Determining stroke's rank as a cause of death using multicause mortality data.
Determining stroke's rank as a cause of death using multicause mortality data.
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DOI：
10.1161/strokeaha.112.656967
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发表时间：
2012-08
期刊：
影响因子：
8.3
通讯作者：
Morgenstern LB
中科院分区：
文献类型：
--
作者：
Burke JF;Lisabeth LD;Brown DL;Reeves MJ;Morgenstern LB
在美国，中风已经从第二大死亡原因下降到第四大死亡原因，而中风的发病率和病死率却没有大幅下降。我们探讨了这种下降是否可归因于死亡率归因方法的变化。使用2000-2008年的多原因死亡率档案，比较将中风作为潜在死亡原因（UCOD）的报告变化与报告任何提及中风（AMCOD）的死亡证明的变化。此外，还计算了六种主要器官和特定疾病死亡原因的UCOD/AMCOD比率。如果中风死亡率被死亡率归因系统低估，我们假设我们会发现：1。与AMCOD相比，UCOD对卒中的降低幅度更大。与其他死因相比，UCOD/AMCOD比率下降。经年龄调整的中风死亡率，如UCOD（2000年为61 / 10万，2008年为41 / 10万）和AMCOD（102 / 10万，2008年为68）均下降了33%。卒中患者UCOD与AMCOD之比没有随时间变化（2000年为0.595,2008年为0.598）。作为UCOD超过中风的诊断中，UCOD/AMCOD比值的变化太小（肺癌没有变化，慢性下呼吸道疾病从0.49轻微增加到0.52），无法解释中风作为UCOD的下降。死亡归因方法的变化不太可能导致中风作为主要死亡原因的下降。发病率、病死率和死亡率的不一致趋势需要进一步研究。
Stroke has fallen from the second to the fourth leading cause of death in the United States without large declines in stroke incidence or case fatality. We explored whether this decline may be attributable to changes in mortality attribution methodology. Multi-cause mortality files from 2000-2008 were used to compare changes in reporting of stroke as underlying cause of death (UCOD) with changes in death certificates reporting any mention (AMCOD) of stroke. In addition, the UCOD/AMCOD ratio was calculated for the six leading organ and disease-specific causes of death. If stroke mortality is underestimated by the system of mortality attribution we hypothesized that we would find: 1. A greater decline in stroke as UCOD than as AMCOD 2. A decline in the UCOD/AMCOD ratio compared to other causes of death. Age-adjusted death rates for stroke as UCOD (61 per 100,000 in 2000 vs. 41 in 2008) and AMCOD (102 per 100,000 vs. 68) both declined by 33%. The ratio of UCOD to AMCOD for stroke did not change over time (0.595 in 2000 vs. 0.598 in 2008). Changes in UCOD/AMCOD ratio for the diagnoses that surpassed stroke as UCOD were too small (no change for lung cancer, and a slight increase from 0.49 to 0.52 for chronic lower respiratory diseases) to explain stroke’s decline as UCOD. Changes in mortality attribution methodology are not likely responsible for stroke’s decline as a leading cause of death. The discordant trends in incidence, case fatality and mortality require further study.