Riggs J E, Schochet S S
Department of Neurology, West Virginia University School of Medicine, Morgantown.
J Clin Epidemiol. 1992 Sep;45(9):1007-12. doi: 10.1016/0895-4356(92)90116-5.
Over the past 15 yr, a marked increase in crude mortality rates from Parkinson's disease (PD) and amyotrophic lateral sclerosis (ALS) has occurred in the U.S. This is often attributed to as yet undefined environmental factors. The deterministic risk of general mortality and mortality due to PD, ALS, ischemic heart disease (IHD), and stroke for the years 1963, 1977, and 1986 in the U.S., as defined by the method of longitudinal Gompertzian analysis, were calculated and compared. When the rise in PD and ALS mortality is viewed from the perspective of deterministic and competitive mortality dynamics, it becomes evident that the major force increasing mortality from these two neurologic diseases is the declining mortality from IHD and stroke. Consequently, there is no need to invoke intrinsic etiologic alterations in the environment to account for the observed increases in PD and ALS mortality. Recognition of the competitive nature of human mortality illustrates the inherent risk of making etiopathogenic conclusions based upon single disease mortality data.
在过去15年里，美国帕金森病（PD）和肌萎缩侧索硬化症（ALS）的粗死亡率显著上升。这通常归因于尚未明确的环境因素。采用纵向Gompertzian分析方法计算并比较了1963年、1977年和1986年美国总体死亡率以及因PD、ALS、缺血性心脏病（IHD）和中风导致的死亡率的确定性风险。当从确定性和竞争性死亡动态的角度看待PD和ALS死亡率的上升时，很明显，这两种神经系统疾病死亡率增加的主要原因是IHD和中风死亡率的下降。因此，无需援引环境中内在的病因改变来解释观察到的PD和ALS死亡率的增加。认识到人类死亡的竞争性本质说明了基于单一疾病死亡率数据得出病因结论的内在风险。
