Fullerton Heather J, Wu Yvonne W, Zhao Shoujun, Johnston S Claiborne
Department of Neurology, University of California, San Francisco, CA 94143-0114, USA.
Neurology. 2003 Jul 22;61(2):189-94. doi: 10.1212/01.wnl.0000078894.79866.95.
Using a California-wide hospital discharge database, the authors analyzed all first admissions for stroke in children 1 month through 19 years of age from 1991 through 2000. Incidence rates were estimated as the number of first hospitalizations divided by the person-years at risk; case fatality rates were based on in-hospital deaths.
The authors identified 2,278 first admissions for childhood stroke, yielding an annual incidence rate of 2.3 per 100,000 children (1.2 for ischemic stroke, 1.1 for hemorrhagic stroke). Compared with whites, black children were at higher risk of stroke (for ischemic stroke, relative risk [RR] 2.59, 95% CI 2.17 to 3.09, p < 0.0001; subarachnoid hemorrhage [SAH], RR 1.59, CI 1.06 to 2.33, p = 0.02; intracerebral hemorrhage [ICH], RR 1.66, CI 1.23 to 2.13, p = 0.0001). Hispanics, however, had a lower risk of ischemic stroke (RR 0.70, CI 0.60 to 0.82, p < 0.0001) and ICH (RR 0.77, CI 0.64 to 0.93, p = 0.0004), whereas Asians had similar risks as whites. Boys were at higher risk for all stroke types than girls (ischemic stroke, RR 1.25, CI 1.11 to 1.40, p = 0.0002; SAH, RR 1.24, CI 1.00 to 1.53, p = 0.047; ICH, RR 1.34, CI 1.16 to 1.56, p = 0.0001). After eliminating cases with coexisting sickle cell disease, excess stroke risk persisted in blacks; after elimination of trauma, excess stroke risk persisted in boys. Case fatality rates were similar among different ethnic groups. Compared with girls, boys had a higher case fatality rate for ischemic stroke (17 vs 12%; p = 0.002) but not for ICH or SAH.
Rates of hospitalization for stroke are higher among black children and boys; sickle cell disease and trauma do not fully account for these findings.
作者利用加利福尼亚州范围的医院出院数据库，分析了1991年至2000年1个月至19岁儿童首次因中风住院的情况。发病率以首次住院人数除以风险人年数来估算；病死率基于住院死亡人数。
作者确定了2278例儿童中风首次住院病例，年发病率为每10万名儿童2.3例（缺血性中风为1.2例，出血性中风为1.1例）。与白人相比，黑人儿童中风风险更高（缺血性中风，相对风险[RR]2.59，95%可信区间2.17至3.09，p<0.0001；蛛网膜下腔出血[SAH]，RR 1.59，可信区间1.06至2.33，p = 0.02；脑出血[ICH]，RR 1.66，可信区间1.23至2.13，p = 0.0001）。然而，西班牙裔缺血性中风（RR 0.70，可信区间0.60至0.82，p<0.0001）和脑出血（RR 0.77，可信区间0.64至0.93，p = 0.0004）风险较低，而亚洲人与白人风险相似。所有中风类型中男孩的风险均高于女孩（缺血性中风，RR 1.25，可信区间1.11至1.40，p = 0.0002；SAH，RR 1.24，可信区间1.00至1.53，p = 0.047；ICH，RR 1.34，可信区间1.16至1.56，p = 0.0001）。排除合并镰状细胞病的病例后，黑人中风风险仍过高；排除创伤因素后，男孩中风风险仍过高。不同种族的病死率相似。与女孩相比，男孩缺血性中风的病死率更高（17%对12%；p = 0.002），但脑出血或SAH并非如此。
黑人儿童和男孩中风住院率较高；镰状细胞病和创伤不能完全解释这些结果。
