Risk Factors Of Acquired Valvular Heart Disease In Hubei Province

Objectives: This study aims to describe the epidemiologic characteristics of acquired valvular heart disease(AVHD)in natural population of Hubei province and explore the risk factors of AVHD,and to provide reference for the prevention and treatment of AVHD.Methods: The data were based on a cross-sectional multi-stage sampling study of AVHD in natural populations in Hubei province.In this study,a total of 19978 valid questionnaires and physical examination details of participants were collected in the cities of Wuhan,Jingzhou,Shiyan and Enshi.We conducted univariate analyses of factors on AVHD,including gender,age,body mass index(BMI),ethnicity,socioeconomic status,smoking,drinking,family history of cardiovascular diseases.Then we included these statistically significant factors and interaction items into complex sampling multivariate weighted Logistic regression analysis.The variables were screened by stepwise method to establish a final logistic regression model.Results:(1)The crude prevalence rate of AVHD was 0.75% among 19978 subjects.The age-and sex-standardized prevalence of AVHD in Hubei province was 0.71%.(2)Univariate analyses showed that the prevalences of AVHD were significantly different on different levels of the demographic characteristics.The prevalence among males was 0.61%,while the prevalence among females was slightly higher(0.88%,P=0.0251).Among the elderly(?60 years old),the prevalence was 2.38%,which was much higher than that among those under 60(0.33%,P<0.0001).Compared with other ethnic groups(1.00%),the prevalence of Han population is lower(0.69%,P=0.0448).Prevalences in practitioners of agriculture,forestry,animal husbandry and fishery(1.62%),other occupations(such as retired,unemployed,etc.)(1.70%),and civil servants and technical personnels(0.59%)were relatively high,but not in workers(0.28%)and students(0.07%).The prevalence rates were significantly higher among ex-smokers,subjects who have a history of hypertension,who drink at least once a day,subjects with educational status of junior high school and below,those with family monthly income of less than 2000 yuan and those with family history of cardiovascular diseases,which was 2.45%,2.41%,1.32%,1.24%,1.23%,1.16%,respectively(with P values smaller than 0.05).(3)Influencing factors of AVHD were screened through the stepwise selection process,including sex,age,smoking,occupations,family monthly income,family history of cardiovascular diseases,as well as the first-order interaction items of smoking and sex,smoking and age.The complex sampling multivariate Logistic regression analysis showed that family history of cardiovascular diseases was a risk factor(OR=4.378,95%CI: 1.438~13.335);compared with workers,civil servants and technical personnels(OR=2.788,95%CI: 1.133~6.859),practitioners of agriculture,forestry,animal husbandry and fishery(OR=4.143,95%CI:1.683~10.196)and other occupations(OR=3.182,95%CI: 1.280~7.913)accounted for a higher risk of AVHD,but the risk was significantly lower among students(OR=0.240,95%CI:0.065~0.883).(4)Interaction analyses showed strong interactions between smoking and sex,as well as smoking and age.Among the non-smokers,the risk of AVHD was higher among males(OR=4.769,95%CI: 1.605~14.170),and elderly people aged more than 60(OR=1.849,95%CI: 1.097~3.117).Among the current smokers and ex-smokers,there was no statistically significant difference in the risks of AVHD between different age and sex groups.Among females,the risk of AVHD was highest among ex-smokers,and then the non-smokers,with lowest risk among smokers,and risks of AVHD were statistically different between ex-smokers and smokers(P value in the group aged less than 60 was 0.0184,and P value in the group aged more than 60 was 0.0047).Among males,risk of AVHD was highest in the non-smokers,and then the ex-smokers,with lowest risk among smokers.Specially,among elderly males aged more than 60,risks of AVHD among smokers(P<0.0001)and ex-smokers(P=0.0381)were significantly lower than non-smokers.Conclusions: The prevalence rate of AVHD was relatively low in Hubei province.Prevalence rates were statistically different in subjects of different chracteristics.The complex sampling multivariate Logistic regression analysis revealed that risk factors of AVHD were sex,age,smoking,occupations,family monthly income and family history of cardiovascular diseases.In order to take appropriate measures,especially in the primary and secondary prevention,emphasis should be laid on the prevention of the elderly,ex-smoking females,those with moderate family incomes and family history of cardiovascular diseases,as well as civil servants and technical personnels and practitioners of agriculture,forestry,animal husbandry and fishery,in order to achieve the best prevention effect with limited medical resources.