Wolfe C D, Giroud M, Kolominsky-Rabas P, Dundas R, Lemesle M, Heuschmann P, Rudd A
Department of Public Health Sciences, Guy's, King's and St Thomas' School of Medicine, London, UK.
Stroke. 2000 Sep;31(9):2074-9. doi: 10.1161/01.str.31.9.2074.
Comparison of incidence and case-fatality rates for stroke in different countries may increase our understanding of the etiology of the disease, its natural history, and management. Within the context of an aging population and the trend for governments to set targets to reduce stroke risk and death from stroke, prospective comparison of such data across countries may identify what drives the variation in risk and outcome.
Population-based stroke registers, using multiple sources of notification, ascertained cases of first in a lifetime stroke between 1995 and 1997 for all age groups. The study populations were in Erlangen, Germany; Dijon, France; and London, UK. Crude incidence rates were age-standardized to the European population for comparative purposes. Case-fatality rates up to 1 year after the stroke were obtained, and logistic regression adjusting for age group, sex, and pathological subtype of stroke was used to compare survival in the 3 communities.
A total of 2074 strokes were registered over the 3 years. The age-standardized rate to the European population was 100.4 (95% CI 91.7 to 109.1) per 100 000 in Dijon, 123.9 (95% CI 115.6 to 132.2) in London, and 136.4 (95% CI 124.9 to 147.9) in Erlangen. Both crude and adjusted rates were lowest in Dijon, France. The incidence rate ratio, with Dijon as the baseline comparison (1), was 1.21 (95% CI 1.09 to 1.34) in London and 1.37 (95% CI 1.22 to 1.54) in Erlangen (P:<0.0001). There were significant differences in the proportion of the subtypes of stroke between populations, with London having lower rates of cerebral infarction and higher rates of subarachnoid hemorrhage and unclassified stroke (P:<0.001). Case-fatality rates varied significantly between centers at 1 year, after adjustment for age, sex, and subtype of stroke (35% overall, 34% Erlangen, 41% London, and 27% Dijon; P:<0.001).
The impact of stroke is considerable, and the risk of stroke varies significantly between populations in Europe as does the risk of death. The striking differences in survival require clarification but lend weight to the evidence that stroke management may differ between northern and central Europe and influence outcome.
比较不同国家中风的发病率和病死率，可能会增进我们对该疾病病因、自然史及治疗方法的了解。在人口老龄化以及各国政府设定降低中风风险和中风死亡目标的背景下，对各国此类数据进行前瞻性比较，可能会找出导致风险和预后差异的因素。
基于人群的中风登记系统利用多种报告来源，确定了1995年至1997年间所有年龄组首次发生中风的病例。研究人群来自德国埃尔朗根、法国第戎和英国伦敦。为便于比较，将粗发病率按欧洲人口进行年龄标准化。获取中风后1年内的病死率，并使用对年龄组、性别和中风病理亚型进行校正的逻辑回归分析来比较三个社区的生存率。
三年间共登记了2074例中风病例。第戎的年龄标准化发病率（按欧洲人口计算）为每10万人100.4（95%可信区间91.7至109.1），伦敦为123.9（95%可信区间115.6至132.2），埃尔朗根为136.4（95%可信区间124.9至147.9）。法国第戎的粗发病率和校正发病率均最低。以第戎为基线比较（1），伦敦的发病率比值为1.21（95%可信区间1.09至1.34），埃尔朗根为1.37（95%可信区间1.22至1.54）（P<0.0001）。不同人群中风亚型的比例存在显著差异，伦敦的脑梗死发病率较低，蛛网膜下腔出血和未分类中风的发病率较高（P<0.001）。在对年龄、性别和中风亚型进行校正后，各中心1年时的病死率存在显著差异（总体为35%，埃尔朗根为34%，伦敦为41%，第戎为27%；P<0.001）。
中风的影响相当大，欧洲不同人群的中风风险以及死亡风险存在显著差异。生存率的显著差异需要进一步阐明，但这也有力地证明了北欧和中欧的中风治疗方法可能不同，并会影响预后。
