30-Year Trends in Stroke Rates and Outcome in Auckland, New Zealand (1981-2012): A Multi-Ethnic Population-Based Series of Studies
30-Year Trends in Stroke Rates and Outcome in Auckland, New Zealand (1981-2012): A Multi-Ethnic Population-Based Series of Studies
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DOI：
10.1371/journal.pone.0134609
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发表时间：
2015-08-20
期刊：
影响因子：
3.7
通讯作者：
Bonita, Ruth
中科院分区：
文献类型：
--
作者：
Feigin, Valery L.;Krishnamurthi, Rita V.;Bonita, Ruth
背景 关于基于人群的发病率和死亡率趋势的数据不足，无法确定中风预防策略和医疗保健提供的改进是否成功。本研究的目的是确定新西兰奥克兰 (NZ) 多民族人群 30 年来与中风管理和危险因素相关的发病率和结果（1 年死亡率、28 天病死率）趋势。 方法 1981-1982 年、1991-1992 年、1991-1992 年对新西兰奥克兰成年居民（年龄 >= 15 岁）进行了四项基于人群的中风发病率登记研究。 2002-2003 年和 2011-2012 年。所有这些都使用标准的世界卫生组织（WHO）诊断标准和多个重叠的病例确定来源来确定住院和非住院、致命和非致命的新中风事件。种族始终被自我认定为四个主要群体。假定泊松分布，计算每 10 万人的粗略和年龄调整（世界卫生组织世界人口标准）年发病率和死亡率以及相应的 95% 置信区间 (CI)。结果 在 30 年的研究期间，在四个 12 个月的招募阶段登记了 5400 名新中风患者； 79% 是新西兰/欧洲人，6% 是毛利人，8% 是太平洋人，7% 是亚洲或其他血统。从 1981 年到 2012 年，总体中风发病率和 1 年死亡率分别下降了 23% (95% CI 5%-31%) 和 62% (95% CI 36%-86%)。自 1991 年起，新西兰所有群体的中风发病率和死亡率均有所下降，但毛利人和太平洋人种下降速度最慢，并且中风发生的年龄明显更年轻（平均年龄 60 岁和 62 岁）岁）与新西兰/欧洲人（平均年龄 75 岁）相比。从 1981 年到 2012 年，所有种族群体的 28 天中风病例死亡率也有所下降（总体下降 14%，95% CI 11%-17%）。然而，中风患者病前高血压、心肌梗塞和糖尿病的频率显着增加，但当前吸烟的频率有所下降。 结论 在这一跨越 30 年的独特时间系列研究中，中风发病率、早期病死率和一年死亡率有所下降，但中风风险和结果的种族差异仍然存在，这表明初级中风预防对于减轻这种疾病的负担仍然至关重要。
Background Insufficient data exist on population-based trends in morbidity and mortality to determine the success of prevention strategies and improvements in health care delivery in stroke. The aim of this study was to determine trends in incidence and outcome (1-year mortality, 28-day case-fatality) in relation to management and risk factors for stroke in the multi-ethnic population of Auckland, New Zealand (NZ) over 30-years.Methods Four stroke incidence population-based register studies were undertaken in adult residents (aged >= 15 years) of Auckland NZ in 1981-1982, 1991-1992, 2002-2003 and 2011-2012. All used standard World Health Organization (WHO) diagnostic criteria and multiple overlapping sources of case-ascertainment for hospitalised and non-hospitalised, fatal and non-fatal, new stroke events. Ethnicity was consistently self-identified into four major groups. Crude and age-adjusted (WHO world population standard) annual incidence and mortality with corresponding 95% confidence intervals (CI) were calculated per 100,000 people, assuming a Poisson distribution.Results 5400 new stroke patients were registered in four 12 month recruitment phases over the 30-year study period; 79% were NZ/European, 6% Maori, 8% Pacific people, and 7% were of Asian or other origin. Overall stroke incidence and 1-year mortality decreased by 23% (95% CI 5%-31%) and 62% (95% CI 36%-86%), respectively, from 1981 to 2012. Whilst stroke incidence and mortality declined across all groups in NZ from 1991, Maori and Pacific groups had the slowest rate of decline and continue to experience stroke at a significantly younger age (mean ages 60 and 62 years, respectively) compared with NZ/Europeans (mean age 75 years). There was also a decline in 28-day stroke case fatality (overall by 14%, 95% CI 11%-17%) across all ethnic groups from 1981 to 2012. However, there were significant increases in the frequencies of pre-morbid hypertension, myocardial infarction, and diabetes mellitus, but a reduction in frequency of current smoking among stroke patients.Conclusions In this unique temporal series of studies spanning 30 years, stroke incidence, early case-fatality and 1-year mortality have declined, but ethnic disparities in risk and outcome for stroke persisted suggesting that primary stroke prevention remains crucial to reducing the burden of this disease.