Abstract：
Stroke is a leading cause of death in the United States across all race/ethnicity and sex groups, though disparities exist. We investigated the potential for primary prevention of total first stroke for Americans aged 20 and older, stratified by sex and race/ethnicity. Specifically, we calculated population attributable fractions (PAF) of first stroke for 7 potentially modifiable risk factors: smoking, physical inactivity, poor diet, obesity, hypertension, diabetes, and atrial fibrillation. PAFs are a function of (1) the relative risk of first stroke for people with the exposure and (2) the prevalence of the risk factor in the population. Relative risks came from recent meta-analyses and sex-race/ethnicity-specific prevalence estimates came from the 2015-2018 NHANES or Multi-Ethnic Study of Atherosclerosis (for atrial fibrillation only). Approximately 1/3 (35.7% [CI: 21.6%-49.0%]) for women, 32.7% [CI: 19.2%-45.1%] for men) of strokes were attributable to the 7 risk factors we considered. A 20% proportional reduction in stroke risk factors would result in approximately 37,000 fewer strokes annually in the United States. The estimated PAF was highest for non-Hispanic Black women (39.3% [CI: 24.8%-52.3%]) and lowest for non-Hispanic Asian men (25.5% [CI: 14.6%-36.2%]). For most groups, obesity and hypertension were the largest contributors to stroke rates.
摘要：
中风是美国所有种族/民族和性别群体的主要死亡原因，虽然差距存在。我们调查了20岁及以上的美国人一级预防总首次中风的潜力，按性别和种族/民族分层。具体来说,我们计算了7个潜在可改变的危险因素的首次卒中的人群归因分数（PAF）：吸烟，缺乏身体活动，不良饮食,肥胖，高血压,糖尿病,和心房颤动。PAF是（1）暴露人群首次中风的相对风险和（2）人群中危险因素的患病率的函数。相对风险来自最近的荟萃分析，性别种族/种族特定的患病率估计来自2015-2018年NHANES或多种族动脉粥样硬化研究（仅适用于心房颤动）。女性约1/3（35.7%[CI：21.6%-49.0%]），32.7%[男性CI：19.2%-45.1%]）的中风归因于我们考虑的7个危险因素。在美国,中风风险因素的20%成比例减少将导致每年减少约37,000次中风。非西班牙裔黑人女性的估计PAF最高(39.3%[CI:24.8%-52.3%])，非西班牙裔亚裔男性最低(25.5%[CI:14.6%-36.2%])。对于大多数群体来说,肥胖和高血压是卒中发生率的最大因素.
