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Research Article
Relationships Between Lifestyle Models with Stroke Occurrence in South Sulawesi, Indonesia

Muhammad Awal, Ridwan Amiruddin, Sukri Palutturi and Anwar Mallongi

Background and Objective: Stroke is a disease condition caused by the interruption of the blood flow supplying the brain; it is a sudden blockage or rupture of blood veins. This condition causes brain tissue to not be exposed to the blood flow of oxygen and nutrients, with the brain becoming damaged. The aim of this research was to determine the model of risk factors for stroke in South Sulawesi. Materials and Methods: This study use observational analytic research with a case control design, which is a study design that epidemiologists use to study relationship concerning the level of exposure to a variety of disease states or other health problems. A case is a stroke patient and the control is someone who is not a stroke patient. This analysis uses odds ratio logistic regression and the value of α = 0.05. Results: The results of this research show the significant association between stroke with hypertension, Odd Ratio (OR) = 4.06, with 95% CI 3.25-5.0; the association of physical activity with the occurrence of stroke, OR = 1.69, with 95% CI 1.29-2.23 and the association of obesity and stroke, OR = 2.00 with 95% CI 1.64-2.47.There is a relationship between smoking and the incidence of stroke, OR = 1.81 with 95% CI 1.42-2.32; however, for stress, p = 0.619 (p>0.05), which means that stress has no relationship with the incidence of stroke, OR = 1.10 with 95% CI 0.75-1.63. Conclusion: To conclude that stroke might be leaded due to the less physical activity, smoking and stressful lifestyle behaviors that end with hypertension. Hypertension is the risk factor that most influences the incidence of stroke compared to other risk factors but all of these risk factors can be eliminated with lifestyle modification.

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  How to cite this article:

Muhammad Awal, Ridwan Amiruddin, Sukri Palutturi and Anwar Mallongi, 2017. Relationships Between Lifestyle Models with Stroke Occurrence in South Sulawesi, Indonesia. Asian Journal of Epidemiology, 10: 83-88.

DOI: 10.3923/aje.2017.83.88

Received: January 10, 2017; Accepted: March 02, 2017; Published: March 15, 2017

Copyright: © 2017. This is an open access article distributed under the terms of the creative commons attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.


Worldwide, fifteen million people are affected by stroke every year, with more than 5 million people dying as a direct result of strokes and 5 million being permanently disabled1. In the USA, the UK and developing countries, stroke is the number three killer after heart disease and cancer1-3.

In addition to being the second leading cause of death, stroke is also the number one cause of disability world widely. This disease has been a global health problem and has become increasingly important, with two-thirds of strokes now occurring in countries that are developing. Globally, at present, there are approximately 80 million people who have suffered a stroke2. There are approximately 13 million new stroke victims each year, of which approximately 4.4 million die within 12 months2. There are approximately 250 million family members related to a person who is a stroke survivor4. During the course of their lives, approximately four out of five families will have one member who is affected stroke2,4.

The number of stroke patients in Indonesia is now at the highest level, making the country the largest state with stroke in Asia. The prevalence of stroke in Indonesia has reached 8.3/1000 population5.This prevalence figure increases with increasing age. Indonesian national data show that stroke is the leading cause of death, with the incidence of stroke/year in Indonesia being 15.4%, gaining approximately 750,000 and with 200,000 of these cases being recurrent strokes5 (South Sulawesi, according to 2013 basic health research data, shows the highest incidence of stroke in Indonesia). Thus, the purpose of this study is to examine the lifestyle factors that affect the incidence of stroke in South Sulawesi.


Locus and research time: This research was conducted in South Sulawesi at the Dr. Wahidin Sudirohusodo General Hospital and the Hasanuddin University Teaching Hospital as the research site; it was performed over 6 months from June-December, 2016.

Research design: This research is an analytic observational study with a case control design, which is a study design that epidemiologists use to study relationships concerning the level of exposure to a variety of disease states or other health problems6.

Population: The population in this research was consisted entirely of 1860 stroke patients who were registered in the medical record in the hospital in 2016. Stroke patients recorded in the medical record from General Hospital Dr. Wahidin Sudirohusodo in Makassar and Hasanuddin University Teaching Hospital who have completed data in accordance with the research variables. However, the controls were non-stroke patients registered in the medical records of the Hasanuddin University Education Hospital who had complete data in accordance with the research variables.

Data collection methods: The data were derived from medical records at the Dr. Wahidin Sudirohusodo General Hospital in Makassar and the Hasanuddin University Teaching Hospital in 2016, with the charging data retrieval observation sheet in the form of a checklist, through observations of patient records by viewing the variables.

Data analysis: A general analysis of the percentage and distribution of each study variable was conducted. The bivariate analysis is the Odds Ratio test to determine the risk of the independent variables on the dependent variable and for multivariate analysis with logistic regression to determine the effect of one or more of the independent variables on the dependent variable. The SPSS version 21 on 7th edition7, software package was used with α = 0.05.


Table 1 shows that the occurrence of stroke is more common in males, with 53.5%; for women, it was 46.5%. In the age group of 50-59, it was 32.1%, for those with a primary school education, it was 32.0%, for housewives, it was 31.2% and for those who were married, it was 94.7%. Based on the chi-square test, then determine the gender, age group, education and marital status of the respondents is homogeneous (p<0.05).

Figure 1 shows that more respondents are suffering from hypertension (61.7%), followed by less physical activity (83.0%), obesity (53.1%), no stress (92.7%) and no smoking (77.4%) respectively. However, the smallest determinant factors to stroke were stress (7.3), no physical activity with (17), hypertension (38.3), obesity (7.3) and smoking (22.6), respectively.

The risk lifestyle factors on the occurrence of stroke in South Sulawesi are illustrated in the following Table 2.

The statistical results obtained with the chi-square test are p = 0.000 (p<0.05), which means that there is a relationship between smoking and the occurrence of stroke, OR = 1.81, with 95% CI 1.42-2.32, which means that smoking is a risk factor of stroke.

Fig. 1:Determinant factors that affect the stroke level in Makassar

Table 1:Characteristics of the respondents based on the occurrence of stroke in South Sulawesi

Table 2:Distribution of the risk of lifestyle factors on the occurrence of stroke in South Sulawesi
*P: Probability, **OR: Odd ration

Table 3:Lifestyle factors that present the greatest risk of stroke in South Sulawesi
*CI: Confidential Interval #B: Beta value, ** Exponential Beta, ##Wald: Degree of significance

The OR value of 1.81 means that the respondents who smoke will have a 1.81 times higher risk of stroke compared to the respondents who do not smoke.

Table 3 shows that the logistic regression results determined that the factor that presents the greatest risk of stroke is hypertension, with OR = 3.58.

An atherosclerotic vascular disease is the leading cause of death worldwide. There are approximately 13 million deaths annually caused by diseases of the blood veins. Worldwide, Coronary Artery Disease (CAD) and stroke account for 12.2% and 9.7% of total deaths per year, respectively. Infark miokard is a main cause of long-term mortality in stroke patients who are still alive, though stroke is the leading cause of disability in the world8.

Hypertension is a target for long-term stroke prevention, but hypertension management procedures should be considered properly; hypertension can be controlled and its management can be planned and structured to prevent a first stroke or stroke recurrence9,10. A decrease in HDL cholesterol is correlated with the occurrence of Acute Ischemic Stroke (AIS) with DM and particularly in the 70 population group, this reduction assists in preventing the incidence of stroke11.

Physical Activity (PA) has potential benefits after stroke or Spinal Cord Injury (SCI), especially in improving the efficiency and functional capacity in the activities of daily living. Presently, many people who could benefit from the PA can be routinely associated with functional capacity and concern for danger12,13.

The prevalence of obesity [defined as in terms of Body Mass Index (BMI)]) among adults in the USA has increased from 13-34% over the last half century. Similar trends have been observed in other countries, although the absolute prevalence of obesity varies. For example, compared to the USA, the obesity rate is now lower in Canada (24%), Germany (23%) and China (4%)14,15.

The obesity is a result of excess energy intake compared to the energy needed by the body, causing the excess energy intake to be stored as fat. Physical activities are one factor that can increase energy needs; thus, when physical activity is low, the likelihood of obesity will increase, whereas medium and high physical activity will reduce the likelihood of obesity16.

In the condition of refraction, obesity causes oxidative stress due to the imbalance proxy and anti-oxidants in the body. Obesity occurs due to excessive lipogenesis and the inhibition of lipolysis lipogenesis is stimulated by a high-carbohydrate diet, which leads to the process of fat deposition and includes the process of synthesis of fatty acids; then, trigliserida synthesis occurs in the heart and energy derived from fat that exceeds the body needs are stored in fatty tissue and the energy derived from carbohydrates and protein that came from food can be stored in the fatty tissue17.

Physical activities are also an important determinant in increased weight because the condition of inactivity can lead to the incidence of overweight. The data show that obesity is more likely in people with light activity, for example, those who spend their spare time just reading and watching television and people who choose to use a motor vehicle instead of walking in doing activities18.

High blood pressure is the only risk factor that can be treated. High blood pressure treatment can decrease the incidence of stroke by half. However, the occurrence of stroke is starting to look less even undiscovered high blood pressure medication that effectively15-18. Hypertension is a main public health problem. The occurrence and prevalence of hypertension have increased at an alarming rate. Hypertension is a main cause of vascular disease. According to the WHO report published in 2012, the prevalence of hypertension in men and women over the age of 25 years was 23.1 and 22.6%, respectively. The number of people who suffer from hypertension is projected to reach 60% in 202519-22.

Some researches suggest that a lifestyle that is not healthy will have a greater risk of developing hypertension, risk factors such as smoking, lack of activity and stress which will eventually lead to stroke. Hypertension is a disease that cannot be separated from the gay life is not healthy to be a precipitating factor the emergence of hypertension, so this needs to be detected early is with regular blood pressure checks and most importantly eliminates the primary disease that became a trigger hypertension19,23.

Some researches show that someone who is overweight has more than 20% and hypercholesterolemia have a greater risk of developing hypertension24. The risk factors are mainly due to a lifestyle that is not healthy. Socio-cultural factors in Indonesian society are different from those in developed countries, so that factors related to the occurrence of hypertension in Indonesia have different possibilities. Performing regular activities (aerobic physical activity for 30-45 min day‾1) is known to be effective in reducing the relative risk of hypertension by 19-30%. Thus, is the case with low respiration cardio fitness in middle age are thought to increase the risk of hypertension by 50%19,25,26.

The implication of this research is to prevent the occurrence of stroke so everyone should keep the pattern of his life, especially physical activity, smoking and stress. The application of this research is the existence of a planned program both individually and government programs to ensure that the lifestyle of the community can be maintained properly.

Limitations of this study:

The secondary data were used; thus, the information obtained was limited
Not all lifestyle factors could be included as research variables


Less physical activity, smoking and stressful lifestyle behaviors can lead to hypertension, leading to a stroke. Hypertension is the risk factor that most influences the incidence of stroke compared to other risk factors, but all of these risk factors can be scaled with lifestyle modification.


This study discovers that less physical activity is the most important lifestyle in the incidence of stroke. Then, combination with smoking can lead to the occurrence of arteriosclerosis, which aggravates the occurrence of hypertension. This study will help the researcher to uncover the critical point of stroke occurrence conclude that stroke still attacks middle-aged individuals but has begun to shift to younger individuals along with lifestyle changes.


Authors would like to thank the director of the Dr. Wahidin Sudirohusodo General Hospital and the Director of the Teaching Hospital of Hasanuddin University.

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