Stroke risk factors in an incident population in urban and rural Tanzania: a prospective, community-based, case-control study

Summary Background 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...

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Published in:The Lancet global health 2013-11, Vol.1 (5), p.e282-e288
Main Authors: Walker, Richard W, Prof, Jusabani, Ahmed, MD, Aris, Eric, MD, Gray, William K, PhD, Unwin, Nigel, Prof, Swai, Mark, MD, Alberti, George, Prof, Mugusi, Ferdinand, MD
Format: Article
Language:English
Subjects:
Aged
Case-Control Studies
Community-Based Participatory Research
Female
HIV Infections - complications
Humans
Incidence
Internal Medicine
Male
Middle Aged
Prospective Studies
Risk Factors
Rural Population
Stroke - epidemiology
Stroke - etiology
Tanzania - epidemiology
Urban Population
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creator Walker, Richard W, Prof
Jusabani, Ahmed, MD
Aris, Eric, MD
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Unwin, Nigel, Prof
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Mugusi, Ferdinand, MD
description Summary Background 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. Methods 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. Findings 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
doi_str_mv 10.1016/S2214-109X(13)70068-8
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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. Methods 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. Findings 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&lt;0·0001), HIV infection (5·61, 2·41–13·09; p&lt;0·0001), a high ratio of total cholesterol to HDL cholesterol (4·54, 2·49–8·28; p&lt;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. Interpretation 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. Funding The Wellcome Trust.</description><identifier>ISSN: 2214-109X</identifier><identifier>EISSN: 2214-109X</identifier><identifier>DOI: 10.1016/S2214-109X(13)70068-8</identifier><identifier>PMID: 24748275</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Aged ; Case-Control Studies ; Community-Based Participatory Research ; Female ; HIV Infections - complications ; Humans ; Incidence ; Internal Medicine ; Male ; Middle Aged ; Prospective Studies ; Risk Factors ; Rural Population ; Stroke - epidemiology ; Stroke - etiology ; Tanzania - epidemiology ; Urban Population</subject><ispartof>The Lancet global health, 2013-11, Vol.1 (5), p.e282-e288</ispartof><rights>Walker et al. Open Access article distributed under the terms of CC-BY</rights><rights>2013 Walker et al. Open Access article distributed under the terms of CC-BY</rights><rights>2013 Walker et al. Open Access article distributed under the terms of CC-BY 2013</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c654t-a4cda6c180cdf471ac8374ac53d944a6820acd136fb1fcb32ed860b57f39cf2b3</citedby><cites>FETCH-LOGICAL-c654t-a4cda6c180cdf471ac8374ac53d944a6820acd136fb1fcb32ed860b57f39cf2b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S2214109X13700688$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,3549,27924,27925,45780</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24748275$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Walker, Richard W, Prof</creatorcontrib><creatorcontrib>Jusabani, Ahmed, MD</creatorcontrib><creatorcontrib>Aris, Eric, MD</creatorcontrib><creatorcontrib>Gray, William K, PhD</creatorcontrib><creatorcontrib>Unwin, Nigel, Prof</creatorcontrib><creatorcontrib>Swai, Mark, MD</creatorcontrib><creatorcontrib>Alberti, George, Prof</creatorcontrib><creatorcontrib>Mugusi, Ferdinand, MD</creatorcontrib><title>Stroke risk factors in an incident population in urban and rural Tanzania: a prospective, community-based, case-control study</title><title>The Lancet global health</title><addtitle>Lancet Glob Health</addtitle><description>Summary Background 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. Methods 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. Findings 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&lt;0·0001), HIV infection (5·61, 2·41–13·09; p&lt;0·0001), a high ratio of total cholesterol to HDL cholesterol (4·54, 2·49–8·28; p&lt;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. Interpretation 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. 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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. Methods 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. Findings 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&lt;0·0001), HIV infection (5·61, 2·41–13·09; p&lt;0·0001), a high ratio of total cholesterol to HDL cholesterol (4·54, 2·49–8·28; p&lt;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. Interpretation 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. Funding The Wellcome Trust.</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>24748275</pmid><doi>10.1016/S2214-109X(13)70068-8</doi><oa>free_for_read</oa></addata></record>
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subjects Aged
Case-Control Studies
Community-Based Participatory Research
Female
HIV Infections - complications
Humans
Incidence
Internal Medicine
Male
Middle Aged
Prospective Studies
Risk Factors
Rural Population
Stroke - epidemiology
Stroke - etiology
Tanzania - epidemiology
Urban Population
title Stroke risk factors in an incident population in urban and rural Tanzania: a prospective, community-based, case-control study
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