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Discover high-risk factor combinations using Bayesian network from cohort data of National Stoke Screening in China

Xuemeng Li¹, Jianfei Pang¹, Mei Li²

¹Information Center, Academy of Military Medical Sciences, Beijing, China.

BMC Medical Informatics and Decision Making

|April 10, 2019

Insights

Improving stroke prevention in China requires refining preliminary screening. This study found current criteria are insufficient, recommending more precise risk factor evaluation for middle-aged adults to enhance early detection and intervention effectiveness.

Area of Science:

Public Health
Epidemiology
Biostatistics

Background:

Stroke poses a significant economic burden in China, prompting the national stroke screening and intervention program initiated in 2011.
Preliminary screening identifies potential high-risk individuals for further examination, but initial criteria relied on expert experience.
The study addresses the need for more precise risk assessment in preliminary stroke screening, particularly for the middle-aged population.

Purpose of the Study:

To investigate the causality of stroke and identify risk factors in a middle-aged cohort.
To evaluate the existing preliminary screening criteria for stroke risk in China.
To explore the development of more precise 'potential high-risk' evaluation criteria for middle-aged adults within the national program.

Main Methods:

Utilized cohort data from the national stroke screening program between 2013 and 2017.
Included 48,007 individuals aged 40-59, free of stroke at baseline, after data cleaning.
Employed Bayesian networks for developing predictive models of stroke risk.

Main Results:

Identified that stroke incidence can be higher in individuals with specific combinations of two risk factors compared to those with three.
Proposed using the ratio of stroke incidence with risk factor combinations versus without any risk factors as a variable threshold.
Demonstrated that adjusting this threshold can lead to more precise preliminary stroke screening criteria, balancing economy and efficiency.

Conclusions:

Current preliminary stroke screening criteria in China are not sufficiently precise for the middle-aged population.
Recommended incorporating more significant risk factors or specific combinations of two risk factors into preliminary screening.
The study's findings can directly enhance the accuracy and efficiency of China's national stroke screening and intervention program.

Read full analysis

Abstract

Background:

In recent years, the increasing incidence and prevalence of stroke has brought a heavy economic burden on families and society in China. The Ministry of Health of the Peoples' Republic of China initiated the national stroke screening and intervention program in 2011 for stroke prevention and control. In the screening, only those who have been classified to "potential high-risk" group in preliminary screening need further examination and physician confirmation to determine the risk level of stroke in rescreening. However, at the beginning of the program, the "potential high-risk" classification method in the preliminary screening are determined by experts based on their experience. The primary aim of this study is to study the causality of stroke and risk factors in middle-aged population using the cohort data, and to explore whether the stroke screening and intervention program should include more precise "potential high-risk" evaluation criteria for this age group in preliminary screening.

Method:

We use the cohort data of screening between 2013 and 2017 in this study. After data cleaning, the cohort consists of 48,007 people aged from 40 to 59 who are free of stroke at baseline. We use Bayesian networks to develop models.

Result:

The results show that the stroke incidence in middle-aged population with certain two risk factors is higher than some of that with three factors, which is in keeping with our previous study results. We can take the ratio of the stroke incidence with combinations of risk factors and incidence without any of the risk factors as a variable threshold. By adjusting the threshold, we can get precise stroke preliminary screening criteria to achieve a balance between economy and efficiency.

Conclusion:

We find that the criteria used in preliminary screening are not reasonable enough. There is a need for national stroke screening and intervention program to further include some more important risk factors or combinations of two risk factors as classification criteria in the preliminary screening. The results of the study can directly guide stroke screening program in China to make the screening more accurate and efficient.

Keywords:

Bayesian network High-risk factors National Stroke Screening

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