Abstract
从祥丰,刘少博,徐婷玲,王文绢,马吉祥,李剑虹.我国成年人腰围身高比与脑卒中及其亚型发病关系的前瞻性研究[J].Chinese journal of Epidemiology,2021,42(11):2010-2017
我国成年人腰围身高比与脑卒中及其亚型发病关系的前瞻性研究
Relationship between waist-to-height ratio and overall and type specific incidence of stroke in adults in China: a prospective study
Received:August 12, 2020  
DOI：10.3760/cma.j.cn112338-20200812-01064
KeyWord: 腰围身高比  脑卒中  缺血性卒中  出血性卒中  前瞻性队列
English Key Word: Waist-to-height ratio  Stroke  Ischemic stroke  Hemorrhagic stroke  Prospective cohort
FundProject:国家重点研发计划（2018YFC1313900，2018YFC1313904）
Author NameAffiliationE-mail
Cong Xiangfeng National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China  
Liu Shaobo National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China  
Xu Tingling National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China  
Wang Wenjuan National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China  
Ma Jixiang Office of Non-Communicable Diseases and Ageing Health Management, Chinese Center for Disease Control and Prevention, Beijing 102206, China  
Li Jianhong National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China lijianhong@ncncd.chinacdc.cn 
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Abstract:
      目的 分析我国成年人腰围身高比与脑卒中及其亚型发病关联。方法 从2010年中国慢性病监测项目选取60个监测点人群（城市监测点25个、农村监测点35个）作为本次研究对象，共计36 632人。将2010年中国慢性病监测项目数据作为基线数据。2016-2017年进行随访，完成随访者27 762人。采用Cox比例风险回归模型分析腰围身高比与脑卒中及其亚型发病风险比。并按年龄、性别等基线特征进行亚组分析，剔除死亡者和基线糖尿病患者进行敏感性分析。结果 脑卒中分析，共纳入27 112名研究对象，观察到脑卒中事件1 333例；缺血性卒中分析，共纳入26 907名研究对象，观察到缺血性卒中事件1 128例；出血性卒中分析，共纳入25 984名研究对象，观察到出血性卒中事件205例。调整相关混杂因素后，以腰围身高比0~0.45组为参照，脑卒中分析，腰围身高比0.46~0.49、0.50~0.54和≥ 0.55组脑卒中发病风险分别增加21%（HR=1.21，95%CI：1.00~1.46）、26%（HR=1.26，95%CI：1.04~1.53）和60%（HR=1.60，95%CI：1.29~1.99），亚组分析发现，年龄对腰围身高比与脑卒中发病风险存在效应修饰作用（交互P=0.001）；缺血性卒中分析，腰围身高比0.46~0.49、0.50~0.54和≥ 0.55组缺血性卒中发病风险分别增加30%（HR=1.30，95%CI：1.05~1.60）、33%（HR=1.33，95%CI：1.07~1.64）和61%（HR=1.61，95%CI：1.26~2.05），亚组分析发现，年龄对腰围身高比与缺血性卒中发病风险存在效应修饰作用（交互P=0.024）；出血性卒中分析，腰围身高比≥ 0.55组出血性卒中发病风险增加73%（HR=1.73，95%CI：1.02~2.94），0.46~0.49和0.50~0.54组差异无统计学意义。敏感性分析结果未发生变化。结论 控制体重预防脑卒中及其亚型，可将腰围身高比作为体重控制指标之一。尤其重点关注腰围身高比≥ 0.55的年龄<50岁人群，同时不应忽视腰围身高比0.46~0.49人群。
English Abstract:
      Objective To analyze the association between waist-to-height ratio and the overall and type specific incidence of stroke in adults in China. Methods A total of 36 632 people were selected from 60 surveillance sites (25 in urban area and 35 in rural area) in China Chronic Disease Surveillance Project in 2010. The China Chronic Disease Surveillance Project data in 2010 were used as baseline data. A total of 27 762 people were followed up from 2016 to 2017. Cox proportional risk regression model was used to analyze the risk ratio of waist-to-height ratio for the overall and type specific incidence of stroke. Subgroup analyses were performed based on baseline characteristics such as age and sex, and sensitivity analysis was performed by excluding those who died and those with diabetes at baseline survey. Results A total of 27 112 subjects were included in the stroke analysis, and 1 333 stroke events were observed. A total of 26 907 subjects were included in the ischemic stroke analysis, and 1 128 ischemic stroke events were observed. A total of 25 984 subjects were included in the hemorrhagic stroke analysis, and 205 cases of hemorrhagic stroke were observed. After adjusting for relevant confounders and taking group with waist-to-height ratio of 0-0.45 as a reference, the stroke analysis indicated that in groups with waist-to-height ratio of 0.46-0.49, 0.50-0.54 and ≥ 0.55 the risk for stroke increased by 21% (HR=1.21, 95%CI:1.00-1.46), 26% (HR=1.26, 95%CI:1.04-1.53) and 60% (HR=1.60, 95%CI:1.29-1.99) respectively. Subgroup analysis revealed that age specific waist-to-height ratio had modification effect on the risk for stroke (interaction P=0.001). Ischemic stroke analysis indicated that in groups with waist-to-height ratio of 0.46-0.49, 0.50-0.54 and ≥ 0.55 the risk for ischemic stroke increased by 30% (HR=1.30, 95%CI:1.05-1.60), 33% (HR=1.33, 95%CI:1.07-1.64) and 61% (HR=1.61, 95%CI:1.26-2.05) respectively. Subgroup analysis revealed that age specific waist-to-height ratio had modification effect on the risk for ischemic stroke (interaction P=0.024). Hemorrhagic stroke analysis indicated that in group with waist-to-height ratio of ≥ 0.55 the risk for hemorrhagic stroke increased by 73% (HR=1.73, 95%CI:1.02-2.94), but the differences in the risk increase in groups with waist-to-height ratio of 0.46-0.49 and 0.50-0.54 were not significant. The sensitivity analysis showed no changes. Conclusions In the prevention and control of stroke by body weight control, it is necessary to take waist to height ratio as one of the indicators of body weight control. Particular attention needed to be paid to the people aged <50 years with waist-to-height ratio of ≥ 0.55 as well as those with waist-to-height ratio of <0.5 (i.e., 0.46-0.49).
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