Change in Incidence and Long-term Prognosis of Stroke and Acute Myocardial Infarction in Large Scale Population

1988年4月1日至1991年3月31日，冲绳县共登记中风病例4,756例（4,511例，急性心肌梗死1,059例，1992例）（1990年人口普查：122万）。随访调查于1999年3月1日进行。使用死亡证明和（或）居民卡确认了他们的存活。随访对象为脑卒中4363例（96.7%），AMI 958例（96.6%）。在脑卒中患者中，对2218例脑梗死（BI）患者和1589例脑出血（BH）患者进行预后分析。BI患者的平均发病年龄为70岁（男性68岁，女性73岁），BH患者的平均发病年龄为64岁（男性61岁，女性67岁），AMI患者的平均发病年龄为67岁（男性63岁，女性75岁）。BI患者10年累积生存率为39%（男性39岁，女性38岁），BH患者为43%（男性44岁，女性42岁），AMI患者为41%（男性48岁，女性27岁）。BI患者的50%生存率为7.8年（男性7.9年，女性7.3年），BH患者的50%生存率为8.1年（男性8.7年，女性7.3年），AMI患者的50%生存率为7.5年（男性9.8年，女性3.8年）。采用COX比例风险模型进行分析。BI患者死亡的重要预测因素为发病年龄（风险比1.07,95%可信区间1.06-1.08）、男性（风险比1.25,95%可信区间1.05-1.48）、复发（风险比1.63,95%可信区间1.35-1.98）、房颤（风险比1.56,95%可信区间1.26-1.93）、发病时任何意识障碍（风险比1.50,95%可信区间1.25-1）。79)和皮质梗死（相对于陷窝1.31,1.09-1.56）。在BH患者中，年龄（1.05,1.04-1.06）、男性（1.33,1.09-1.60）、复发率（vs首次病例1.43,1.13-1.81）、意识障碍（1.83,1.50-2.23）、病变直径大于6cm（3.03, 2.39-3.83）。AMI患者的发病年龄（风险比1.06,95%可信区间1.05 ~ 1.08）、男性（风险比1.11,0.86 ~ 1.43）、高血压史（风险比1.68,1.32 ~ 2.14）、Q波梗死（与非Q比0.60,0.48 ~ 0.77）、Killip分级（每分级上升1.51,1.36 ~ 1.66）。1988年4月1日至1991年3月31日期间，卒中和急性心肌梗死的年龄调整发病率（每100万人每年）分别为141例（男性187例，女性108例）和32例（男性52例，女性16例）。1999年是在病例确认过程中。少

A total of 4,756 strokes cases (4,511 patients and 1,059 acute myocardial infarction (AMI) cases 1992 patients) were registered between April 1, 1988 and March 31, 1991 in Okinawa (1990 census population: 1.22 million).Follow-up survey was done at March 1, 1999. Their survival was confirmed using the death certificate and/or resident card.The subjects followed were 4,363 patients (96.7%) in stroke patients and 958 patients (96.6%) in AMI. Among stroke patients, 2,218 patients with brain infarction (BI) and 1,589 patients with brain hemorrhage (BH) were analyzed for prognosis.The mean age at onset was 70 years (men 68 and women 73) in patients with BI, 64 years (men 61 and women 67) in patients with BH and 67 years (men 63, women 75) in patients with AMI. The cumulative survival rate at 10-years was 39% (men 39 and women 38) in patients with BI, 43% (men 44 and women 42) in patients with BH and 41% (men 48, women 27) in patients with AMI. Fifty percent survival was 7.8 years (men 7.9 an … More d women 7.3) in patients with BI, 8.1 years with BH (men 8.7 and women 7.3) in patients with BH, and 7.5 years (men 9.8, women 3.8) in patients with AMI.COX proportional hazard model was applied for analysis.Significant predictors of death in patients with BI were age at onset (Risk Ratio 1.07, 95% confidence interval 1.06-1.08), men (vs women 1.25, 1.05-1.48), recurrence (vs first-ever 1.63, 1.35-1.98), atrial fibrillation (1.56, 1.26-1.93), any consciousness disturbance at onset (1.50, 1.25-1 .79), and cortical infarction (vs lacuna 1.31, 1.09-1.56). That in patients with BH were age (1.05, 1.04-1.06), men (1.33, 1.09-1.60), recurrence (vs firtst-ever 1.43, 1.13-1.81), any consciousness disturbance (1.83, 1.50-2.23), and size of lesion lager than 6cm in diameter (3.03, 2.39-3.83). And that in patients with AMI were age at onset (Risk Ratio 1.06, 95% confidence interval 1.05-1.08), men (1.11, 0.86-1.43), history of hypertension (1.68, 1.32-2.14), Q wave infarction (vs non-Q 0.60, 0.48-0.77), and Killip class (every one class up 1.51, 1.36-1.66).Age-adjusted incidence rate (per 1000000 per year) of stroke and AMI between Apr 1, 1988 and Mar 31, 1991 were 141 (men 187, women 108), 32 (men 52, women 16). And that of 1999 was now on case confirming process. Less