Goldacre Michael J, Duncan Marie, Griffith Myfanwy, Rothwell Peter M
Unit of Health-Care Epidemiology, Department of Public Health, University of Oxford, Old Road Campus, Old Road, Oxford OX3 7LF, United Kingdom.
Stroke. 2008 Aug;39(8):2197-203. doi: 10.1161/STROKEAHA.107.509695. Epub 2008 Jun 5.
Stroke mortality appears to be declining more rapidly in the UK than in many other Western countries. To understand this apparent decline better, we studied trends in mortality in the UK using more detailed data than are routinely available.
Analysis of datasets that include both the underlying cause and all other mentioned causes of death (together, termed "all mentions"): the Oxford Record Linkage Study from 1979 to 2004 and English national data from 1996 to 2004.
Mortality rates based on underlying cause and based on all mentions showed similar downward trends. Mortality based on underlying cause alone misses about one quarter of all stroke-related deaths. Changes during the period in the national rules for selecting the underlying cause of death had a significant but fairly small effect on the trend. Overall, mortality fell by an average annual rate of 2.3% (95% confidence interval 2.1% to 2.5%) for stroke excluding subarachnoid hemorrhage; and by 2.1% (1.7% to 2.6%) per annum for subarachnoid hemorrhage. Coding of stroke as hemorrhagic, occlusive, or unspecified varied substantially across the study period. As a result, rates for hemorrhagic and occlusive stroke, affected by artifact, seemed to fall substantially in the first part of the study period and then leveled off.
Studies of stroke mortality should include all mentions as well as the certified underlying cause, otherwise the burden of stroke will be underestimated. Studies of stroke mortality that include strokes specified as hemorrhagic or occlusive, without also considering stroke overall, are likely to be misleading. Stroke mortality in the Oxford region halved between 1979 and 2004.
英国的卒中死亡率似乎比许多其他西方国家下降得更快。为了更好地理解这一明显的下降趋势，我们使用了比常规可得数据更详细的数据来研究英国的死亡率趋势。
对包含根本死因和所有其他提及的死因（合称为“所有提及死因”）的数据集进行分析：1979年至2004年的牛津记录链接研究以及1996年至2004年的英国国家数据。
基于根本死因和基于所有提及死因的死亡率呈现出相似的下降趋势。仅基于根本死因的死亡率遗漏了约四分之一的所有与卒中相关的死亡。在此期间，国家选择根本死因的规则变化对趋势有显著但相当小的影响。总体而言，不包括蛛网膜下腔出血的卒中死亡率平均每年下降2.3%（95%置信区间为2.1%至2.5%）；蛛网膜下腔出血的死亡率每年下降2.1%（1.7%至2.6%）。在整个研究期间，将卒中编码为出血性、闭塞性或未明确分类的情况有很大差异。因此，受人为因素影响，出血性和闭塞性卒中的死亡率在研究期的第一部分似乎大幅下降，然后趋于平稳。
卒中死亡率研究应包括所有提及死因以及经认证的根本死因，否则卒中负担将被低估。仅研究指定为出血性或闭塞性卒中的死亡率而不考虑总体卒中情况的研究可能会产生误导。牛津地区的卒中死亡率在1979年至2004年间减半。
