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竞争风险模型分析缺血性脑卒中戒烟者复吸的影响因素
Application of Competing Risks Model in Predicting Smoking Relapse Following Ischemic Stroke
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摘要: 目的探讨住院期间戒烟的男性缺血性脑卒中患者出院后复吸的影响因素。方法纳入2010~2014年入住koko体育app 华西医院神经内科的155例男性缺血性脑卒中戒烟患者进行前瞻性随访研究。采用Kaplan-Meier法和竞争风险法估计患者复吸的长期趋势，采用竞争风险回归模型探讨复吸的影响因素。结果采用Kaplan-Meier方法计算的累积风险率高于竞争风险计算的累积风险率。考虑竞争风险的情况下，患者出院后4年的累积复吸率为43.1%，并且在出院后3个月、6个月和45个月复吸的风险相对较大。竞争风险回归模型分析结果提示：未婚者（P<0.01）、公共场所有被动吸烟者（P=0.01）、每日吸烟数超过20支者（P=0.02）出院后更可能发生复吸。结论在有竞争风险存在的情况下，宜使用竞争风险模型进行分析。针对上述特征幸存者应给予更多的关注或干预措施；同时应加强公共场所禁烟政策的实施。Abstract: Objective To determine factors associated with smoking relapse in men who survived from their first stroke. Methods Data were collected through face to face interviews with stroke patients in the hospital, and then repeated every three months via telephone over the period from 2010 to 2014. Kaplan-Meier method and competing risk model were adopted to estimate and predict smoking relapse rates. Results The Kaplan-Meier method estimated a higher relapse rate than the competing risk model. The four-year relapse rate was 43.1% after adjustment of competing risk. Exposure to environmental tobacco smoking outside of home and workplace (such as bars and restaurants) (P=0.01), single (P<0.01), and prior history of smoking at least 20 cigarettes per day (P=0.02) were significant predictors of smoking relapse. Conclusion When competing risks exist, competing risks model should be used in data analyses. Smoking interventions should give priorities to those without a spouse and those with a heavy smoking history. Smoking ban in public settings can reduce smoking relapse in stroke patients.
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