Sarti Cinzia, Stegmayr Birgitta, Tolonen Hanna, Mähönen Markku, Tuomilehto Jaakko, Asplund Kjell
Department of Epidemiology and Health Promotion, National Public Health Institute, Mannerheimintie 166, 00300 Helsinki, Finland.
Stroke. 2003 Aug;34(8):1833-40. doi: 10.1161/01.STR.0000081224.15480.52. Epub 2003 Jul 10.
Mortality from stroke has been declining over recent decades in most countries, except in Eastern Europe. In this analysis, based on the World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease (WHO MONICA) Project, we explored to what extent these trends are due to changes in stroke event rate and to changes in case fatality.
The WHO MONICA Project collected standardized data from 14 populations in 9 countries. All acute strokes occurring in men and women 35 to 64 years of age were included. Registration was carried out between 1982 and 1995, resulting in time spans from 7 to 13 years. Trends in event rates and case fatality were calculated as average annual percentage change.
Up to 6-fold differences were observed in stroke mortality. Mortality declined in 8 of 14 populations in men and in 10 of 14 populations in women. An increase in mortality was observed in Eastern Europe. In the populations with a declining trend, about two thirds of the change could be attributed to a decline in case fatality. In populations with increasing mortality, the rise was explained by an increase in case fatality.
In most populations, changes in stroke mortality, whether declining or increasing, were principally attributable to changes in case fatality rather than changes in event rates. Whether this was due to changes in the management of stroke or changes in disease severity cannot be established on the basis of these results.
除东欧外，近几十年来大多数国家的卒中死亡率一直在下降。在这项基于世界卫生组织心血管疾病监测趋势和决定因素（WHO MONICA）项目的分析中，我们探讨了这些趋势在多大程度上归因于卒中事件发生率的变化和病死率的变化。
WHO MONICA项目从9个国家的14个人群中收集了标准化数据。纳入所有35至64岁男性和女性发生的急性卒中。登记工作在1982年至1995年期间进行，时间跨度为7至13年。事件发生率和病死率的趋势以平均年度百分比变化来计算。
观察到卒中死亡率存在高达6倍的差异。男性14个人群中有8个死亡率下降，女性14个人群中有10个死亡率下降。在东欧观察到死亡率上升。在呈下降趋势的人群中，约三分之二的变化可归因于病死率的下降。在死亡率上升的人群中，上升是由病死率的增加所解释的。
在大多数人群中，卒中死亡率的变化，无论是下降还是上升，主要归因于病死率的变化而非事件发生率的变化。基于这些结果无法确定这是由于卒中管理的变化还是疾病严重程度的变化所致。
