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Proportional Hazard Model for Predicting Stroke Mortality
The First NIDA Business Analytics and Data Sciences Contest/Conferenceวันที่ 1-2 กันยายน 2559 ณ อาคารนวมินทราธิราช สถาบันบัณฑิตพัฒนบริหารศาสตร์
• Prospective cohort study เป็นระเบียบวิธีวิจัย เชิงสังเกต ที่ท าให้ทราบถึงความสัมพันธ์เชิงเหตุผล(causality)• Framingham Heart Study เป็นโครงการวิจัย
prospective cohort study ที่มีชื่อเสียงในระดับโลก
โอกาสพัฒนา
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• Recruited 5,209 men and women between the age of 30 and 62 from the town of Framingham and Massachusetts, began the first round of extensive physical examinations and lifestyle interview since 1948• 5,124 children and their spouses were enrolled in the Farmingham
Offspring Study in 1971
• Their grandchildren were enrolled in 2012
• The study success in identifying the cardiovascular disease (CVD) risk factors
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• The concept of CVD risk factors of their study has become and integral part of the modern medical curriculum and has led to the development of effective treatment and preventive strategies in clinical practice
• Since 1951 the Framingham Heart Study has published in peer reviewed medical journals about 3,169 articles and all of them are very useful for cardiovascular disease control
1. To determine the association of various factors, including demographic characteristics, behavioral, biomedical, environmental, and genetic factors with stroke mortality
2. To construct the stroke mortality model life table in Thailand
วัตถุประสงค์
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• Stroke definition • The world Health Organization (WHO) has recommened standard
definition for stroke or cerebrovascular disease in medical term, that is “A focal (or at times global) neurological impairment of sudden onset, and lasting more than 24 hours (or leading to death), and of presumed vascular origin”
• The International Statistical Classification of Diseases and Related Health Problems Tenth revision (ICD-10) has stated stroke in Chapter IX as diseases of circulation system and defined ICD-10 code I60-I69 for cerebrovarcular diseases
การทบทวนวรรณกรรม
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• Types of stroke There are two main types of stroke1. Ischemic stroke
Ischemic is the more common type of stroke. An ischemic stroke occurs if an artery supplies oxygen-rich blood to the brain becomes blocked. Blood clots often cause the blockages that lead to ischemic strokes.
2. Hemorrhagic strokehemorrhagic stroke occurred if an artery in the brain leaks blood or ruptures (break open). The pressure from the leaked blood damages brain cells.
การทบทวนวรรณกรรม
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• Ischemic stroke (70%)
Types of stroke
Intracerebral hemorrhage (25%)
• Hemorrhagic stroke (30%)
Subaracnoid hemorrhage (5%)26
• No stroke incident data in Thailand
• Stroke prevalence
- Stoke prevalence differed among five geographic region with the
highest prevalence in Bangkok (3.34%) , followed by Central (2.41%),
Southern (2.29%), Northern (1.46%), and Northeastern region (1.09%)
(Hanchaiphiboolkul, 2011)
การทบทวนวรรณกรรม
Studyyear
Age of population
Prevalence/100,000population
1983 > 20 690
1994-1996 > 60 1,120
2004-2006 45-80 1,880
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• Factor affecting / Risk factor WHO has state risk factor as any attribute, characteristic or
exposure of an individual that increases the likelihood of developing a disease or injury
The Australian institute of health and welfare has define the risk factors to health in five groups 1. Demographic risk factors2. Behavioral risk factors3. Biomedical risk factors4. Environment risk factors5. Genetic risk factors
การทบทวนวรรณกรรม
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• Factors affecting /Risk factor of stroke mortality• Global
hypertrophy• Impair glucose tolerance, uric acid, serum potassium and sodium• Urban living
การทบทวนวรรณกรรม
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• Factors affecting /Risk factor of stroke mortality• Thailand
There is less information about stroke mortality risk factors in Thailand. However, Thailand has some strong evidence about stroke prevalence and risk factors• Age, Male gender, Occupation, Education level, Low personal income,
• Study design and population• This dissertation conducted under the Thai Epidemiologic
Stroke (TES) Study • Ongoing community-based Prospective Cohort Study• Enrolled a total of 19,620 general population, • aged 45-80 year olds • from Bangkok and four communities in each geographic regions
of Thailand• stroke free at health status survey period in 2004-2006
• Follow-up until death/withdraws/lost follow-up occurred or study end (31 December 2014)
ระเบียบวิธีวิจัย
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2003 2004 2005 2006 2007 2008- 2012 2013- 2017
Preparation
Baseline survey of health status
Case ascertainment /Follow-up
ActivitiesYear
31 December 201428 July 2004 n = 19,620Person-years = 169,729 33
Study timeline
Study population
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• This dissertation focused on factors which were corrected at baseline health status survey in 2004-2006
1) Demographic factors
sex, age, religion, marital status, socioeconomic status (SES)
2) Behavioral factors
smoking, alcohol drinking, physical activities, snoring, the drug used, contraceptive, hormone replacement, and food consumptions
Measurement of affecting factors
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• Measurement of affecting factorsThis dissertation focused on factors which were corrected at baseline health status survey in 2004-20063) Biomedical factors
obesity, hypertension, diabetes mellitus, hypercholesterolemia, heart disease, depression, and stress
4) Environment factorthe region of living
5) Genetic factorsfamily health history (hypertension, diabetes mellitus, hypercholesterolemia, heart disease)
Measurement of affecting factors
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Ascertainment of mortality
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• competing risk survival analysis
Interesting event (stroke death and other causes of death)
The start time defined as register date and the time end is death/withdraws/lost follow-up date or study end (31 December 2014)
• Double decrement life table
use for cohort death experience
define two ways to exit from the cohort, stroke death and others cause of death
การวิเคราะห์ข้อมูล
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• ใช้เป็นข้อมูลส าคัญในก าหนดนโยบายด้านการป้องกัน โรคหลอดเลือดสมองในประชากรไทย และการติดตามประเมินผล• Stroke service plan