Risk of stroke in children - Ethnic and gender disparities
Risk of stroke in children - Ethnic and gender disparities
复制标题
DOI：
10.1212/01.wnl.0000078894.79866.95
复制
发表时间：
2003-07-22
期刊：
影响因子：
9.9
通讯作者：
Johnston, SC
中科院分区：
文献类型：
--
作者：
Fullerton, HJ;Wu, YW;Johnston, SC
方法：使用加州范围内的医院出院数据库，作者分析了1991年至2000年间所有1个月至19岁的儿童首次入院的中风患者。发病率估计为首次住院人数除以风险人年；病死率以住院死亡为基础。结果：作者确定了2278例首次入院的儿童中风，年发病率为每10万儿童2.3例（缺血性中风1.2例，出血性中风1.1例）。与白人相比，黑人儿童卒中风险较高（缺血性卒中相对危险度[RR] 2.59, 95% CI 2.17 ~ 3.09, p < 0.0001；蛛网膜下腔出血[SAH]， RR 1.59, CI 1.06 ~ 2.33, p = 0.02；脑出血[ICH]， RR 1.66, CI 1.23 ~ 2.13, p = 0.0001）。然而，西班牙裔人缺血性卒中（RR 0.70, CI 0.60 ~ 0.82, p < 0.0001）和脑出血（RR 0.77, CI 0.64 ~ 0.93, p = 0.0004）的风险较低，而亚洲人的风险与白人相似。所有卒中类型中，男孩的风险均高于女孩（缺血性卒中，RR 1.25, CI 1.11 ~ 1.40, p = 0.0002； SAH, RR 1.24, CI 1.00 ~ 1.53, p = 0.047； ICH, RR 1.34, CI 1.16 ~ 1.56, p = 0.0001）。在排除合并镰状细胞病的病例后，黑人的中风风险仍然过高；在消除创伤后，男孩的中风风险仍然过高。不同族裔群体的病死率相似。与女孩相比，男孩缺血性卒中的病死率更高（17% vs 12%; p = 0.002），但脑出血或SAH的病死率不高。结论：黑人儿童和男孩中风住院率较高；镰状细胞病和创伤不能完全解释这些发现。
Methods: Using a California-wide hospital discharge database, the authors analyzed all first admissions for stroke in children 1 month through 19 years of age from 1991 through 2000. Incidence rates were estimated as the number of first hospitalizations divided by the person-years at risk; case fatality rates were based on in-hospital deaths. Results: The authors identified 2,278 first admissions for childhood stroke, yielding an annual incidence rate of 2.3 per 100,000 children (1.2 for ischemic stroke, 1.1 for hemorrhagic stroke). Compared with whites, black children were at higher risk of stroke (for ischemic stroke, relative risk [RR] 2.59, 95% CI 2.17 to 3.09, p < 0.0001; subarachnoid hemorrhage [SAH], RR 1.59, CI 1.06 to 2.33, p = 0.02; intracerebral hemorrhage [ICH], RR 1.66, CI 1.23 to 2.13, p = 0.0001). Hispanics, however, had a lower risk of ischemic stroke (RR 0.70, CI 0.60 to 0.82, p < 0.0001) and ICH (RR 0.77, CI 0.64 to 0.93, p = 0.0004), whereas Asians had similar risks as whites. Boys were at higher risk for all stroke types than girls (ischemic stroke, RR 1.25, CI 1.11 to 1.40, p = 0.0002; SAH, RR 1.24, CI 1.00 to 1.53, p = 0.047; ICH, RR 1.34, CI 1.16 to 1.56, p = 0.0001). After eliminating cases with coexisting sickle cell disease, excess stroke risk persisted in blacks; after elimination of trauma, excess stroke risk persisted in boys. Case fatality rates were similar among different ethnic groups. Compared with girls, boys had a higher case fatality rate for ischemic stroke (17 vs 12%; p = 0.002) but not for ICH or SAH. Conclusions: Rates of hospitalization for stroke are higher among black children and boys; sickle cell disease and trauma do not fully account for these findings.