Ischemic stroke subtypes - A population-based study of incidence rates among blacks and whites
Ischemic stroke subtypes - A population-based study of incidence rates among blacks and whites
复制标题
DOI：
10.1161/01.str.0000129335.28301.f5
复制
发表时间：
2004-07-01
期刊：
影响因子：
8.3
通讯作者：
Broderick, J
中科院分区：
文献类型：
--
作者：
Schneider, AT;Kissela, B;Broderick, J
背景与目的：黑人比白人有过重的中风负担；然而，比较两组缺血性卒中亚型的数据有限，通常涉及相对频率。本研究的目的是比较黑人和白人在一个大的，有代表性的，混血儿人群中的缺血性脑卒中亚型的发病率。方法：大辛辛那提/北肯塔基卒中研究旨在测量所有卒中的发病率和趋势在一个明确的，大的，双种族人群。根据国际疾病分类（第九版）出院代码确定住院病例。院外事件是通过对急诊科入院记录的前瞻性筛查、对验尸官病例的审查以及对所有公共卫生和医院基础初级保健诊所的监测来确定的。采用抽样方案确定疗养院和所有其他初级保健医生办公室的事件。所有可能的病例都进行了详细的图表提取，并经医生复查确认。根据所有可用的临床、实验室和影像学信息，缺血性脑卒中病例被分为以下几类：心栓性、大血管性、小血管性、其他和原因不明的脑卒中。在调整了年龄和性别后，计算并比较了种族特异性发病率，并将其标准化为1990年美国人口。结果：1993年7月1日至1994年6月30日和1956年6月30日期间，研究人群中黑人和白人首次发生缺血性中风。小血管中风和原因不明的中风在黑人中的发病率几乎是黑人的两倍。大血管中风在黑人中的发病率比白人高40%，并且心脏栓塞性中风在黑人中更为常见。结论：与白人相比，黑人缺血性中风的额外负担在不同亚型中并不均匀分布。大血管中风更常见，心脏栓塞性中风在黑人中也很常见，传统上认为在白人中更常见。
Background and Purpose - Blacks have an excess burden of stroke compared with whites; however, data comparing ischemic stroke subtypes among the 2 groups are limited and typically involve relative frequencies. The objective of this study is to compare the incidence rates of ischemic stroke subtypes between blacks and whites within a large, representative, biracial population.Methods - The Greater Cincinnati/Northern Kentucky Stroke Study is designed to measure incidence rates and trends of all strokes within a well-defined, large, biracial population. Hospitalized cases were ascertained by International Classification of Disease (9th revision; ICD-9) discharge codes. Out-of-hospital events were ascertained by prospective screening of emergency department admission logs, review of coroners' cases, and monitoring all public health and hospital-based primary care clinics. A sampling scheme was used to ascertain events from nursing homes and all other primary care physician offices. All potential cases underwent detailed chart abstraction and confirmed by physician review. Based on all available clinical, laboratory, and radiographic information, ischemic stroke cases were subtyped into the following categories: cardioembolic, large-vessel, small-vessel, other, and stroke of undetermined cause. Race-specific incidence rates were calculated and compared after adjusting for age and gender, and standardizing to the 1990 US population.Results - Between July 1, 1993, and June 30, 1994, 1956 first-ever ischemic strokes occurred among blacks and whites in the study population. Small-vessel strokes and strokes of undetermined cause were nearly twice as common among blacks. Large-vessel strokes were 40% more common among blacks than whites, and there was a trend toward cardioembolic strokes being more common among blacks.Conclusions - The excess burden of ischemic strokes among blacks compared with whites is not uniformly spread across the different subtypes. Large-vessel strokes are more common and cardioembolic stroke are as common among blacks, traditionally thought to be more common among whites.