Epidemiology of intracranial stenosis in asymptomatic Asian subjects.

Tang, Suk Yan Amy.Thesis (M.Phil.)--Chinese University of Hong Kong, 2001.Includes bibliographical references (leaves [207]-[227]).Abstracts in English and Chinese.ACKNOWLEDGEMENTSABSTRACTSTABLE OF CONTENTS"LIST OF APPENDIX, TABLES & FIGURES"Chapter CHAPTER ONE --- INTRODUCTION --- p.1Chapter 1.1 --- Cerebrovascular disease --- p.1Chapter 1.1.1 --- Ischemic Stroke --- p.1Chapter 1.1.2 --- Hemorrhagic Stroke --- p.2Chapter 1.2 --- Laboratory diagnosis --- p.3Chapter 1.2.1 --- Transcranial Doppler ultrasonography --- p.4Chapter 1.2.1.1 --- Normal Brain --- p.4Chapter 1.2.1.2 --- Intracranial Large Artery Stenosis --- p.5Chapter 1.3 --- Asymptomatic Intracranial Stenosis --- p.6Chapter CHAPTER TWO --- LITERATURE REVIEW --- p.7Chapter 2.1 --- Global Stroke Facts --- p.7Chapter 2.2 --- Stroke Studies --- p.7Chapter 2.2.1 --- Risk profile of stroke --- p.7Chapter 2.2.2 --- Stroke epidemiological study --- p.8Chapter 2.2.2.1 --- Incidence --- p.8Chapter 2.2.2.2 --- Mortality --- p.10Chapter 2.2.2.3 --- Increased stroke rates with increased age --- p.12Chapter 2.2.2.4 --- Associated disease in stroke subjects --- p.12Chapter 2.2.3 --- Stroke risk factors --- p.13Chapter 2.3 --- Stroke Impact --- p.14Chapter 2.3.1 --- Stroke patients --- p.14Chapter 2.3.2 --- Medical burden --- p.15Chapter 2.3.3 --- Socioeconomic burden --- p.16Chapter 2.4 --- Stroke Prevention --- p.17Chapter 2.5 --- Stroke Facts in Hong Kong --- p.19Chapter 2.6 --- Stroke Facts in China --- p.21Chapter 2.7 --- Asymptomatic Intracranial Stenosis in Asian Subjects --- p.22Chapter 2.7.1 --- Asymptomatic individuals --- p.22Chapter 2.7.2 --- Intracranial occlusive disease --- p.23Chapter 2.8 --- Transcranial Doppler Sonography --- p.25Chapter CHAPTER THREE --- AIM & OBJECTIVES OF THE RESEARCH --- p.30Chapter 3.1 --- Aim of the research --- p.30Chapter 3.2 --- Objectives of this research --- p.30Chapter CHAPTER FOUR --- "CLINIC-BASED CROSS-SECTIONAL SCREENING IN AN URBAN CITY 226}0ؤ HONG KONG, THE PEOPLE'S REPUBLIC OF CHINA" --- p.31Chapter 4.1 --- Background & Purpose --- p.31Chapter 4.2 --- Methods --- p.34Chapter 4.2.1 --- Defining the population --- p.34Chapter 4.2.2 --- Procedures --- p.36Chapter 4.2.2.1 --- Standardized TCD Report Form --- p.39Chapter 4.2.2.2 --- Transcranial Doppler Screening --- p.39Chapter 4.2.2.3 --- Data collected --- p.40Chapter 4.2.3 --- Defining the Risk Factors --- p.43Chapter 4.3 --- Statistical Analyses --- p.45Chapter 4.3.1 --- Research Design --- p.46Chapter 4.3.2 --- Descriptive Summary --- p.46Chapter 4.3.2.1 --- Cross-tabulated between Gender --- p.46Chapter 4.3.2.2 --- Cross-tabulated between Normal & Abnormal MCA status --- p.47Chapter 4.3.3 --- Measures for Association --- p.48Chapter 4.3.3.1 --- Univariate analysis --- p.48Chapter 4.3.3.2 --- Multivariate analysis --- p.48Chapter 4.3.4 --- Modeling the Risks --- p.50Chapter 4.3.5 --- nfluence of the number of associated risk factors on the MCA status --- p.50Chapter 4.4 --- Result --- p.51Chapter 4.4.1 --- Baseline characteristics of all screened subjects by Gender --- p.51Chapter 4.4.1.1 --- Age by Gender --- p.53Chapter 4.4.1.2 --- "Medical History of HT, DM, Hyperlipidemia, IHD, Retinopathy and Albuminuria by Gender" --- p.55Chapter 4.4.1.3 --- Social habit in Smoking by Gender --- p.56Chapter 4.4.1.4 --- Body Mass Index and Waist-to-Hip Ratio by Gender --- p.57Chapter 4.4.2 --- Diseased Middle Cerebral Artery --- p.61Chapter 4.4.3 --- Characteristics between subjects with Normal TCD result and Abnormal TCD result in the MCA status --- p.62Chapter 4.4.3.1 --- Age --- p.64Chapter 4.4.3.2 --- Gender --- p.67Chapter 4.4.3.3 --- "Medical History of HT, DM, Hyperlipidemia, IHD, Retinopathy and Albuminuria" --- p.67Chapter 4.4.3.4 --- Social habit in cigarette smoking --- p.68Chapter 4.4.3.5 --- Body Mass Index and Waist-to-Hip Ratio --- p.71Chapter 4.4.3.6 --- "Other Measurements - on Blood Pressure, Fasting Plasma Glucose, HbAlc, Lipid profiles and Fibrinogen" --- p.79Chapter 4.4.4 --- Unadjusted Odds Ratio --- p.84Chapter 4.4.4.1 --- By contingency table method --- p.84Chapter 4.4.4.2 --- By logistic regression model --- p.86Chapter 4.4.5 --- Adjusted Odds Ratio --- p.92Chapter 4.4.5.1 --- Entering all explanatory variables: --- p.92Chapter 4.4.5.2 --- Using Forward and Backward Stepwise methods with the probability for entry of 0.05 and probability for removal of 0.10: --- p.95Chapter 4.4.5.3 --- Applying the Model-Building Strategy: --- p.100Chapter 4.4.6 --- Comparing the final fitted multiple logistic regression models made by the three approaches ： --- p.103Chapter 4.4.7 --- Probability and Odds derived from the logistic regression model --- p.110Chapter 4.4.8 --- Relationship between the diseased MCA and the number of significant risk indicators that the subjects associated with..… --- p.112Chapter 4.4.8.1 --- Logistic regression analysis on number of risk indicators associated with the MCA status --- p.115Chapter 4.5 --- Discussion --- p.118Chapter 4.5.1 --- Research Design --- p.118Chapter 4.5.1.1 --- Advantage --- p.118Chapter 4.5.1.2 --- Disadvantage --- p.118Chapter 4.5.2 --- Sampling --- p.119Chapter 4.5.3 --- Data collected and Outcome variable classified --- p.119Chapter 4.5.3.1 --- Medical Record - Patients Characteristics --- p.119Chapter 4.5.3.2 --- Transcranial Doppler - Middle Cerebral Artery status --- p.120Chapter 4.5.4 --- Statistical Analyses --- p.121Chapter 4.5.4.1 --- Odds Ratio --- p.121Chapter 4.5.4.2 --- Logistic Regression Model --- p.122Chapter 4.5.4.3 --- Sources of Error --- p.123Chapter 4.5.5 --- Result --- p.125Chapter 4.5.5.1 --- Prevalence --- p.125Chapter 4.5.5.2 --- Risk indicators --- p.126Chapter CHAPTER FIVE --- "POPULATION-BASED CROSS-SECTIONAL SURVEY IN A RURAL VILLAGE OF HENAN, PEOPLE'S REPUBLIC OF CHINA" --- p.134Chapter 5.1 --- Background & Purpose --- p.134Chapter 5.2 --- Methods --- p.135Chapter 5.2.1 --- Defining the Population --- p.135Chapter 5.2.2 --- Procedures --- p.135Chapter 5.2.2.1 --- Standardized Screening Form --- p.136Chapter 5.2.2.2 --- Transcranial Doppler Examination --- p.137Chapter 5.2.3 --- Defining the Risk Factors --- p.137Chapter 5.3 --- Statistical Analyses --- p.140Chapter 5.3.1 --- Research Design --- p.141Chapter 5.3.2 --- Descriptive Summary --- p.141Chapter 5.3.2.1 --- Cross-tabulated between Gender --- p.141Chapter 5.3.2.2 --- Cross-tabulated between With & Without intracranial large artery stenosis --- p.142Chapter 5.3.3 --- Measures for Association --- p.143Chapter 5.3.3.1 --- Univariate analysis --- p.143Chapter 5.3.3.2 --- Multivariate analysis --- p.143Chapter 5.3.4 --- Modeling the Risks --- p.144Chapter 5.3.5 --- Influence of the number of associated risk factors on the prevalence of intracranial large artery stenosis --- p.144Chapter 5.4 --- Result --- p.145Chapter 5.4.1 --- Baseline characteristics of all examined villagers by Gender --- p.145Chapter 5.4.1.1 --- Age by Gender --- p.147Chapter 5.4.1.2 --- "Medical History of HT, DM and Heart disease by Gender" --- p.149Chapter 5.4.1.3 --- Social habit in Cigarette smoking and Alcoholic drinking by Gender --- p.149Chapter 5.4.1.4 --- "Family History of HT, DM, Stroke and Heart disease by Gender" --- p.149Chapter 5.4.1.5 --- Body Mass Index and Waist-to-Hip Ratio by Gender --- p.150Chapter 5.4.2 --- Distribution of the Diseased intracranial artery --- p.154Chapter 5.4.3 --- Characteristics between subjects with and without intracranial large artery stenosis --- p.155Chapter 5.4.3.1 --- Age --- p.157Chapter 5.4.3.2 --- Gender --- p.158Chapter 5.4.3.3 --- "Medical History of HT, DM and Heart disease" --- p.158Chapter 5.4.3.4 --- Social habit in cigarette smoking and alcohol drinking --- p.158Chapter 5.4.3.5 --- "Family History of HT, DM, Stroke and Heart Disease" --- p.159Chapter 5.4.3.6 --- Body Mass Index and Waist-to-Hip Ratio --- p.160Chapter 5.4.3.7 --- Other Measurements - on BP and Urine Glucose --- p.163Chapter 5.4.4 --- Unadjusted Odds Ratio --- p.165Chapter 5.4.4.1 --- By contingency table method --- p.165Chapter 5.4.4.2 --- By logistic regression model --- p.166Chapter 5.4.5 --- Adjusted Odds Ratio --- p.172Chapter 5.4.5.1 --- Entering all explanatory variables: --- p.172Chapter 5.4.5.2 --- Using the Stepwise methods available with the probability for entry is 0.05 and 0.10 for removal: --- p.175Chapter 5.4.5.3 --- Applying the Model-Building Strategy: --- p.180Chapter 5.4.6 --- Comparing the final multiple logistic regression models by the three approaches： --- p.182Chapter 5.4.7 --- Probability and Odds derived from the logistic regression model --- p.189Chapter 5.4.8 --- Relationship between the transcranial Doppler result on Intracranial large artery and the number of significant risk indicators that the subjects associated with --- p.190Chapter 5.4.8.1 --- Logistic Regression Model --- p.192Chapter 5.5 --- Discussion --- p.196Chapter 5.5.1 --- Research Design --- p.196Chapter 5.5.1.1 --- Advantage --- p.196Chapter 5.5.1.2 --- Disadvantage --- p.196Chapter 5.5.2 --- Sampling --- p.197Chapter 5.5.3 --- Data collected and the Outcome variable classified --- p.197Chapter 5.5.3.1 --- Self-Reported - Subjects Characteristics --- p.197Chapter 5.5.3.2 --- Transcranial Doppler - Intracranial Large Artery status --- p.198Chapter 5.5.4 --- Statistical Methods --- p.199Chapter 5.5.4.1 --- Odds Ratio --- p.199Chapter 5.5.4.2 --- Logistic Regression --- p.199Chapter 5.5.4.3 --- Sources of Error --- p.199Chapter 5.5.5 --- Result --- p.200Chapter 5.5.5.1 --- Prevalence --- p.200Chapter 5.5.5.2 --- Risk Indicators --- p.201Chapter CHAPTER SIX --- CONCLUSION --- p.204Chapter 6.1 --- The Clinic-based study of diseased middle cerebral artery among asymptomatic hong kong chinese --- p.204Chapter 6.2 --- The Population-base study of intracranial large artery stenosis among mid-aged & above chinese in rural china --- p.205REFERENCESAPPENDIXAppendix I Neuroimaging - Transcranial Doppler UltrasonographyAppendix II Statistical Methods"Appendix III (a) Standardized TCD report form used in PWH, Hong Kong (b) Standardized Screening Form used In Yuzhou, China"Appendix IV The ICD 9th Revision - Disease of the Circulatory System"Appendix V Prospective Hospital-Based study in Asia, AASAP (a) Standardized Data Collection From used in AASAP"Appendix VI Contributed in published paper