Prognostic factors of first-ever stroke patients in suburban Malaysia by comparing regression models
More details
Hide details
Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Kuala Terengganu, Terengganu, MALAYSIA
Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, MALAYSIA
Faculty of Medicine, Medical Campus, Universiti Sultan Zainal Abidin, Jalan Sultan Mahmud, Kuala Terengganu, Terengganu, MALAYSIA
Pharmacology Unit, Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500 Selangor Darul Ehsan, MALAYSIA
Center for Transdisciplinary Research, Department of Pharmacology, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, 600077, INDIA
Faculty of Health and Life Sciences, INTI International University, Nilai, Negeri Sembilan, MALAYSIA
Faculty of Dentistry, AIMST University, Bedong, Kedah, MALAYSIA
Centre for Global Health Research, Saveetha Medical College and Hospital, Saveetha University, Chennai, Tamil Nadu, INDIA
Online publication date: 2023-09-24
Publication date: 2023-11-01
Electron J Gen Med 2023;20(6):em545
The aim of this study was to compare regression models based on the parameter estimates of prognostic factors of mortality in first-ever stroke patients.

A retrospective study among 432 first-ever stroke patients admitted to Hospital Universiti Sains Malaysia, Kelantan, Malaysia, was carried out. Patient’s medical records were extracted using a standardized data collection sheet. The statistical analyses used for modelling the prognostic factors of mortality were Cox proportional hazards regression, multinomial logistic regression, and multiple logistic regression.

A total of 101 (23.4%) events of death were identified and 331 patients (76.6%) were alive. Despite using three different statistical analyses, the results were very similar in terms of five major aspects of parameter estimates, namely direction, estimation, precision, significance, and magnitude of risk assessment. It was reported slightly better in Cox proportional hazards regression model, especially in terms of the precision of the results.

Given that this study had compared the findings from three different types of advanced statistical methods, this research has clearly yielded that with data of high quality, the selection of appropriate statistical method should not be a worrisome problem for researchers who may not be of expertise in the field of medical statistics.

WHO. World health statistics 2020. World Health Organization; 2020. Available at: https://www.who.int/data/gho/p... ()Accessed: 13 August 2023.
Castro HH, Alencar AP, Benseñor IM, Lotufo P A, Goulart AC. Multimorbidities are associated to lower survival in Ischaemic stroke: Results from a Brazilian stroke cohort (EMMA study). Cerebrovasc Dis. 2017;44(3-4):232-9. https://doi.org/10.1159/000479... PMid:28848194.
Peng Y, Ngo L, Hay K, Alghamry A, Colebourne K, Ranasinghe I. Long-term survival, stroke recurrence, and life expectancy after an acute stroke in Australia and New Zealand from 2008-2017: A population-wide cohort study. Stroke. 2022;53(8):2538-48. https://doi.org/10.1161/STROKE... PMid:35418238.
Ekker MS, Boot EM, Singhal AB, et al. Epidemiology, aetiology, and management of ischaemic stroke in young adults. Lancet Neurol. 2018;17(9):790-801. https://doi.org/10.1016/S1474-... PMid:30129475.
Barlas RS, Honney K, Loke YK, et al. Impact of hemoglobin levels and anemia on mortality in acute stroke: Analysis of UK regional registry data, systematic review, and meta-analysis. J Am Heart Assoc. 2016;5(8):e003019. https://doi.org/10.1161/JAHA.1... PMid:27534421 PMCid:PMC5015269.
Avan A, Digaleh H, Di Napoli M, et al. Socioeconomic status and stroke incidence, prevalence, mortality, and worldwide burden: An ecological analysis from the global burden of disease study 2017. BMC Med. 2019;17(1):191. https://doi.org/10.1186/s12916... PMid:31647003 PMCid:PMC6813111.
Kooi CW, Peng HC, Aziz ZA, Looi I. A review of stroke research in Malaysia from 2000-2014. Med J Malaysia. 2016;71(Supplement 1):58-69.
Bolayir A, Gokce SF, Cigdem B, et al. Monocyte/high-density lipoprotein ratio predicts the mortality in ischemic stroke patients. Neurol Neurochir Pol. 2018;52(2):150-5. https://doi.org/10.1016/j.pjnn... PMid:28864326.
Aminov A, Rogers JM, Middleton S, Caeyenberghs K, Wilson PH. What do randomized controlled trials say about virtual rehabilitation in stroke? A systematic literature review and meta-analysis of upper-limb and cognitive outcomes. J Neuroeng Rehabil. 2018;5(1):29. https://doi.org/10.1186/s12984... PMid:29587853 PMCid:PMC5870176.
Russell JB, Charles E, Conteh V, Lisk DR. Risk factors, clinical outcomes and predictors of stroke mortality in Sierra Leoneans: A retrospective hospital cohort study. Ann Med Surg (Lond). 2020;60:293-300. https://doi.org/10.1016/j.amsu... PMid:33204420 PMCid:PMC7649580.
Ryan TP. Sample size determination and power. Toronto, ON: John Wiley & Sons; 2013. https://doi.org/10.1002/978111....
Naing NN. A practical guide on determination of sample size in medical and health sciences research. Kelantan, Malaysia: Pustaka Aman Press; 2014.
Singh RJ, Chen S, Ganesh A, Hill MD. Long-term neurological, vascular, and mortality outcomes after stroke. Int J Stroke. 2018;13(8):787-96. https://doi.org/10.1177/174749... PMid:30160619.
Hosmer DW, Lemeshow S, May S. Applied survival analysis: Regression modeling of time-to-event data. Hoboken, NJ: John Wiley & Sons, Inc; 2008. https://doi.org/10.1002/978047....
Hosmer DW, Lemeshow S. Applied logistic regression. New York City, NY: John Wiley & Sons, Inc; 2000. https://doi.org/10.1002/047172... PMid:10886529.
Sargolzaie N, Kiani M, Salari M, Khosravi M. Top ten causes of death and life expectancy in Zahedan (South-East Iran) in 2014. Glob J Health Sci. 2016;9(6):135. https://doi.org/10.5539/gjhs.v....
Khoo S, Poh BK, Suhaimi SA, Chong KH, Ramirez Varela A. Physical activity promotion in Malaysia: Challenges and opportunities. Front Public Health. 2020;8:536239. https://doi.org/10.3389/fpubh.... PMid:33194945 PMCid:PMC7652762.
Rolden HJA. Population ageing and health care expenditure [Doctoral dissertation]. Leiden: Leiden University; 2016.
Greenland S, Senn SJ, Rothman KJ, et al. Statistical tests, P values, confidence intervals, and power: A guide to misinterpretations. Eur J Epidemiol. 2016;31:337-50. https://doi.org/10.1007/s10654... PMid:27209009 PMCid:PMC4877414.
Brown KA, Daneman N, Stevens VW, et al. Integrating time-varying and ecological exposures into multivariate analyses of hospital-acquired infection risk factors: A review and demonstration. Infect Control Hosp Epidemiol. 2016;37(4):411-9. https://doi.org/10.1017/ice.20... PMid:26880280.
Fang C, Zhu T, Zhang P, Xia L, Sun C. Risk factors of neurosurgical site infection after craniotomy: A systematic review and meta-analysis. Am J Infect Control. 2017; 45(11):e123-34. https://doi.org/10.1016/j.ajic... PMid:28751035.
Ge ML, Simonsick EM, Dong BR, Kasper JD, Xue QL. Frailty, with or without cognitive impairment, is a strong predictor of recurrent falls in a US population-representative sample of older adults. J Gerontol A Biol Sci med Sci. 2021; 76(11):e354-60. https://doi.org/10.1093/gerona... PMid:33721909 PMCid:PMC8562403.
Fekete M, Szarvas Z, Fazekas-Pongor V, et al. Nutrition strategies promoting healthy aging: From improvement of cardiovascular and brain health to prevention of age-associated diseases. Nutrients. 2022;15(1):47. https://doi.org/10.3390/nu1501... PMid:36615705 PMCid:PMC9824801.
Hartley P, Forsyth F, O’Halloran A, Kenny RA, Romero-Ortuno R. Eight-year longitudinal falls trajectories and associations with modifiable risk factors: Evidence from The Irish longitudinal study on ageing (TILDA). Age Ageing. 2023;52(3):afad037. https://doi.org/10.1093/ageing... PMid:36995137 PMCid:PMC10061938.
Guo X, Pei J, Ma Y, et al. Cognitive frailty as a predictor of future falls in older adults: A systematic review and meta-analysis. J Am Med Dir Assoc. 2022;24(1):38-47. https://doi.org/10.1016/j.jamd... PMid:36423679.
Journals System - logo
Scroll to top