睡眠质量与吸烟对老年卒中的人群归因分数分析OA

Objective To analyze the epidemiological characteristics of stroke among the elderly in Jing'an District,Shanghai,to explore the independent and interactive effects of sleep quality and smoking on stroke in the elderly,and to calculate the population attributable fraction(PAF),so as to provide a scientific basis for formulating primary prevention strategies for stroke in the elderly. Methods A cross-sectional survey was conducted among 2380 permanent residents(residing continuously in Jing'an District for more than 6 months)aged ≥ 60 years in Jing'an District,Shanghai,from April to July 2025 using a multistage stratified random sampling method.Information such as demographic characteristics,stroke prevalence,smoking status,and chronic disease history was collected.The sleep quality of the study participants was assessed using the Pittsburgh sleep quality index(PSQI).Multivariate logistic regression was used to analyze influencing factors of stroke in the elderly and to test the interaction between poor sleep quality(PSQI total score＞7 points)and smoking.The PAF of poor sleep quality and smoking,as well as their combined PAF for stroke in the elderly,was calculated.Two sensitivity analyses were conducted to test the robustness of the results,including adjusting the cutoff for poor sleep quality(PSQI total score＞5 points)and excluding patients with atrial fibrillation. Results A total of 224 stroke patients were included,with a prevalence rate of 9.41％.There were 751 participants(31.55％)with poor sleep quality and 587 smokers(24.66％).After adjusting for confounding factors including age and hypertension history,multivariate logistic regression showed that poor sleep quality(OR 2.782,95％CI 2.082-3.717,P＜0.001)and smoking(OR 1.538,95％CI 1.116-2.120,P=0.009)were independent risk factors for stroke in the elderly,with no significant interaction between the two factors(Pfor interaction=0.791).PAF analysis showed that the PAF of poor sleep quality was 35.99％,the PAF of smoking was 11.71％,and the combined PAF was 43.49％.Sensitivity analyses confirmed robust associations between poor sleep quality and stroke(OR 2.29-3.01),with a combined PAF of 44.02％-45.57％,further confirming the robustness of the results. Conclusions The prevalence of stroke is relatively high among the elderly in Jing'an District,Shanghai.Poor sleep quality and smoking are important risk factors for stroke in this population.This provides a scientific basis for integrating sleep health management into the routine health management system for the elderly and promoting it jointly with tobacco control measures to reduce the stroke burden in this population.