Disparities in Ischemic Stroke Subtypes and Risk Factors between Taiwanese Aborigines and Han Chinese in Taitung, Taiwan

Is the excellent air quality a protective factor of health problems for Taitung County in eastern Taiwan? Perspectives from visual analytics

Taitung, an agricultural country in Eastern Taiwan, was famous for its fresh air with less industrial and petrochemical pollution. Air pollution may induce cardiovascular disease, chronic obstructive pulmonary disease (COPD), asthma, and stroke, poor air quality also resulted in a higher depression rate and less feeling of happiness; therefore, our study aims to use visualization tools to demonstrate the association between air quality index (AQI) and the among negative factors and try to find that whether Taitung got the benefit of good air quality on health issues. We retrieved data from the government of Taiwan and other open sources in the year 2019, then visual maps and generalized association plots with clusters demonstrated the relationship between each factor and each county/city. Taitung had the lowest AQI and asthma attack rate, but AQI had a negative relationship to air pollution-caused death (R = -0.379), happiness index (R = -0.358), and income (R = -0.251). The GAP analysis revealed that smoke and overweight were the nearest to air pollution causing death, also counties and cities were divided into two major clusters initially based on the air pollution-related variables. In conclusion, the World Health Organization (WHO) definition and the weight of each air pollution cause death may not be suitable for Taiwan due to too many confounding factors.

Gender Gap and Risk Factors for Poor Stroke Outcomes: A Single Hospital-Based Prospective Cohort Study

BACKGROUND

This study intended to investigate whether etiological stroke subtypes and their corresponding major risk factors have differential effects on outcomes between genders.

PATIENTS AND METHODS

We enrolled 403 consecutive patients with first-ever acute ischemic stroke (170 women, 233 men), from a referral hospital in Taiwan over a 2-year period. Gender differences in demographics, vascular risk factors, access to health care, etiological stroke subtypes, stroke severity, and outcomes were examined. The primary outcome variable of the study was any unfavorable outcome due to acute ischemic stroke, defined as a modified Rankin Scale score of 3 or higher at 90 days after stroke. Multivariable logistic regression models were used to identify predictors of poor outcomes.

RESULTS

There were no gender disparities in baseline severity, stroke subtypes, access to health care, and medical comorbidities. Although women had poorer outcomes, female gender was not a predictor of unfavorable outcomes. Important predictors included age of 75years or older (odds ratio [OR] = 2.67; 95% confidence interval [CI], 1.46-4.90), National Institutes of Health Stroke Scale greater than or equal to 8 (OR = 8.38; 95% CI, 4.61-15.2), lack of cohabitation (OR = 2.13; 95% CI, 1.26-3.61), subtypes of cardioembolism (OR = 2.76; 95% CI, 1.29-5.93), and large-artery atherosclerosis (OR = 2.93; 95% CI, 1.47-5.85). In subgroup analyses, the gender-specific independent predictors were cardioembolism (OR = 7.42; 95% CI, 2.21-24.9) or atrial fibrillation (OR = 3.57; 95% CI, 1.31-9.74) in women, and large-artery atherosclerosis (OR = 3.35; 95% CI, 1.30-8.64) or symptomatic large-artery stenosis (OR = 3.42; 95% CI, 1.69-6.96) in men. The differential effects of these predictors according to gender were revealed by interaction tests.

CONCLUSION

Atrial fibrillation and symptomatic large-artery stenosis are predictors of poor stroke outcomes in women and men, respectively.