Riggs J E
Department of Neurology, West Virginia University School of Medicine, Morgantown 26506.
Neurology. 1991 Sep;41(9):1335-8. doi: 10.1212/wnl.41.9.1335.
Although stroke mortality has been declining since the first part of this century, the rate of decline increased sharply during the early 1970s. The basis for the fall in stroke mortality is often attributed to effective management of risk factors, particularly hypertension. However, some investigators have questioned whether risk factor reduction alone can adequately account for the magnitude of the recent decline in stroke mortality. When viewed from the perspective of competitive and deterministic mortality dynamics, the major force decreasing stroke mortality is the decreasing deterministic competitiveness of stroke and the increasing deterministic competitiveness of various malignant neoplasms and degenerative diseases as causes of mortality. These reciprocal trends are a natural consequence of the competitive deterministic mortality dynamics which describe these diseases in an environment that is becoming more conducive to human survival. The competitive nature of human mortality makes drawing etiopathogenic conclusions based upon single disease mortality data hazardous.
尽管自本世纪上半叶以来中风死亡率一直在下降，但在20世纪70年代初下降速度急剧加快。中风死亡率下降的原因通常归因于对风险因素的有效管理，尤其是高血压。然而，一些研究人员质疑，仅风险因素的降低是否足以解释近期中风死亡率下降的幅度。从中风死亡率的竞争和确定性动态角度来看，降低中风死亡率的主要力量是中风确定性竞争力的下降以及各种恶性肿瘤和退行性疾病作为死亡原因的确定性竞争力的上升。这些相互的趋势是竞争确定性死亡动态的自然结果，这种动态描述了在一个越来越有利于人类生存的环境中的这些疾病。人类死亡率的竞争性使得基于单一疾病死亡率数据得出病因学结论具有风险。
