TY - JOUR
T1 - Variations in the prevalence of atrial fibrillation, and in the strength of its association with ischemic stroke, in countries with different income levels
T2 - INTERSTROKE case-control study
AU - Murphy, Robert
AU - Damasceno, Albertino
AU - Reddin, Catriona
AU - Hankey, Graeme J
AU - Iversen, Helle K
AU - Oveisgharan, Shahram
AU - Lanas, Fernando
AU - Czlonkowska, Anna
AU - Langhorne, Peter
AU - Ogunniyi, Adesola
AU - Wasay, Mohammad
AU - Rumboldt, Zvonko
AU - Judge, Conor Stephen
AU - Oguz, Aytekin
AU - Mondo, Charles
AU - Winter, Yaroslav
AU - Rosengren, Annika
AU - Pogosova, Nana
AU - Avezum, Alvaro
AU - Nilanont, Yongchai
AU - Penaherrera, Ernesto
AU - Xavier, Denis
AU - Lopez Jamarillo, Patrio
AU - Wang, Xingyu
AU - Yusuf, Salim
AU - O'Donnell, Martin
PY - 2024/6
Y1 - 2024/6
N2 - BACKGROUND: 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.
AB - BACKGROUND: 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.
KW - Stroke
KW - Atrial fibrillation
KW - Population attributable fraction
UR - https://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=uwapure5-25&SrcAuth=WosAPI&KeyUT=WOS:001152526300001&DestLinkType=FullRecord&DestApp=WOS_CPL
U2 - 10.1177/17474930241227783
DO - 10.1177/17474930241227783
M3 - Article
C2 - 38204182
SN - 1747-4930
VL - 19
SP - 559
EP - 568
JO - International Journal of Stroke
JF - International Journal of Stroke
IS - 5
ER -
