Stroke：研究发现西欧国家近几十年来脑卒中死亡率下降而发病率增高

在西欧，过去几十年里缺血性卒中的死亡率显着下降。年龄性别特异性缺血性卒中的死亡、缺血性卒中发病率、发病后30天病死率和住院后1年死亡率是用来描述新千年里缺血性卒中死亡率改变趋势的重要指标。为了检验缺血性卒中的死亡率和发病率之间的匹配情况，荷兰乌德勒支医学中心Julius生命科学和初级救护中心的IloncaVaartjes博士等人进行了一项研究，研究结果在线发表在2012年12月4日的Stroke杂志上。研究结果发现：近几十年来缺血性卒中的死亡率呈显着下降趋势，但缺血性卒中的发病率并没有改变，甚至有轻微的增加。缺血性卒中是残疾的首要原因。非致死性缺血性卒中的增加趋势为社会带来了巨大的人力和经济负担，应加强缺血性卒中的预防。

研究人员根据死亡年份、性别、年龄对荷兰1980-2010年所有缺血性卒中死亡病例进行分组。节点回归使用于检验某个时间点显着的改变趋势。链接到国家范围内注册，构建一组于1997-2005年因缺血性卒中首次入院的队列，计算年龄性别特异的发病后30天病死率及发病后1年死亡率。根据年龄和性别计算缺血性卒中发病率（包括住院缺血性卒中患者和院外缺血性卒中死亡患者）。使用Mann-Kendall检验进行趋势评价。

研究结果显示：缺血性卒中在1980-2000年死亡率持续下降，某些年龄性别组在1990年代出现了衰减。除年轻男性组外，所有年龄性别组在2000年以后的缺血性卒中死亡率均显着下降。在几乎所有的年龄性别组也可以看到发病后30天病死率和发病后1年死亡率的下降。然而，缺血性卒中的发病率在1997-2005年保持稳定，甚至轻微增加。

该研究发现：近几十年缺血性卒中的死亡率显着下降与非致死性缺血性卒中事件数量的下降并不匹配。这很令人担忧，因为缺血性卒中已经是成人残疾的首要病因，带来了沉重的人力和经济负担。由此可见，目前最重要的是加强缺血性卒中的预防。

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• Stroke：研究发现西欧国家近几十年来脑卒中死亡率下降而发病率增高
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doi: 10.1161/STROKEAHA.112.677724
PMC:
PMID:

Remarkable Decline in Ischemic Stroke Mortality Is not Matched by Changes in Incidence

Vaartjes I, O'Flaherty M, Capewell S, Kappelle J, Bots M.

BACKGROUND AND PURPOSE: In Western Europe, mortality from ischemic stroke (IS) has declined over several decades. Age-sex-specific IS mortality, IS incidence, 30-day case fatality, and 1-year mortality after hospital admission are essential for explaining recent trends in IS mortality in the new millennium. METHODS: Data for all IS deaths (1980-2010) in the Netherlands were grouped by year, sex, and age. A joinpoint regression was fitted to detect points in time at which significant changes in the trends occur. By linking nationwide registers, a cohort of patients first admitted for IS between 1997 and 2005 was constructed and age-sex-specific 30-day case fatality and 1-year mortality were computed. IS incidence (admitted IS patients and out-of-hospital IS deaths) was computed by age and sex. Mann-Kendall tests were used for trend evaluation. RESULTS: IS mortality declined continuously between1980 and 2000 with an attenuation of decline in the 1990s in some of the age-sex groups. A remarkable decline in IS mortality after 2000 was observed in all age-sex groups, except for young men. An improved decline in 30-day case fatality and in 1-year mortality was also observed in almost all age-sex groups. In contrast, IS incidence remained stable between 1997 and 2005 or even increased slightly. CONCLUSIONS: The recent remarkable decline in IS mortality was not matched by a decline in the number of incident nonfatal IS events. This is worrying, because IS is already a leading cause of adult disability, claiming a heavy human and economic burden. Prevention of IS is therefore now of the greatest importance.