A retrospective cohort study on the risk of stroke in relation to a priori health knowledge level among people with type 2 diabetes mellitus in Taiwan

BMC Cardiovascular Disorders

Research Article

Hsiao-Yun Hu¹  Po-Wen Ku²  Ya-Ling Lee³  Dachen Chu⁴  Yun-Ju Lai⁵  Yung-Feng Yen⁶ 

[1] Department of Education and Research, Taipei City Hospital, Taipei, Taiwan;Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan;Graduate Institute of Sports and Health, National Changhua University of Education, Changhua, Taiwan;Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan;Department of Dentistry, Taipei City Hospital, Taipei, Taiwan;Department of Dentistry, School of Dentistry, National Yang-Ming University, Taipei, Taiwan;Institute of Public Health and Community Medicine Research Center, National Yang-Ming University, Taipei, Taiwan;Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan;Department of Neurosurgery, Taipei City Hospital, Taiwan, No.145, Zhengzhou Rd., Datong Dist., 10341, Taipei, Taiwan;Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan;School of Medicine, National Yang-Ming University, Taipei, Taiwan;Division of Endocrinology and Metabolism, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, Nantou, Taiwan;Department of Exercise Health Science, National Taiwan University of Sport, Taichung, Taiwan;School of Medicine, National Yang-Ming University, Taipei, Taiwan;Section of Infectious Diseases, Taipei City Hospital, Taipei City Government, No.145, Zhengzhou Rd., Datong Dist., 10341, Taipei, Taiwan;Department of Health and Welfare, College of City Management, University of Taipei, Taipei, Taiwan;Center for Infectious Disease and Cancer Research, Kaohsiung Medical University, Kaohsiung, Taiwan;

关键词: Type 2 diabetes mellitus;    Stroke;    Health knowledge;    Retrospective cohort study;    Taiwan;   

DOI  :  10.1186/s12872-017-0568-4

 received in 2017-01-24, accepted in 2017-05-14,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundIntervention of diabetes care education with regular laboratory check-up in outpatient visits showed long-term benefits to reduce the risk of macrovascular complications among people with type 2 diabetes. However, research on the level of a priori health knowledge to the prevention of diabetic complications in community settings has been scarce. We therefore aimed to investigate the association of health knowledge and stroke incidence in patients with type 2 diabetes in Taiwan.MethodsA nationally representative sample of general Taiwanese population was selected using a multistage systematic sampling process from Taiwan National Health Interview Survey (NHIS) in 2005. Subjects were interviewed by a standardized face-to-face questionnaire in the survey, obtaining information of demographics, socioeconomic status, family medical history, obesity, health behaviors, and 15-item health knowledge assessment. The NHIS dataset was linked to Taiwan National Health Insurance claims data to retrieve the diagnosis of type 2 diabetes in NHIS participants at baseline and identify follow-up incidence of stroke from 2005 to 2013. Univariate and multivariate Cox regressions were used to estimate the effect of baseline health knowledge level to the risk of stroke incidence among this group of people with type 2 diabetes.ResultsA total of 597 diabetic patients with a mean age of 51.28 years old and nearly half of males were analyzed. During the 9-year follow-up period, 65 new stroke cases were identified among them. Kaplan–Meier curves comparing the three groups of low/moderate/high knowledge levels revealed a statistical significance (p-value of log-rank test <0.01). After controlling for potential confounders, comparing to the group of low health knowledge level, the relative risk of stroke was significantly lower for those with moderate (adjusted hazard ratio [AHR] = 0.63; 95% CI, 0.33–1.19; p-value = 0.15) and high level of health knowledge (AHR = 0.43; 95% CI, 0.22–0.86; p-value = 0.02), with a significant linear trend (p-value = 0.02).ConclusionsAn exposure-response gradient of moderate to high health knowledge levels to the prevention of stroke incidence among people with type 2 diabetes in community was found with 9 years of follow-up in Taiwan. Development and delivery of health education on stroke prevention to people with type 2 diabetes are warranted.

【 授权许可】

CC BY   
© The Author(s). 2017