In:
International Journal of Stroke, SAGE Publications
Abstract:
The contribution of atrial fibrillation (AF) to the aetiology and burden of stroke may vary by country income-level. Aims: We examined differences in the prevalence of AF and describe variations in the magnitude of the association between AF and ischaemic stroke by country income-level. Methods In the INTERSTROKE case-control study, participants with acute first ischaemic stroke were recruited across 32 countries. We included 10,363 ischemic stroke cases and 10,333 community or hospital controls who were matched for age, sex and centre. Participants were grouped into high-income (HIC), upper middle-income (subdivided into two groups UMIC1, UMIC2) and lower middle-income (LMIC) countries, based on gross national income. We evaluated the risk factors for AF overall, and by country income-level and evaluated the association of AF with ischaemic stroke. Results AF was documented in 11.9% (n = 1235) of cases and 3.2% (n = 328) of controls. Compared to HIC, the prevalence of AF was significantly lower in UMIC-2 (aOR 0.35, 95% CI 0.29 – 0.41) and LMIC (aOR 0.50, 95% CI 0.41 – 0.60), on multivariable analysis. Hypertension, female sex, valvular heart disease, and alcohol intake were stronger risk factors for AF in lower income countries, and obesity a stronger risk factor in higher income countries. The magnitude of association between AF and ischemic stroke was significantly higher in lower income countries compared to higher income countries. The population attributable fraction for AF and stroke varied by region, and was 15.7% (95% CI 13.7% – 17.8%) in HIC, 14.6% (95% CI 12.3 – 17.1) in UMIC-1, 5.7% (95% CI 4.9% – 6.7%) in UMIC-2 and 6.3% (95% CI 5.3% – 7.3%) in LMIC. Conclusions Risk factors for AF vary by country-income level. AF contributes to stroke burden to a greater extent in higher income countries than in lower income countries, due to a higher prevalence and despite a lower magnitude of odds ratio.
Type of Medium:
Online Resource
ISSN:
1747-4930
,
1747-4949
DOI:
10.1177/17474930241227783
Language:
English
Publisher:
SAGE Publications
Publication Date:
2024
detail.hit.zdb_id:
2211666-7
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