Objective To investigate urban and rural differences of the risk factors for high-risk population of stroke in Tianjin area in order to provide the basis for developing regional stroke prevention and control measures.Methods This was a community-based cross-sectional study.From December 2014 to February 2015,the past medical history,family history,and life style of high-risk population of stroke in 2 communities of Tianjin urban and rural communities were inquired on-site,and the physical examination,laboratory examination,and cervical vascular ultrasound examination were conducted.The risk factors and test results of the urban and rural high-risk populations of stroke were compared,and the age and sex were adjusted.Results A total of 2 003 permnanent residents aged over 40 years were enrolled finally,including 334 residents with high risk of stroke;2 051 residents in a rural community,including 471 with high risk of stroke The proportion of the high-risk population of stroke in the rural community was higher than that in the rural community (22.96％ vs.16.67％;x2 =25.189,P＜0.001),and their age was younger than that in the urban community (59.17 ± 9.67 years vs.63.78 ± 8.52 years;t=7.154,P＜ 0.001).The constituent ratios of hyperlipidemia (69.2％ vs.35.7％;x2 =87.694,P ＜ 0.001),diabetes mellitus (29.3％ vs.22.9％;x2 =4.219,P=0.040),family history of stroke (56.6％ vs.42.7％;x2 =15.143,P＜0.001),and history of atrial fibrillation or heart valve disease (47.6％ vs.23.8％;x2 =49.675,P ＜ 0.001) in the high-risk population of stroke of the urban community were significantly higher than those of the rural community.The constituent ratios of overweight (34.1％ vs.49.7％;x2 =19.254,P ＜ 0.001) and smoking (39.8％ vs.63.3％;x2 =43.199,P ＜0.001) were lower than those of the rural community.After adjusting for age and gender,there were still significant differences (all P ＜ 0.005).The constituent ratios of the previous history of stroke or transient ischemic attack in the high-risk population of stroke of the urban community were significantly higher (32.6％ vs.24.2％;x2 =6.936,P =0.004).However,after adjusting age and sex,there was no significant difference (P =0.148).There was no significant difference in the constituent ratios between hypertension (74.9％ vs.75.2％;x2 =0.010,P =0.921) and lack of physical exercise (55.4％ vs.60.9％;x2 =2.477,P=0.116).The systolic blood pressure (139.45 ± 18.85 mmHgvs.143.28± 17.52 mmHg;t=-2.957,P=0.003;1 mmHg=0.133 kPa) and waist circumference (M,IQR;90[85 ～ 97]cm vs.92[86 ～ 98]cm;Z =-2.439,P =0.015) in the high-risk population of stroke of the rural community were significantly higher and more than those of the urban community,while there were no significant differences in diastolic blood pressure,hip circumference,fasting blood glucose,total cholesterol,triglyceride,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,and homocysteine levels (all P＞ 0.05).The constituent ratio of intima-media thickness in the high-risk population of stroke of the rural community was significantly higher than that of the urban community (62.2％ vs.40.7％;x2 =36.255,P ＜0.001).After adjusting for age and sex,there was significant difference (P ＜ 0.001).The plaque detection rate of the rural community and the urban community had a tendency of higher than that of the urban community (23.1％ vs.22.5％;x2 =0.819,P =0.052),but after adjusting for age and sex,there was significant difference (P =0.031).There was significant difference in the eating habits between the residents of urban community and those of the rural community.The constituent ratios of high-salt diet (53.3％ vs.42.8％;x2 =8.583,P =0.003),low intake of fruit (58.4％ vs.46.4％;x2 =11.270,P =0.001),and low intake of milk (84.9％ vs.65.9％;x2 =40.099,P ＜0.001) in the rural high-risk population of stroke were higher.After adjusting for age and sex,there were still significant differences (all P ＜ 0.05).Conclusions Compared with the urban community,the ratio of the rural high-risk population of stroke is higher and younger in Tianjin area.The ratios of risk factors and unhealthy living habits are higher.Therefore,attention should be paid to the prevention and treatment of stroke in rural areas,enhancing health education of the rural residents and actively promoting healthy lifestyle.%目的 探讨天津地区城市和乡村卒中高危人群危险因素的差异,为制定区域性卒中防治措施提供依据.方法 本研究为基于社区的横断面研究,在2014年12月至2015年2月期间对天津地区城市和乡村2个社区的卒中高危人群进行现场问询既往病史、家族史以及生活行为方式,并进行体格检查、实验室检查和颈部血管超声检查,对城市和乡村卒中高危人群的危险因素及检查结果进行比较,并且对年龄和性别进行了校正.结果 最终纳入天津地区城市社区40岁以上常住居民2 003名,其中卒中高危人群334名;乡村社区2 051名,其中卒中高危人群471名.乡村社区卒中高危人群所占比例高于城市社区(22.96％对16.67％;x2=25.189,P＜0.001)而且年龄小于城市社区[(59.17±9.67)岁对(63.78±8.52)岁;t=7.154,P＜0.001].城市社区卒中高危人群高脂血症(69.2％对35.7％;x2=87.694,P＜0.001)、糖尿病(29.3％对22.9％;x2 =4.219,P=0.040)、卒中家族史(56.6％对42.7％;x2 =15.143,P＜0.001)、心房颤动或心脏瓣膜病病史(47.6％对23.8％;x2=49.675,P＜0.001)的构成比均显著高于乡村社区,超重(34.1％对49.7％;x2=19.254,P＜0.001)和吸烟(39.8％对63.3％;x2=43.199,P＜0.001)的构成比低于乡村社区,校正年龄与性别后差异仍有统计学意义(P均＜0.05).城市社区卒中高危人群中既往卒中或短暂性脑缺血发作史的构成比显著较高(32.6％对24.2％x2 =6.936,P=0.004),但校正年龄与性别后丧失统计学意义(P=0.148).高血压(74.9％对75.2％;x2=0.010,P=0.921)和缺乏体力活动(55.4％对60.9％;x2=2.477,P=0.116)的构成比差异无统计学意义.乡村社区卒中高危人群的收缩压[(139.45土18.85)mmHg对(143.28 ±17.52)mmHg;t=-2.957,P=0.003;1 mmHg=0.133 kPa]和腰围[中位数,四分位数间距;90(85 ～ 97) cm对92(86 ～98)cm;Z=-2.439,P=0.015]显著高于和大于城市社区(P＜0.05),而舒张压、臀围、空腹血糖、总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇和高半胱氨酸水平均差异无统计学意义(P均＞0.05).乡村社区卒中高危人群检出内膜-中膜增厚的构成比显著高于城市社区(62.2％对40.7％;x2=36.255,P＜0.001),校正年龄和性别后差异仍有统计学意义(P＜0.00l);乡村社区和城市社区卒中高危人群的斑块检出率有高于城市社区的趋势(23.1％对22.5％;x2 =0.819,P=0.052),但校正年龄和性别后差异有统计学意义(P=0.031).城乡和乡村社区居民的饮食习惯有明显差异,乡村卒中高危人群高盐饮食(53.3％对42.8％;x2=8.583,P=0.003)、水果缺乏(58.4％对46.4％;x2=11.270,P=0.001)及牛奶缺乏(84.9％对65.9％;x2=40.099,P＜0.001)的构成比较高,校正年龄和性别后差异依然有统计学意义(P均＜0.05).结论 与城市社区相比,天津地区乡村卒中高危人群比例更高且更年轻化,危险因素和不良生活习惯比例较高,因此应重视乡村卒中防治,加强乡村居民健康教育,积极提倡健康生活方式.
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