Abstract
Objective
To determine the major risk factors and their interactions of ischemic stroke (IS)
and to develop a classification tree model to predict the incidence risk of IS for
a Chinese population.
Methods
Exhaustive Chi-squared Automatic Interaction Detection (Exhaustive CHAID) algorithm
of classification tree method was applied to build a prediction model for the incidence
risk of IS under the design of 1:1 matched case-control study. The statistics of misclassification
risk was used to evaluate the fitness of the model.
Results
In the prediction model, six variables of physical exercise, history of hypertension,
tea drinking, HDL-c level, smoking status and educational level were in turn selected
as the predictors of IS incidence risk. In the subgroup of lacking of physical exercise,
individuals who had history of hypertension would have a significantly higher IS risk
(92%) than that of the ones who had no history of hypertension (64%). The misclassification
risk estimate of the prediction model was 0.21 with the standard error of 0.02, indicating
that 79% of the cases could be classified correctly based on current prediction model.
Conclusions
Lacking of physical exercise and history of hypertension are identified to be the
prominent predicting variables of IS risk for a hospital population of southern China.
Although CHAID analysis could provide detailed information and insight about interactions
among risk factors of IS, we still need to validate our model and improve the vascular
risk prediction for Chinese subjects in further studies.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the Neurological SciencesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Epidemiology of stroke in Europe: geographic and environmental differences.J Neurol Sci. 2007; 262: 85-88
- Effects of polymorphisms of heat shock protein 70 gene on ischemic stroke, and interaction with smoking in China.Clin Chim Acta. 2007; 384: 64-68
- A role of TNF-alpha gene variant on juvenile ischemic stroke: a case-control study.Eur J Neurol. 2005; 12: 989-993
- Analysis of the XRCC1 gene as a modifier of the cerebral response in ischemic stroke.BMC Med Genet. 2006; 7: 78
- The epidemiology of stroke in the Middle East and North Africa.J Neurol Sci. 2010; 295: 38-40
- Emerging risk factors for ischemic stroke.Neurol Sci. 2003; 24: S11-S12
- Metabolic syndrome and ischemic stroke risk: Northern Manhattan Study.Stroke. 2008; 39: 30-35
- Arterial hypertension and stroke prevention: an update.Clin Exp Hypertens. 2006; 28: 317-326
- Update on stroke.Curr Opin Neurol. 2004; 17: 447-451
- Tooth loss, hypertension and risk for stroke in a Korean population.Atherosclerosis. 2009; 203: 550-556
- Insulin-like growth factor (IGF) I, -II, and IGF binding protein-3 and risk of ischemic stroke.J Clin Endocrinol Metab. 2005; 90: 5937-5941
- The intron 4c allele of the NOS3 gene is associated with ischemic stroke in African Americans.BMC Med Genet. 2007; 8: 76
- Stroke prevention: modifying risk factors.Ther Adv Cardiovasc Dis. 2008; 2: 287-303
- Serum cellular fibronectin and matrix metalloproteinase-9 as screening biomarkers for the prediction of parenchymal hematoma after thrombolytic therapy in acute ischemic stroke: a multicenter confirmatory study.Stroke. 2007; 38: 1855-1859
- Prediction of stroke in the general population in Europe (EUROSTROKE): Is there a role for fibrinogen and electrocardiography?.J Epidemiol Community Health. 2002; 56: i30-i36
- Identification of insulin resistance in Asian Indian adolescents: classification and regression tree (CART) and logistic regression based classification rules.Clin Endocrinol (Oxf). 2009; 70: 717-724
- Logistic regression and CART in the analysis of multimarker studies.Clin Chim Acta. 2008; 394: 1-6
- The use of classification and regression trees in clinical epidemiology.J Clin Epidemiol. 2001; 54: 603-609
- Chi-squared automatic interaction detection analysis and its application in evaluating factors attributing to Chinese university teachers' professional burnout.Di Yi Jun Yi Da Xue Xue Bao. 2003; 23: 1352-1354
- Analysis of intervariable relationships between major risk factors in the development of coronary artery disease: a classification tree approach.Anadolu Kardiyol Derg. 2007; 7: 140-145
- Mechanisms of stroke protection by physical activity.Ann Neurol. 2003; 54: 582-590
- The burden of physical activity-related ill health in the UK.J Epidemiol Community Health. 2007; 61: 344-348
- Healthy lifestyle and the risk of stroke in women.Arch Intern Med. 2006; 166: 1403-1409
- Management of hypertension in acute stroke.Expert Rev Cardiovasc Ther. 2009; 7: 637-646
- Predicting stroke risk in hypertensive patients with coronary artery disease: a report from the INVEST.Stroke. 2008; 39: 343-348
- Tea consumption and ischemic stroke risk: a case-control study in southern China.Stroke. 2009; 40: 2480-2485
- Association of lipid profile with ischemic stroke.Mymensingh Med J. 2009; 18: 131-135
- Low plasma HDL-c, a vascular risk factor in high risk patients independent of LDL-c.Eur J Clin Invest. 2009; 39: 680-688
- High-density lipoprotein cholesterol: an emerging target for stroke treatment.Stroke. 2007; 38: 1104-1109
- Cigarette smoking and risk of stroke in the Chinese adult population.Stroke. 2008; 39: 1688-1693
- Impact of tobacco smoking and smoking cessation on cardiovascular risk and disease.Expert Rev Cardiovasc Ther. 2008; 6: 883-895
- Study on the application of classification tree model in screening the risk factors of malignant tumor.Zhonghua Liu Xing Bing Xue Za Zhi. 2006; 27: 540-543
- General cardiovascular risk profile for use in primary care: the Framingham Heart Study.Circulation. 2008; 117: 743-753
Eichler K, Puhan MA, Steurer J, Bachmann LM. Prediction of first coronary events with the Framingham score: a systematic review. Am Heart J 2007; 153: 722–31, 31 e1-8.
- Evaluation of the Framingham risk score in the European Prospective Investigation of Cancer-Norfolk cohort: does adding glycated hemoglobin improve the prediction of coronary heart disease events?.Arch Intern Med. 2008; 168: 1209-1216
- Multiple biomarkers for the prediction of first major cardiovascular events and death.N Engl J Med. 2006; 355: 2631-2639
- Improving global vascular risk prediction with behavioral and anthropometric factors. The multiethnic NOMAS (Northern Manhattan Cohort Study).J Am Coll Cardiol. 2009; 54: 2303-2311
- Classification and regression tree analysis in public health: methodological review and comparison with logistic regression.Ann Behav Med. 2003; 26: 172-181
- Predicting employment outcomes of rehabilitation clients with orthopedic disabilities: a CHAID analysis.Disabil Rehabil. 2006; 28: 257-270
- Classification tree analysis: a statistical tool to investigate risk factor interactions with an example for colon cancer (United States).Cancer Causes Control. 2002; 13: 813-823
- Classification tree modeling to identify severe and moderate vehicular injuries in young and middle-aged adults.Artif Intell Med. 2009; 45: 1-10
Article info
Publication history
Published online: April 14, 2011
Accepted:
March 18,
2011
Received in revised form:
February 11,
2011
Received:
October 14,
2010
Identification
Copyright
© 2011 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
