Change in stroke incidence, mortality, case-fatality, severity, and risk factors in Oxfordshire, UK from 1981 to 2004 (Oxford Vascular Study)
Change in stroke incidence, mortality, case-fatality, severity, and risk factors in Oxfordshire, UK from 1981 to 2004 (Oxford Vascular Study)
复制标题
DOI：
10.1016/s0140-6736(04)16405-2
复制
发表时间：
2004-06-12
期刊：
影响因子：
168.9
通讯作者：
Anslow, P
中科院分区：
文献类型：
--
作者：
Rothwell, PM;Coull, AJ;Anslow, P
背景随着人口的快速老龄化，中风的发病率预计会上升。然而，在过去的二十年中，随机试验的结果已经确定了几种有效预防中风的干预措施。为了确定预防策略的实施是否能够抵消脑卒中发病率的预测上升，需要关于脑卒中发病率的时间趋势、主要危险因素和人口老龄化中预防性治疗的使用的可靠数据。我们的目标是获得这些数据。方法我们确定了1981-84年（牛津社区卒中项目；OCSP）和2002-04年（牛津血管研究；OXVASC）期间短暂性脑缺血发作和卒中发生率、危险因素和病前预防治疗使用的变化。结果在476例脑缺血发作或脑卒中患者中，262例脑卒中和93例脑缺血发作为偶发事件。尽管病例确定比OCSP更完整，经年龄和性别调整的首次卒中发病率下降了29%（相对发病率0.71,95% Cl 0.61-0.83, p=0.0002）。原发性脑出血的发生率下降了50%以上（0.47,0.27-0.83,p=0.01），但蛛网膜下腔出血的发生率没有变化（0.83,0.44-1.57,p=0.57）。因此，尽管在OXVASC中，仅由于人口变化（75岁或以上的人增加33%），预计卒中发生率增加28%(366对286)，但观察到的数量下降（262对286）。卒中死亡率（0.63,0.44-0.90,p=0.02）和致残或致死性卒中发生率（0.60,0.50-0.73,p=0.02）均有显著降低
Background The incidence of stroke is predicted to rise because of the rapidly ageing population. However, over the past two decades, findings of randomised trials have identified several interventions that are effective in prevention of stroke. Reliable data on time-trends in stroke incidence, major risk factors, and use of preventive treatments in an ageing population are required to ascertain whether implementation of preventive strategies can offset the predicted rise in stroke incidence. We aimed to obtain these data.Methods We ascertained changes in incidence of transient ischaemic attack and stroke, risk factors, and premorbid use of preventive treatments from 1981-84 (Oxford Community Stroke Project; OCSP) to 2002-04 (Oxford Vascular Study; OXVASC).Findings Of 476 patients with transient ischaemic attacks or strokes in OXVASC, 262 strokes and 93 transient ischaemic attacks were incident events. Despite more complete case-ascertainment than in OCSP, age-adjusted and sex-adjusted incidence of first-ever stroke fell by 29% (relative incidence 0.71, 95% Cl 0.61-0.83, p=0.0002). Incidence declined by more than 50% for primary intracerebral haemorrhage (0.47, 0.27-0.83, p=0.01) but was unchanged for subarachnoid haemorrhage (0.83, 0.44-1.57, p=0.57). Thus, although 28% more incident strokes (366 vs 286) were expected in OXVASC due to demographic change alone (33% increase in those aged 75 or older), the observed number fell (262 vs 286). Major reductions were recorded in mortality rates for incident stroke (0.63, 0.44-0.90, p=0.02) and in incidence of disabling or fatal stroke (0.60, 0.50-0.73, p