Rosamond W D, Folsom A R, Chambless L E, Wang C H, McGovern P G, Howard G, Copper L S, Shahar E
Department of Epidemiology and Collaborative Studies Coordinating Center, University of North Carolina, Chapel Hill, NC27514, USA.
Stroke. 1999 Apr;30(4):736-43. doi: 10.1161/01.str.30.4.736.
Although stroke mortality rates in the United States are well documented, assessment of incidence rates and case fatality are less well studied.
A cohort of 15 792 men and women aged 45 to 64 years from a population sample of households in 4 US communities was followed from 1987 to 1995, an average of 7. 2 years. Incident strokes were identified through annual phone contacts and hospital record searching and were then validated.
Of the 267 incident definite or probable strokes, 83% (n=221) were categorized as ischemic strokes, 10% (n=27) were intracerebral hemorrhages, and 7% (n=19) were subarachnoid hemorrhages. The age-adjusted incidence rate (per 1000 person-years) of total strokes was highest among black men (4.44), followed by black women (3.10), white men (1.78), and white women (1.24). The black versus white age-adjusted rate ratio (RR) for ischemic stroke was 2.41 (95% CI, 1.85 to 3.15), which was attenuated to 1.38 (95% CI, 1.01 to 1.89) after adjustment for baseline hypertension, diabetes, education level, smoking status, and prevalent coronary heart disease. There was a tendency for the adjusted case fatality rates to be higher among blacks and men, although none of the case fatality comparisons across sex or race was statistically significant.
After accounting for established baseline risk factors, blacks still had a 38% greater risk of incident ischemic stroke compared with whites. Identification of new individual and community-level risk factors accounting for the elevated incidence of stroke requires further investigation and incorporation into intervention planning.
尽管美国中风死亡率已有充分记录，但发病率和病死率的评估研究较少。
对来自美国4个社区家庭人口样本中的15792名年龄在45至64岁之间的男性和女性进行队列研究，随访时间从1987年至1995年，平均为7.2年。通过年度电话联系和医院记录检索确定新发中风病例，随后进行验证。
在267例确诊或可能的新发中风病例中，83%（n = 221）被归类为缺血性中风，10%（n = 27）为脑出血，7%（n = 19）为蛛网膜下腔出血。总中风年龄调整发病率（每1000人年）在黑人男性中最高（4.44），其次是黑人女性（3.10）、白人男性（1.78）和白人女性（1.24）。缺血性中风的黑人与白人年龄调整发病率比（RR）为2.41（95%CI，1.85至3.15），在调整基线高血压、糖尿病、教育水平、吸烟状况和冠心病患病率后，该比值降至1.38（95%CI，1.01至1.89）。尽管性别或种族间的病死率比较均无统计学意义，但调整后的病死率在黑人和男性中往往更高。
在考虑既定的基线风险因素后，黑人发生缺血性中风的风险仍比白人高38%。确定导致中风发病率升高的新的个体和社区层面风险因素需要进一步研究，并纳入干预计划。
