title: A population-based case-control study of 1250 stroke deaths in rural Bangladesh.
abstract: OBJECTIVE
  There are limited population-based studies to determine the risk factors for stroke in Bangladesh.
  
  
  METHODS
  A health and demographic surveillance system has been maintained in Matlab, Bangladesh (population 223 886, 142 villages in 2008). All adult stroke and injury deaths (2005-2008) were monitored by verbal autopsy. Risk factors for stroke deaths were calculated using a multivariable logistic regression model with adult injury deaths as controls.
  
  
  RESULTS
  A total of 1250 stroke deaths (51% women; mean age 72.3 years, range 20-101) occurred out of 4955 total deaths and were compared with 246 adult injury deaths (47% women, mean age 55.8 years, range 20-100). The population-attributable mortality of stroke was 25.2% based on the verbal autopsy instrument and 17.8% when accounting for the reported sensitivity and specificity of a similar verbal autopsy instrument that has been validated for stroke death. Risk of stroke death was significantly increased with hypertension (OR 7.94, 95% CI 4.44-15.54, P < 0.001), diabetes mellitus (OR 2.54, 1.21-6.21, P = 0.02), and betel consumption (OR 2.36, 1.45-3.80, P < 0.001) when adjusted for age and sex. An increased risk was not observed with heart disease (OR 1.37, 0.45-5.95, P = 0.62), cigarette smoking (OR 1.41, 0.82-2.45, P = 0.22), tobacco powder (OR 1.15, 0.30-7.64, P = 0.86), or cigar/hookah pipe smoking 0.94 (0.45-2.18, P = 0.88) when adjusted for age and sex. There were more strokes in winter (December-March) than summer (June-September) (P < 0.001).
  
  
  CONCLUSIONS
  There is a high modifiable burden of risk factors for adult stroke deaths in rural Bangladesh, most notably including hypertension. Betel consumption may be an under-recognized risk factor for stroke death.
authors.affiliation: Department of International Health, Bloomberg School of Public Health, 600North Wolfe Street, Baltimore, MD 21287, USA. fmateen@jhsph.edu
authors.forename: F J
authors.initials: FJ
authors.lastname: Mateen
authors.forename: M
authors.initials: M
authors.lastname: Carone
authors.forename: N
authors.initials: N
authors.lastname: Alam
authors.forename: P K
authors.initials: PK
authors.lastname: Streatfield
authors.forename: R E
authors.initials: RE
authors.lastname: Black
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001459:Bangladesh / Q000453:epidemiology; D016022:Case-Control Studies; D002423:Cause of Death / Q000639:trends; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods*; D012307:Risk Factors; D012424:Rural Population / Q000639:trends*; D020521:Stroke / Q000453:epidemiology / Q000401:mortality*; D055815:Young Adult