The 'epidemiologic necropsy'. Unexpected detections, demographic selections, and changing rates of lung cancer.
The 'epidemiologic necropsy'. Unexpected detections, demographic selections, and changing rates of lung cancer.
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“流行病学尸检”。
DOI：
10.1001/jama.1987.03400030047030
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发表时间：
1987
期刊：
影响因子：
--
通讯作者：
C. Chan
中科院分区：
文献类型：
--
作者：
M. Mcfarlane;A. Feinstein;C. Wells;C. Chan
当某一特定疾病的发病率报告上升时，临床医生往往无法确定该疾病是实际发病率上升，还是由于更好的诊断技术和扩大获得医疗保健的机会而改进了检测。尸检数据的流行病学应用可能有助于回答这些问题，但由于担心在尸检患者的人口统计学和临床选择中存在偏见，因此一直受到抑制。人口统计问题可以通过适当调整和标准化尸检中发现的发病率来管理，而临床问题可以通过研究因其他不相关的临床原因进行的尸检中意外发现疾病的比率来减少或避免。在通过尸检“筛选”的人群中获得的结果可以提示共存并补充疾病报告发生率的“未检测到的水库”的大小。在耶鲁-纽黑文（康涅狄格州）医院1972年至1981年的一项尸检研究中，女性的肺癌尸检检出率略高于男性，而男性和女性的肺癌尸检检出率都明显高于一般人群的常规检出率。结果表明，报告的比率在男女中可能继续上升，直到它们在接近目前未检测到的水库的大小时基本相等。“流行病学尸检”提供了一种潜在的有价值的方法，以帮助区分疾病的真实发生率与可归因于现代技术改进的诊断检测的变化。
When rising rates of occurrence are reported for a particular disease, clinicians often cannot determine whether the disease has increased in actual occurrence or in the improved detection provided by better diagnostic technology and expanded access to medical care. The epidemiologic use of necropsy data, which might help answer these questions, has been inhibited by fears of bias in demographic and clinical selection of patients for necropsy. The demographic problem can be managed by suitable adjustment and standardization of the disease rates found at necropsy, and the clinical problem can be reduced or avoided by studying the rates with which the disease is found unexpectedly in necropsies performed for other, unrelated clinical reasons. The results, obtained in population groups "screened" via necropsy, can suggest the magnitude of the "undetected reservoir" that coexists and supplements the rates of reported occurrence for a disease. In a study of necropsies at Yale-New Haven (Conn) Hospital from 1972 to 1981, the necropsy detection rates for lung cancer were slightly higher for women than for men, and were substantially higher for both genders than the customarily reported rates in the general population. The results suggest that the reported rates may continue to rise in both genders until they become essentially equal at a size approximating that of the currently undetected reservoir. The "epidemiologic necropsy" offers a potentially valuable method to help distinguish the true occurrence rates of disease from the changes attributable to improved diagnostic detection with modern technology.