Changes in case fatality of aneurysmal subarachnoid haemorrhage overtime, according to age, sex, and region: a meta-analysis
Changes in case fatality of aneurysmal subarachnoid haemorrhage overtime, according to age, sex, and region: a meta-analysis
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DOI：
10.1016/s1474-4422(09)70126-7
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发表时间：
2009-07-01
期刊：
影响因子：
48
通讯作者：
Rinkel, Gabriel E.
中科院分区：
文献类型：
--
作者：
Nieuwkamp, Dennis J.;Setz, Larissa E.;Rinkel, Gabriel E.
背景在1997年发表的一项系统性综述中，我们发现1960-95年间蛛网膜下腔出血（SAH）的病死率下降。由于诊断和治疗策略的改善，以及自1995年以来发表的来自以前未研究地区的新研究，我们进行了更新的荟萃分析，以评估病死率和发病率的变化以及根据年龄，性别和region.Methods的差异。1995年和2007年7月。使用新的纳入标准重新评估了之前系统性综述中纳入的研究。病例死亡率随时间的变化以及年龄和性别的影响用加权线性回归进行量化。区域差异进行了分析，线性回归分析，和感兴趣的区域随后被定义为参考区域，并与其他regions.Findings 33研究（其中23发表在1995年或以后）进行了比较，包括描述39个研究周期。这些研究报告了8739例患者，其中7659例[88%]是在1995年之后报告的。在之前的综述中纳入的11项研究不符合当前更严格的纳入标准。1973年至2002年期间，患者的平均年龄从52岁增加到62岁。研究之间的病死率从8.3%到66.7%不等，每年下降0.8%（95%CI 0.2至1.3）。调整性别后，下降幅度不变，但调整年龄后，每年下降0.4%（-0.5至1.2）。日本的病死率比欧洲、美国、澳大利亚和新西兰低11.8%（3.8 - 19.9）。不包括日本的数据，未经调整的病死率每年下降0.6%（0.0至1.1），30年来下降了17%。六项研究报告的病例发病率的数据，但这些都不足以评估随着时间的推移的变化。解释尽管增加了平均年龄的SAH患者，病例死亡率下降了17%，1973年至2002年之间，并显示潜在的重要区域差异。这一减少与采用改进的管理战略相吻合。
Background In a systematic review, published in 1997, we found that the case fatality of aneurysmal subarachnoid haemorrhage (SAH) decreased during the period 1960-95. Because diagnostic and treatment strategies have improved and new studies from previously non-studied regions have been published since 1995, we did an updated meta-analysis to assess changes in case fatality and morbidity and differences according to age, sex, and region.Methods A new search of PubMed with predefined inclusion criteria for case finding and diagnosis identified reports on prospective population-based studies published between January, 1995, and July, 2007. The studies included in the previous systematic review were reassessed with the new inclusion criteria. Changes in case fatality over time and the effect of age and sex were quantified with weighted linear regression. Regional differences were analysed with linear regression analysis, and the regions of interest were subsequently defined as reference regions and compared with the other regions.Findings 33 studies (23 of which were published in 1995 or later) were included that described 39 study periods. These studies reported on 8739 patients, of whom 7659 [88%] were reported on after 1995. 11 of the studies that were included in the previous review did not meet the current, more stringent, inclusion criteria. The mean age of patients had increased in the period 1973 to 2002 from 52 to 62 years. Case fatality varied from 8.3% to 66.7% between studies and decreased 0.8% per year (95% CI 0.2 to 1.3). The decrease was unchanged after adjustment for sex, but the decrease per year was 0.4% (-0.5 to 1.2) after adjustment for age. Case fatality was 11.8% (3.8 to 19.9) lower in Japan than it was in Europe, the USA, Australia, and New Zealand. The unadjusted decrease in case fatality excluding the data for Japan was 0.6% per year (0.0 to 1.1), a 17% decrease over the three decades. Six studies reported data on case morbidity, but these were insufficient to assess changes over time.Interpretation Despite an increase in the mean age of patients with SAH, case-fatality rates have decreased by 17% between 1973 and 2002 and show potentially important regional differences. This decrease coincides with the introduction of improved management strategies.