Global, Regional, and Country-Specific Lifetime Risks of Stroke, 1990 and 2016
Global, Regional, and Country-Specific Lifetime Risks of Stroke, 1990 and 2016
复制标题
DOI：
10.1056/nejmoa1804492
复制
发表时间：
2018-12-20
影响因子：
158.5
通讯作者：
Roth, Gregory A.
中科院分区：
文献类型：
--
作者：
Feigin, Valery L.;Nguyen, Grant;Roth, Gregory A.
研究背景在有限数量的选定人群中计算了卒中的终生风险。我们试图估计中风的终身风险在区域，国家和全球水平使用的数据从一个全面的研究流行的主要疾病。方法我们使用全球疾病负担（GBD）研究2016年估计中风发病率和死亡的竞争风险，从任何原因以外的中风，计算累积终身风险的首次中风，缺血性中风，或出血性中风。比较了1990年和2016年的终生风险估计。根据GBD研究中使用的社会人口指数（SDI），将各国划分为五分位数，并在五分位数之间比较风险。使用点估计值和代表估计值周围第2.5和第97.5个象限的不确定性区间进行比较。（95%不确定度区间，23.5 ~ 26.2）;男性的风险为24.7%（95%不确定区间，23.3至26.0），女性的风险为25.1%（95%不确定区间，23.7至26.5）。缺血性卒中的风险为18.3%，出血性卒中的风险为8.2%。在高SDI、中高SDI和低SDI国家，估计的卒中终生风险分别为23.5%、31.1%（最高风险）和13.2%（最低风险）; 95%不确定性区间在这些类别之间没有重叠。根据GBD地区，估计的卒中终生风险最高的是东亚（38.8%）、中欧（31.7%）和东欧（31.6%），风险最低的是撒哈拉以南非洲东部（11.8%）。全球卒中的平均终生风险从1990年的22.8%增加到2016年的24.9%，相对增加了8.9%。（95%不确定度区间，6.2 ~ 11.5）;在计算中考虑了除中风以外的任何原因导致的死亡的竞争风险。结论在2016年，从25岁起，全球终生中风风险在男性和女性中均约为25%。中风的终生风险存在地理差异，东亚、中欧和东欧的风险最高。
BACKGROUNDThe lifetime risk of stroke has been calculated in a limited number of selected populations. We sought to estimate the lifetime risk of stroke at the regional, country, and global level using data from a comprehensive study of the prevalence of major diseases.METHODSWe used the Global Burden of Disease (GBD) Study 2016 estimates of stroke incidence and the competing risks of death from any cause other than stroke to calculate the cumulative lifetime risks of first stroke, ischemic stroke, or hemorrhagic stroke among adults 25 years of age or older. Estimates of the lifetime risks in the years 1990 and 2016 were compared. Countries were categorized into quintiles of the sociodemographic index (SDI) used in the GBD Study, and the risks were compared across quintiles. Comparisons were made with the use of point estimates and uncertainty intervals representing the 2.5th and 97.5th percentiles around the estimate.RESULTSThe estimated global lifetime risk of stroke from the age of 25 years onward was 24.9% (95% uncertainty interval, 23.5 to 26.2); the risk among men was 24.7% (95% uncertainty interval, 23.3 to 26.0), and the risk among women was 25.1% (95% uncertainty interval, 23.7 to 26.5). The risk of ischemic stroke was 18.3%, and the risk of hemorrhagic stroke was 8.2%. In high-SDI, high-middle-SDI, and low-SDI countries, the estimated lifetime risk of stroke was 23.5%, 31.1% (highest risk), and 13.2% (lowest risk), respectively; the 95% uncertainty intervals did not overlap between these categories. The highest estimated lifetime risks of stroke according to GBD region were in East Asia (38.8%), Central Europe (31.7%), and Eastern Europe (31.6%), and the lowest risk was in eastern sub-Saharan Africa (11.8%). The mean global lifetime risk of stroke increased from 22.8% in 1990 to 24.9% in 2016, a relative increase of 8.9% (95% uncertainty interval, 6.2 to 11.5); the competing risk of death from any cause other than stroke was considered in this calculation.CONCLUSIONSIn 2016, the global lifetime risk of stroke from the age of 25 years onward was approximately 25% among both men and women. There was geographic variation in the lifetime risk of stroke, with the highest risks in East Asia, Central Europe, and Eastern Europe.