Secular trends in mortality by stroke subtype in the 20th century: a retrospective analysis
Secular trends in mortality by stroke subtype in the 20th century: a retrospective analysis
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DOI：
10.1016/s0140-6736(02)11769-7
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发表时间：
2002-12-07
期刊：
影响因子：
168.9
通讯作者：
Ebrahim, S
中科院分区：
文献类型：
--
作者：
Lawlor, DA;Smith, GD;Ebrahim, S
研究背景由于脑梗死和冠心病都是由动脉粥样硬化引起的，因此它们的死亡率有相似的长期趋势。由于鉴别诊断中风亚型的常规死亡证书是不准确的，我们的目的是估计长期的趋势，在整个世纪，英格兰和威尔士，与尸检study.Methods的数据，我们计算了脑梗死脑出血的比率从所有可用的来源，从20世纪世纪的尸检数据。这些数据被用来估计脑梗死出血的比例，每年，因此，估计脑梗死和脑出血的总中风死亡率，从英国国家统计局获得的比率。脑梗塞与脑出血的比率增加了四倍，从1930年代的0.5增加到1990年代的2.0;大部分增加发生在1930年代和1970年代之间。估计的长期趋势表明，在整个世纪，脑出血的死亡率稳步下降，而脑梗死的死亡率在20世纪70年代达到峰值，然后下降。脑梗死死亡率的趋势与冠心病死亡率的趋势密切相关。解释脑梗死和冠心病的密切相关趋势表明有共同的原因，但脑出血的趋势非常不同，表明其原因可能与这些情况有重要区别。
Background Since both cerebral infarction and coronary heart disease are caused by atherosclerosis, they would be expected to have similar secular trends in mortality. Because differential diagnosis of stroke subtype on routine death certificates is inaccurate, we aimed to estimate secular trends in cerebral infarct and haemorrhage throughout the 20th century, for England and Wales, with data from autopsy studies.Methods We calculated the ratio of cerebral infarct to cerebral haemorrhage from all available sources of autopsy data from the 20th century. These data were used to estimate the ratio of cerebral infarct to haemorrhage for every year, and hence to estimate rates of cerebral infarct and cerebral haemorrhage from the total stroke mortality rate, obtained from the UK Office for National Statistics.Findings Data about stroke subtypes from autopsies were available from 1932 to 1999. The ratio of cerebral infarct to cerebral haemorrhage increased fourfold from 0.5 in the 1930s to 2.0 by the 1990s; most of the increase took place between the 1930s and the 1970s. Estimated secular trends suggested that there was a steady fall in mortality from cerebral haemorrhage throughout the 20th century, whereas mortality from cerebral infarct increased to a peak in the 1970s and then fell. Trends in estimated cerebral infarct mortality closely matched those for coronary heart disease mortality.Interpretation The closely related trends in cerebral infarct and coronary heart disease suggest common causes, but the very different trend in cerebral haemorrhage shows that its cause probably differs importantly from these conditions.