Population Attributable Fraction of Stroke Risk Factors in Thailand: Utilization of Non-communicable Disease Surveillance Systems

Abstract

In Thailand, stroke is the third leading cause of death. The objective of this study was to measure the impacts of behavioral risk and underlying disease factors on stroke. The study design was a case-cohort study comparing prevalence of demographic characteristics and risk factors between stroke patients and general population. We obtained data of stroke patients and risk factors in general population of 12 provinces from two non-communicable disease surveillance systems to calculate population-attributable fraction: the national health information system for morbidity and mortality surveillance, and the behavioral risk factor surveillance system. Multiple logistic regression, based on weighted data and adjusted for clustering effect in each province, was carried out. It was found that approximately 41.6% (95% CI = 35.1-46.2) of stroke in Thai population was related to hypertension. From an age group-specific model, among those aged 15-34 years, smoking carried the highest population attributable fraction of stroke, 32.7% (95% CI = 3.9-40.4). This study demonstrates that impact measurement of stroke risk factors could help devise stroke prevention and control strategies to tackle influential factors. In Thailand, hypertension control program should be a priority in middle and old age groups whereas smoking prevention should be emphasized in young people.