Carotid Intima-Media Thickness Among Low-Income Adults Aged 45 Years and Older: A Population-Based Cross-Sectional Study in Rural China.

Front Cardiovasc Med 2020 12;7:547365. Epub 2020 Nov 12.

Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.

Worldwide, the stroke burden remains severe, especially for people in low socioeconomic groups. Atherosclerosis is a leading cause of stroke that is attracting increasingly greater attention. Blood pressure, including pulse pressure (PP) and systolic (SBP) and diastolic (DBP) blood pressures, is a traditional risk factor for atherosclerosis; its association with carotid intima-media thickness (CIMT) has also been widely studied. However, published studies have not reported on the relationship between PP and CIMT in low-income adults. Thus, this study investigated the relationship between PP and CIMT in a low-income population, in China. A total of 3,789 people, aged ≥45 years and without histories of stroke or cardiovascular disease, were recruited into this study. B-mode ultrasonography was performed to determine CIMTs. Demographic characteristics, physical examination data, previous medical histories, and laboratory test results were collected for each study participant. Multiple linear regression models were used to analyze the association between CIMT and PP. The mean CIMT was 567.1 μm (males, 583.5 μm; females, 555.7 μm). The SBP, DBP, PP, and mean arterial pressure (MAP) values were all positively correlated with CIMT, in the univariate analysis; PP and MAP showed the strongest correlations. In addition, in three multiple linear regression models, PP was shown to be significantly associated with CIMT; each 1-mm Hg increase in PP resulted in a CIMT increase of ≥0.41 μm (all < 0.001). Our results demonstrated that, when compared with SBP, DBP, and MAP, PP may be the best predictor of CIMT. Thus, controlling blood pressure, especially PP levels, is vital to decreasing the prevalence of atherosclerosis, especially in this low socioeconomic status population in China.
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http://dx.doi.org/10.3389/fcvm.2020.547365DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7688472PMC
November 2020

Epidemiological Features of Glycemic Levels and Relative Determinants at Different Altitudes Among Tibetans in China: A Cross-Sectional Population-Based Study.

Front Public Health 2020 10;8:472. Epub 2020 Sep 10.

Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.

Risk factors associated with diabetes mellitus have been widely researched worldwide, but the determinants of glycemic levels among Tibetans in China are currently unclear. We thus aimed to determine the relationship between altitude and glycemic levels and to identify factors associated with glycemic levels among Tibetans in China. In 2011, a total of 1,659 Tibetans (aged ≥18 years) from Changdu, China, were enrolled to this cross-sectional research. Potential factors associated with postprandial glucose (PPG), fasting plasma glucose (FPG), and insulin (INS) levels were assessed. FPG and PPG levels increased with age and total cholesterol (TC) level. In addition, FPG levels were higher among patients with rural residence and hypertension, while PPG levels increased with increasing BMI. INS levels increased with residence, lower education, higher BMI, and higher TG levels and decreased with higher altitude and TC levels. Moreover, risk factors for FPG, PPG, and INS differed in those residing at a higher altitude. These findings identify several important risk factors that affect glycemic levels and may be used to develop effective strategies for metabolic disease prevention among populations in high-altitude areas. Furthermore, these findings suggest that it is necessary to formulate a standard for PPG, FPG, and INS in high-altitude areas.
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http://dx.doi.org/10.3389/fpubh.2020.00472DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7511752PMC
May 2021

Obesity at a young age is associated with development of diabetes mellitus: A prospective cohort study in rural China.

Postgrad Med 2020 Nov 16;132(8):709-713. Epub 2020 Jun 16.

Department of Neurology, Tianjin Medical University General Hospital , Tianjin, China.

Objectives: We aimed to assess the age-dependent association of obesity with the risk of developing diabetes mellitus (DM) among a low-income population in China.

Methods: In this prospective cohort study, we estimated the hazard ratios (HR) for the association of body mass index (BMI) with DM risk from 1991 to 2014, after adjusting for other possible risk factors, using Cox-regression analysis.

Results: A total of 971 participants were followed up for 23 years in this study. The incidence of DM in this population was as high as 467.0/100,000 person-years. Compared with normal weight, the HR (and 95% confidence interval [CI]) for overweight affecting DM risk was 2.23 (1.45-3.41) overall, including 2.43 (1.05-5.63) for men and 2.17 (1.31-3.59) for women. The HR associated with the impact of obesity was 3.59 (2.06-6.27) overall, including 6.04 (1.84-19.81) for men and 3.23 (1.69-6.16) for women. Being overweight had a significant association with DM for people aged 40-49 years (HR, 1.99; 95% CI, 1.03-3.84); the HR for an association between DM and obesity was the highest among individuals aged 30-39 years (HR, 4.43; 95% CI, 1.84-10.67). There was no statistical significance between BMI and DM among individuals aged ≥50 years.

Conclusions: These findings suggest that obesity is associated with developing DM in rural China, especially among adults aged <50 years. Weight management is the highest priority for reducing the heavy burden of DM.
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http://dx.doi.org/10.1080/00325481.2020.1778383DOI Listing
November 2020

Macroeconomic Development and Dramatic Increase in Stroke Burden in Rural China: A 25-Year Population-Based Study.

Front Neurol 2020 13;11:385. Epub 2020 May 13.

Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.

Low socioeconomic status is associated with a high stroke risk. However, few studies have quantitatively assessed the relationship between stroke burden and national economic development indicators. We explored the quantitative association between macroeconomic development and stroke burden in rural China. In this population-based, prospective study (1992-2016), we collected data on annual registrations of stroke events and deaths in Tianjin, China. Economic development over the period was represented by gross domestic product annually adjusted for purchasing power parity (PPP-aGDP) and per capita net income (PCNI) of rural residents in China. We assessed the association of first-ever stroke incidence with PPP-aGDP and PCNI. During the 25-year study period, there were 1,185 stroke events and 362,296 person years of surveillance. First-ever stroke incidence increased by an average of 10.7% per 1,000 USD increase in overall PPP-aGDP and by 12.0% per 1,000 Yuan increase in PCNI; respectively, the mean increases were 9.6 and 10.8% in men and 13.0 and 14.4% in women (all, < 0.001). These same changes in PPP-aGDP and PCNI also resulted in increases in the incidence of ischemic stroke (12.6 and 14.3%, respectively; < 0.05), and intracerebral hemorrhage (both, 6.2%; < 0.05). Similarly, in men, the age of onset of intracerebral hemorrhage decreased by 0.96-years ( = 0.002) for each 1,000 USD increase in PPP-aGDP and by 1.08-years ( = 0.003) for each 1,000 Yuan increase in PCNI. Macroeconomic development was positively associated with stroke incidence in rural China. Thus, enhancing health-care investments is crucial for containing the stroke burden during this remarkable economic development in China. Our findings could guide other developing countries with information regarding the timely control of stroke risk factors and reductions in stroke burden during the initial stages of economic development.
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http://dx.doi.org/10.3389/fneur.2020.00385DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7237581PMC
May 2020

Sex-specific differences in the prevalence of and risk factors for hyperuricemia among a low-income population in China: a cross-sectional study.

Postgrad Med 2020 Aug 12;132(6):559-567. Epub 2020 May 12.

Department of Endocrinology and Metabolism, Tianjin Medical University General Hospital , Tianjin, China.

: China has already entered the aging society, and its aging population is the largest worldwide. Accordingly, several aging-related conditions including hyperuricemia are becoming a public health concern owing to their increasing prevalence in rural areas. However, the sex-specific differences in the risk factors for hyperuricemia among the middle-aged and elderly in rural North China are unclear. Thus, this study aimed to evaluate sex-specific differences in the prevalence of and risk factors for hyperuricemia in low-income adults in rural North China. : This population-based cross-sectional study recruited participants aged ≥50 years from the Tianjin Brain Study between April and August 2019. After excluding those who had cancer, severe psychiatric disturbances, hepatic failure, and serious renal disease (i.e., an estimated glomerular filtration rate (eGFR) of <30 mL/min/1.73 m), 3119 (1392 men and 1727 women) eligible participants were included. Basic information and blood samples were collected, and data were analyzed using logistic regression models. : Hyperuricemia was prevalent in 14.4% (men, 14.2%; women, 14.5%)of the participants, and the prevalence significantly increased with increasing age in both sexes (male, = 0.034; female, < 0.001). In multivariate analysis, obesity, metabolic syndrome, and high levels of total cholesterol, 2 h plasma glucose, and blood urea nitrogen were risk factors for hyperuricemia in both men and women. Physical activity was a risk factor in men, while a high white blood cell count was a risk factor in women. A high eGFR was a protective factor in both sexes. : Hyperuricemia was highly prevalent in low-income adults in Tianjin, with men and women showing differences in risk profiles and comorbidities. Early management of hyperuricemia according to sex-specific risk factors should be considered in primary care to reduce the prevalence and burden of hyperuricemia in rural China.
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http://dx.doi.org/10.1080/00325481.2020.1761133DOI Listing
August 2020

Association of Carotid Atherosclerosis With Lipid Components in Asymptomatic Low-Income Chinese: A Population-Based Cross-Sectional Study.

Front Neurol 2020 24;11:276. Epub 2020 Apr 24.

Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.

Intima-media thickness is a non-invasive arterial marker of early-stage atherosclerosis. Identifying carotid plaque is a superior surrogate endpoint for assessing atherosclerotic lesions. The aim of this study was to investigate the association of carotid intima-media thickness (CIMT) and carotid plaque with lipids among asymptomatic low-income rural residents in China. A total of 3,789 people aged ≥45 years without a history of stroke or cardiovascular disease were recruited to this study. B-mode ultrasonography was performed to measure CIMT and identify carotid plaque for early identification of atherosclerosis. Multivariate analysis was used to assess the association of blood lipid levels with atherosclerosis. The mean CIMT across our cohort was 567 μm. A linear regression analysis showed that low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) were risk factors for early-stage atherosclerosis; however, high-density lipoprotein cholesterol and triglycerides protected against early-stage atherosclerosis after adjusting for potential risk factors ( < 0.001). Carotid plaque risk increased by 24 and 62% for each 1-mmol/L increase in TC and LDL-C ( < 0.001). These findings suggest that it is vital to manage and control the dyslipidemia standard levels in China, especially among rural residents, in order to reduce the burden of cardiovascular diseases.
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http://dx.doi.org/10.3389/fneur.2020.00276DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7193094PMC
April 2020

Determinants of carotid intima-media thickness in asymptomatic elders: a population-based cross-sectional study in rural China.

Postgrad Med 2020 Aug 3;132(6):544-550. Epub 2020 May 3.

Department of Neurology, Tianjin Medical University General Hospital , Tianjin, China.

: To examine the mean carotid intima-media thickness (CIMT) and potentially relevant determinants of increased CIMT in elders. : Stroke-free and cardiovascular disease-free residents aged ≥65 years were recruited in a low-income population in China. B-mode ultrasonography was performed to measure CIMT. : A total of 1039 individuals (47.9% men) were recruited. The mean CIMT value was 0.60 (SD: 0.09) mm. The mean CIMT was 24.07 (SEM: 6.52) µm greater in men than in women (P < 0.001) and 28.29 (SEM: 7.47) µm greater in patients with hypertension than in those without hypertension (P < 0.001). Moreover, the mean CIMT increased by 1.53 (SEM: 0.49) µm for each 1-year increase in age (P = 0.002). However, the mean CIMT decreased by 5.55 (SEM: 2.40) μm and 6.45 (SEM: 2.62) μm for every 1-mmol/L increase in triglyceride concentration and the high-density lipoprotein cholesterol: low-density lipoprotein cholesterol ratio, respectively (P < 0.05). However, high triglyceride level was negatively associated with mean CIMT only among individuals without metabolic syndrome (P = 0.036). : These findings suggest that there is an urgent need to delay atherosclerosis progression and reduce the stroke burden by managing hypertension, especially for men. Moreover, to decrease the stroke burden in rural China, caution is advised regarding lipid-lowering treatment in elderly patients without metabolic syndrome.
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http://dx.doi.org/10.1080/00325481.2020.1757266DOI Listing
August 2020

Rate and Determinants of Recurrence at 1 Year and 5 Years After Stroke in a Low-Income Population in Rural China.

Front Neurol 2020 23;11. Epub 2020 Jan 23.

Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.

Recurrent stroke is becoming an increasingly important public health issue owing to the increased risk of disability and death. However, population-based studies investigating the rate of recurrent stroke in China are rare. We explored the rate and determinants of recurrent stroke within 1 and 5 years after the initial stroke in a rural population in China. Data for stroke events were obtained from the Tianjin Brain Study, conducted between 1992 and 2016. The age-standardized rates of recurrent stroke within the first year and the first 5 years after the initial stroke were calculated for this period. Determinants of recurrent stroke were assessed using Cox regression analyses. The overall age-standardized rate of recurrent stroke within 1 year was 5.7% (men, 6.9%; women, 4.6%); within 5 years, the overall recurrent stroke rate was 22.5% (men, 24.0%; women, 20.2%). The recurrence rate increased with advancing age and decreased with increased educational attainment. Age ≥65 years and a history of alcohol consumption were independent risk factors for recurrent stroke within 1 year after the incident stroke, after adjusting for age, sex, education, hypertension, diabetes, smoking, and alcohol consumption. However, the risk of recurrent stroke within 5 years after the incident stroke was positively associated with male sex, age ≥65 years, a lower level of education, known diabetes, and alcohol consumption, after adjusting for the previously indicated covariates. These findings suggest a crucial need to address risk factor management among stroke patients to reduce the burden of stroke, especially among low-income populations. Furthermore, a multicenter, large sample, nationwide study is urgently needed.
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http://dx.doi.org/10.3389/fneur.2020.00002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6989474PMC
January 2020

Sex-Based Differences in Diabetes Prevalence and Risk Factors: A Population-Based Cross-Sectional Study Among Low-Income Adults in China.

Front Endocrinol (Lausanne) 2019 25;10:658. Epub 2019 Sep 25.

Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.

The prevalence of diabetes mellitus (DM) among adults has reached epidemic proportions worldwide, including China. In China, sex-based differences in the prevalence and risk factors of DM may exist, particularly among low-income individuals. Thus, we assessed these differences in the prevalence of DM and its risk factors in a low-income Chinese population. Residents aged ≥45 years without histories of strokes or cardiovascular disease were recruited for this study. Multivariate logistic regression analyses were performed to assess the association of risk factors with DM prevalence. This study included 3,725 participants (41.2%, men; 58.8%, women). The mean age of the women (61.12 years) was higher than that of the men (59.14 years, < 0.001). There was no significant sex-based difference in DM prevalence (men, 14.1%; women, 14.5%). Overweight, obesity, high triglyceride levels, and hypertension were independent risk factors for DM in both sexes. However, high-density lipoprotein-cholesterol levels were negatively associated with DM risk among men [odds ratio (OR), 0.544; 95% confidence interval (CI), 0.355-0.833; = 0.005]. Among women, advanced age and high low-density lipoprotein-cholesterol levels were independent risk factors for DM; there was a higher DM risk for women aged 55-74 years than for those aged 45-54 years; however, physical activity was associated with an increased risk of DM (OR, 1.705; 95% CI, 1.195-2.432; = 0.003). These findings suggest a crucial need to implement individualized blood pressure, weight, and lipid managements in low-income populations in China to reduce the burden of DM, especially among older women.
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http://dx.doi.org/10.3389/fendo.2019.00658DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6773800PMC
September 2019

Association between blood pressure components and the presence of carotid plaque among adults aged 45 years and older: a population-based cross-sectional study in rural China.

Blood Press Monit 2019 Oct;24(5):234-240

Neurology, Tianjin Medical University General Hospital.

Objective: Pulse pressure is strongly associated with the early development of large-vessel atherosclerotic disease. However, the relationship between pulse pressure and carotid plaque in China is unknown. Thus, we investigated the associations of pulse pressure and mean arterial pressure with the presence of carotid plaques in a low-income population in rural China.

Participants And Methods: Residents, aged ≥45 years, without histories of stroke or cardiovascular disease were enrolled. Participant demographics, previous medical histories, and lifestyle information were collected; anthropometric measures, serum profiles, and B-mode ultrasonographic investigations were also performed.

Results: The mean age of participants (n = 3789) was 59.9 years overall (men 61.1 years; women, 59.1 years). The mean SBP (146.42 mmHg) and DBP (86.81 mmHg), pulse pressures (59.61 mmHg), and mean arterial pressures (106.68 mmHg) were high in this population. The odds ratio (95% confidence interval) for the association of pulse pressure with the presence of carotid plaques was 1.028 (1.023-1.033), in the univariate analysis. After gradual adjustment for demographic features, risk factors, and serum profile measurements, this positive association remained statistically significant (all, P < 0.001). However, there was no significant relationship between mean arterial pressure and the presence of carotid plaques.

Conclusion: These findings suggest that an elevated pulse pressure is an independent risk factor for the presence of carotid plaque. These results suggest that enhanced monitoring of blood pressure components, among low-income residents, is crucial for decreasing the risk of stroke and other cardiovascular disease in China.
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http://dx.doi.org/10.1097/MBP.0000000000000396DOI Listing
October 2019

Strict target blood pressure management for reducing the stroke risk according to 2017 ACC/AHA blood pressure guideline.

Aging (Albany NY) 2019 08 27;11(16):6522-6534. Epub 2019 Aug 27.

Department of Neurology, Tianjin Medical University General Hospital, Tianjin 300052, China.

Background And Purpose: We explored the new BP thresholds and their impact on first-ever stroke risk determinations.

Results: During a mean following-up period of 21.85 years, 638 first-ever strokes occurred among 3906 participants. After adjusting for covariates, the hazard ratios for ischemic stroke (IS) in men aged <60 years were significant higher in participants with elevated BP, stage 1 hypertension, and stage 2 hypertension than normal BP (all P<0.05); an increased risk of intracerebral hemorrhage (ICH) was also observed for those with stage 2 hypertension. Similarly, in women aged, the risk of stroke increased for those with stage 2 hypertension both in <60 years and in ≥60 years. Moreover, more than 60% of incident strokes were attributed to systolic BP (SBP) ≥120mmHg and diastolic BP (DBP) <80mmHg in men aged <60 years.

Conclusions: Elevated BP increases the risk of developing stroke, particularly in the absence of routine BP measurements and hypertension treatment. A strict BP management target (SBP, <120 mmHg; DBP, <80 mmHg) should be adopted for young and middle-aged men.

Methods: This population-based cohort study was conducted between October 1991 and January 2018. The association of BP categories, defined by the 2017 ACC/AHA BP guideline, with first-ever stroke risk was assessed using Cox regression models.
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http://dx.doi.org/10.18632/aging.102207DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6738440PMC
August 2019

Association of Blood Pressure With Stroke Risk, Stratified by Age and Stroke Type, in a Low-Income Population in China: A 27-Year Prospective Cohort Study.

Front Neurol 2019 29;10:564. Epub 2019 May 29.

Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.

Association of stroke risk with new blood pressure criterion 2017 is unknown in China. We assessed the association between blood pressure (BP) values and stroke risk in a low-income population in Tianjin, China. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) values were categorized into five strata and strokes were recorded as stroke, ischemic stroke, and hemorrhagic stroke. Stroke risk was analyzed according to blood pressure stratum using Cox regression analysis. Overall, 4,017 residents (age, ≥18 years) were included in this prospective cohort study. Over a 27-year follow-up period (total, 86,515.78 person-years), 638 participants experienced first-ever strokes. The stroke risk was higher among individuals with SBPs ≥140 mmHg or DBPs ≥90 mmHg than among those with SBPs < 130 mmHg or DBPs < 80 mmHg (reference group), after adjusting for covariates. However, hemorrhagic stroke risk increased only in participants with SBPs ≥160 mmHg. The stroke risk increased for individuals < 65-years-old having BP values ≥130/80 mmHg and for individuals ≥65-years-old with BP values ≥160/90 mmHg. To reduce the stroke burden in China, target BP goals must be established for adults, with different targets for the middle-aged and the elderly segments of the population. These results are very important for guiding clinical practice and may be generalized to other developing countries experiencing rapid economic development and where transitions in the spectrum of prevalent diseases have occurred.
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http://dx.doi.org/10.3389/fneur.2019.00564DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6548813PMC
May 2019

Trends in the prevalence, awareness, treatment and control of diabetes in rural areas of northern China from 1992 to 2011.

J Diabetes Investig 2020 Jan 27;11(1):241-249. Epub 2019 Jun 27.

Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.

Aims/introduction: The worldwide prevalence of diabetes mellitus has been increasing over the past decades, particularly in developing countries. Because of the lack of information regarding changes in diabetes mellitus prevalence, awareness, treatment and control in rural China, we assessed these trends - overall and in the context of related health conditions - to explore the impact of these primary health issues on these rates in a poorly educated, rural population.

Materials And Methods: Diabetes mellitus prevalence, awareness, treatment and control rates were compared between two surveys carried out in 1992 and 2011. The residents of three villages, aged 35-64 years, were recruited for this study.

Results: In 1992, 1,091 individuals were interviewed and, in 2011, 2,338 individuals were interviewed. Between the two surveys, the overall diabetes mellitus prevalence in the study population was lower in 1992 than that in 2011 (P < 0.001); among men, the prevalence was 5.2-fold higher in 2011 than in 1992 (10.5 vs 1.7%) and nearly 4.3-fold higher (11.2 vs 2.1%) among women. Men aged 35-44 years, with >6 years of education, stage I hypertension and being overweight, had a higher prevalence of diabetes mellitus in 2011 than in 1992. Similarly, for the same time periods, there was also a higher diabetes mellitus prevalence among women aged 55-64 years, with 1-6 years of education, stage III hypertension and who were overweight. However, there were no significant changes in diabetes mellitus awareness, treatment or control in this population.

Conclusions: These results suggest that particular efforts must be made to enhance diabetes mellitus prevention, control and public awareness in rural communities in China.
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http://dx.doi.org/10.1111/jdi.13095DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6944834PMC
January 2020

Age- and Sex-Associated Impacts of Body Mass Index on Stroke Type Risk: A 27-Year Prospective Cohort Study in a Low-Income Population in China.

Front Neurol 2019 1;10:456. Epub 2019 May 1.

Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.

The relationship between body mass index (BMI) and stroke type has remained controversial despite studies demonstrating that BMI is related to stroke risk, especially in specific groups. We assessed the age- and sex-associated impacts of BMI on stroke type in a low-income, poorly educated population in China. The association of BMI with stroke type was estimated using Cox regression analyses in this prospective cohort study, after adjusting for sex, age, education level, hypertension, diabetes, smoking, and alcohol drinking status. During the follow-up period, 638 stroke cases occurred among the 3,906 participants included in this prospective study. For men aged <65 years, being overweight was an independent predictor of all stroke subtypes, compared with normal-weight individuals; the hazard ratios (HRs) and 95% confidence intervals (CIs) were 1.98 (1.52-2.58) for total stroke, 1.69 (1.22-2.33) for ischemic stroke, and 3.62 (2.09-6.25) for hemorrhagic stroke, all < 0.001. Being underweight was also an independent predictor of hemorrhagic stroke (HR, 5.10; 95%CI, 1.80-14.50, = 0.002). For women <65-years-old, being overweight was a risk factor for total (HR, 1.38; 95% CI, 1.01-1.89; = 0.044) and hemorrhagic strokes (HR, 2.06; 95% CI, 1.00-4.28; = 0.050); obesity was a risk factor for total (HR, 2.47; 95% CI, 1.60-3.82) and ischemic strokes (HR, 2.53; 95% CI, 1.54-4.15), all < 0.001. These findings suggest that weight management should be a high priority for substantially reducing the heavy burden of strokes in rural China among both men and women <65-years-old; men<65-years-old should maintain their weight within a reasonable range.
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http://dx.doi.org/10.3389/fneur.2019.00456DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6504695PMC
May 2019

Sex Differences in the Prevalence, Awareness, Treatment, and Control of Diabetes Mellitus Among Adults Aged 45 Years and Older in Rural Areas of Northern China: A Cross-Sectional, Population-Based Study.

Front Endocrinol (Lausanne) 2019 14;10:147. Epub 2019 Mar 14.

Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.

Diabetes mellitus (DM) has reached epidemic proportions among adults worldwide, with China having the world's largest population of individuals with the disease. Although the consequences of low rates of awareness, treatment, and control of DM are understood, sex-related differences in these rates remain unknown. We assessed sex-related differences in the prevalence, awareness, treatment, and control of DM in a low-income, rural population in China. Individuals ≥45 years old without cardiovascular disease were recruited into this study. The prevalence, awareness, treatment, and control of DM in both men and women were assessed after accounting for age, educational level, body mass index, and blood pressure. A total of 3,725 participants (women, 58.8%) were included. A male preponderance in the prevalence of DM was found among individuals aged 45-54 years, whereas there was a female preponderance among patients aged 65-74 years and among those who were illiterate. Among individuals with >6 years of formal education, overweight individuals, and normotensive individuals, there was greater DM awareness among women than among men. There was also a higher DM treatment rate among overweight women than among overweight men. However, better disease control was observed among men than among women for individuals aged 55-64-years, those with 1-6 years of education, and those with stage II hypertension. These results suggest that DM awareness should be improved among men and that regular DM screening should be implemented for men, especially young men. In addition, disease education and management should be strengthened for elderly women, especially those with low levels of education. Further studies are necessary to explore this situation among a representative population sample in China in order to establish a valid protocol against DM.
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http://dx.doi.org/10.3389/fendo.2019.00147DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6426742PMC
March 2019

Trends in the incidence of recurrent stroke at 5 years after the first-ever stroke in rural China: a population-based stroke surveillance from 1992 to 2017.

Aging (Albany NY) 2019 03;11(6):1686-1694

Department of Neurology, Tianjin Medical University General Hospital, Tianjin 300052, China.

Recent data on the incidence and trends for recurrent strokes in China are scarce. We assessed the temporal trends in recurrent stroke incidence using in rural China. The age-standardized incidences of recurrent stroke, within 5 years of the incident stroke event, were estimated for 3 time periods: 1992-1998, 1999-2005, and 2006-2012. Among the 768 documented incident stroke cases, 26.3% of the patients experienced recurrent stroke within 5 years. The overall age-adjusted recurrent stroke incidence was 43.93 per 100,000 person-years (1992-2012). During the 2006-2012 period, the recurrent stroke incidence per 100,000 person-years was 107.79 in men, and 557.76 in individuals ≥65 years old. There were significant upward tendencies observed in this population across sex, age, or type of stroke (except for among individuals ≥65 years old with incident intracerebral hemorrhages). Compared with the recurrent stroke incidence observed in the 1992-1998 period, that observed during the 2006-2012 period was more than 3-fold higher; the greatest increase (6.8-fold) was observed in women. These findings suggest an urgent need to improve risk factor management and implement appropriate medical resources to contain this upward trend in recurrent stroke incidence and reduce the overall stroke burden in China.
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http://dx.doi.org/10.18632/aging.101862DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6461163PMC
March 2019

Determinants of Developing Stroke Among Low-Income, Rural Residents: A 27-Year Population-Based, Prospective Cohort Study in Northern China.

Front Neurol 2019 5;10:57. Epub 2019 Feb 5.

Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China.

Although strokes are the leading cause of death and disability in many countries, China still lacks long-term monitoring data on stroke incidence and risk factors. This study explored stroke risk factors in a low-income, rural population in China. The study population was derived from the Tianjin Brain Study, a population-based stroke monitoring study that began in 1985. This study documented the demographic characteristics, past medical histories, and personal lifestyles of the study participants. In addition, physical examinations, including measurements of blood pressure (BP), height, and weight, were performed. Hazard ratios (HRs) were estimated for the risk factors for all subtypes of stroke using multivariate Cox regression analyses. During the study with mean following-up time of 23.16 years, 3906 individuals were recruited at baseline, and during 27 years of follow-up, 638 strokes were documented. The multivariate Cox regression analyses revealed a positive correlation between age and stroke incidence. Limited education was associated with a 1.9-fold increase in stroke risk (lowest vs. highest education level). Stroke risk was higher among former smokers than among current smokers (HR, 1.8 vs. 1.6; both, < 0.05). Moreover, stroke risk was significantly associated with sex (HR, 1.8), former alcohol drinking (HR, 2.7), baseline hypertension (HR, 3.1), and overweight (HR, 1.3). In conclusion, this study identified uncontrollable (sex and age) and controllable (education, smoking, alcohol drinking, hypertension, and overweight) risk factors for stroke in a low-income, rural population in China. Therefore, it is critical to control BP and weight effectively, advocate cessation of smoking/alcohol drinking, and enhance the education level in this population to prevent increase in the burden of stroke in China.
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http://dx.doi.org/10.3389/fneur.2019.00057DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6370670PMC
February 2019

Trends in stroke incidence among elderly low-income residents of rural China: a population-based study from 1992 to 2016.

Aging (Albany NY) 2018 11;10(11):3438-3449

Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, China.

In China, >70% of stroke deaths occur in people aged ≥65 years. However, trends in the stroke incidence among elderly people are unclear. We aimed to determine trends in the stroke incidence among elderly people in rural China. This was a population-based surveillance study conducted in Tianjin, China. Stroke events and all deaths were registered annually. Trends and annual proportion of change in incidence of first-ever stroke were evaluated from 1992 to 2016. The age-standardized incidence of first-ever stroke increased annually by 3.7% overall in elderly people (2.7% for men; 5.0% for women; all P<0.05). However, from 2008 to 2016, there was no significant change in the trends of stroke incidence among elderly people, across gender and subtypes. The proportion of elderly patients with first-ever stroke decreased by 1.1% annually. In contrast to young patients, annual changes in the incidence of stroke tended to be slight in elderly patients (3.7% vs. 9.5%) with greater increase in female patients than those in male patients (2.7% vs. 10.3% for men; 5.0% vs. 8.9% for women). Thus, the control of risk factors for stroke among elderly people is crucial, especially among older women, to reduce the burden of stroke in China.
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http://dx.doi.org/10.18632/aging.101657DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6286840PMC
November 2018

Sex Differences in the Prevalence of and Risk Factors for Nonvascular Cognitive Function in Rural, Low-Income Elderly in Tianjin, China.

Neuroepidemiology 2018 9;51(3-4):138-148. Epub 2018 Aug 9.

Department of Neurology, Tianjin Medical University General Hospital, Tianjin,

Background: At the global level, dementia is the leading cause of dependence and disability among the elderly. Although the preponderant prevalence in women has been identified, the sex differences in risk factors were unclear. We aimed to evaluate the sex differences in the prevalence of nonvascular cognitive impairment and the risk factors among the elderly in rural China screened with the Mini-Mental State Examination (MMSE).

Methods: Between 2014 and 2015, a population-based cross-section study was conducted to collect basic information among the elderly aged 60 years and over. Those participants with the previous history of stroke or heart disease were excluded in this study. Nonvascular cognitive impairment was assessed using the MMSE scores.

Results: The prevalence of cognitive impairment was 32.4% overall, 25.6% in men and 38.1% in women. In the multivariate analysis, older age and lower education were risk factors both in men and in women; older, large waist circumference was a protective factor for cognitive function in men; higher blood pressure was the risk factor in women.

Conclusion: These findings suggest that it is crucial to manage and control hypertension and improve educational attainment in order to reduce the prevalence and burden of nonvascular cognitive impairment among low-income residents, both men and women, in rural China.
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http://dx.doi.org/10.1159/000490496DOI Listing
September 2019

Sex differences in outcomes and associated factors among stroke patients with small artery occlusion in China.

Biol Sex Differ 2018 08 2;9(1):35. Epub 2018 Aug 2.

Department of Neurology, Tianjin Huanhu Hospital, 6 Jizhao Road, Jinnan District, Tianjin, 300350, China.

Background: Sex differences in outcomes after small artery occlusion (SAO) stroke have not been well described, particularly in a Chinese population. We aimed to assess sex differences in outcomes and related risk factors among patients with SAO.

Methods: All consecutive patients with SAO were recruited between May 2005 and September 2014. Clinical features and risk factors were recorded. The mortality, recurrence, and dependency rates at 3 months after stroke were assessed.

Results: A total of 2524 patients with SAO were included in this study. There was a higher frequency of mild stroke, current smoking, and alcohol consumption in men than in women. Women were more likely than men to be older, to have diabetes and obesity, and to have higher total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol levels. There were worse outcomes in men than in women at 3 months after stroke (P < 0.05). There were more independent risk factors of poor outcome in men than in women. Older age was a common predictive factor of outcome both in men and in women. In men, low triglyceride levels and high fasting plasma glucose levels were independent risk factors for mortality; in addition, a high low-density lipoprotein cholesterol level was associated with recurrence. Moreover, in men, moderate and severe stroke, and high total cholesterol and fasting plasma glucose levels were risk factors for dependency. A negative association was found between low-density lipoprotein cholesterol level and risk of mortality and between total cholesterol level and risk of recurrence in women.

Conclusions: These findings suggest that it is crucial to control conventional risk factors and fasting plasma glucose and lipid levels among patients with SAO, especially male patients, to reduce the burden of stroke in China.
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http://dx.doi.org/10.1186/s13293-018-0194-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6090906PMC
August 2018

Correlation between hypertension and common carotid artery intima-media thickness in rural China: a population-based study.

J Hum Hypertens 2018 09 5;32(8-9):548-554. Epub 2018 Jun 5.

Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, China.

We aimed to explore the impact of blood pressure (BP) levels on atherosclerosis in a rural Chinese population with a low-education level, low income, high incidence of stroke, and high prevalence of hypertension. B-mode ultrasonography was used to measure carotid intima-media thickness (CIMT) in adults aged ≥ 45 years with no history of stroke or cardiovascular disease. A total of 5403 eligible subjects were included in this study. The mean CIMT was 0.57 mm overall, 0.58 mm for men and 0.56 mm for women. Systolic blood pressure (SBP) and hypertension were significantly associated with increased CIMT. CIMT increased by 0.42 μm for every 1 mm Hg-increase in SBP (P < 0.001). The mean CIMT in participants with a history of hypertension was 17.42 μm greater than that in participants with no history of hypertension (P < 0.001). Diastolic blood pressure (DBP) was a protective factor, as CIMT decreased by 0.44 μm with every 1 mm Hg-increase in DBP (P = 0.011).
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http://dx.doi.org/10.1038/s41371-018-0074-xDOI Listing
September 2018
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