Impact of sequential adjustment on the association between metabolic syndrome and stroke: A population-based study in Korea
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Background
Stroke is among the foremost contributors to mortality and lasting disability and continues to place a heavy clinical and societal burden worldwide. Although metabolic syndrome (MetS) is recognized as a contributor to stroke risk, insufficient attention has been paid to how this relationship behaves when potential confounders are entered into the model in a stepwise manner.
Objectives
This study aimed to characterize the relationship between MetS and stroke prevalence using a series of sequentially adjusted models built from the Korea National Health and Nutrition Examination Survey (KNHANES). We explored whether self-rated health is a useful functional indicator for stratifying stroke risk.
Methods
Of the 22,559 KNHANES VIII respondents, 12,536 participants aged ≥19 years and with information required to classify physician-diagnosed stroke (DI3_dg) or define MetS were included in the final analysis. Associations were estimated using complex-sample logistic regression under a sequential adjustment scheme: Model 1 (unadjusted), Model 2 (adjusted for age and sex), Model 3 (further adjusted for educational level and family history of stroke), and Model 4 (additionally incorporating economic activity status and self-rated health).
Results
MetS was associated with an increased risk of stroke in all models: Model 1 (odds ratio [OR] 3.372, 95% confidence interval [CI] 2.443–4.654), Model 2 (OR 1.956, 95% CI 1.396–2.740), Model 3 (OR 1.813, 95% CI 1.292–2.546), and Model 4 (OR 1.636, 95% CI 1.153–2.321). A graded pattern was noted concerning self-rated health, with progressively poorer perceived health corresponding to higher odds of stroke, and the “very poor” category showed substantially elevated odds (OR 9.836 in Model 4).
Conclusions
MetS was independently associated with stroke prevalence even after sequential adjustment. Self-rated health appears to capture both metabolic burden and broader functional health aspects.
