Dalal P M, Bhattacharjee Madhumita, Vairale Jaee, Bhat Priya
Lilavati Hospital and L. K. M. M. Trust Research Centre, A-791, Bandra Reclamation, Mumbai-400 050, India.
J Assoc Physicians India. 2008 Sep;56:675-80.
India will face enormous socioeconomic burden because life expectancy is increasing placing larger numbers of older people at risk of stroke and other chronic diseases. In order to plan prevention strategies, reliable information on stroke epidemiology is required. For uniform data collection (population based), WHO recommends use of STEPS Stroke instrument.
A well-defined community (H-ward) with verifiable census data, and representative of population structure of Mumbai (Bombay), was selected. The manual on WHO STEPwise approach to stroke surveillance (STEPS; http://www.who.int/chp/steps/Manual.pdf) was the operational protocol.
During the two year study period (Jan 2005 to Dec 2006), 521 new stroke (CVD) cases (males--275 and females--246) were identified; of which 456 (238 males and 218 females) had "first ever stroke"(FES) indicating an annual incidence of 145 per 100,000 persons (CI 95%: 120-170); age adjusted Segi rate: 152/100,000/year (CI 95% 132-172). Two thirds of the FES cases were admitted to health care facilities (Step I: "in-hospital" cases), the remaining 150 (32.8%) either died outside of hospital or were treated at home or nursing homes (Step II: Fatal events in community and Step III: Non-fatal events in community). CVD Diagnosis was supported by CT (Computed Tomography) in 407 (89%) of 456 FES cases: 366 (80.2%) had Ischaemic CVD, 81 (17.7%) had hemorrhagic CVD and 9 (1%) were of unspecified category. The mean age was 66 yrs SD +/- 13.60 and women were older compared with men (mean age 68.9 yrs SD +/- 13.12 versus 63.4 yrs SD +/- 13.53). Hypertension (BP more than 140/90 mm Hg) alone or in various combinations was present in 378 ( 82.8%) cases. Case fatality at 28 days after the FES stroke was 29.8%. Of 320 surviving patients 38.5% had moderate to severe disability.
WHO STEPs stroke surveillance Instrument is simple to use and, practical for community surveys. The data are useful for planning stroke prevention campaigns on public awareness and education with regard to diet, exercise, blood pressure control and early symptoms of minor strokes.
由于预期寿命的增加，印度将面临巨大的社会经济负担，这使得越来越多的老年人面临中风和其他慢性病的风险。为了制定预防策略，需要可靠的中风流行病学信息。为了进行统一的数据收集（基于人群），世界卫生组织建议使用中风监测步骤（STEPS）工具。
选取了一个定义明确、拥有可核实人口普查数据且代表孟买人口结构的社区（H区）。世界卫生组织中风监测逐步方法手册（STEPS；http://www.who.int/chp/steps/Manual.pdf）为操作方案。
在为期两年的研究期间（2005年1月至2006年12月），共识别出521例新的中风（心血管疾病）病例（男性275例，女性246例）；其中456例（男性238例，女性218例）为“首次中风”（FES），表明年发病率为每10万人145例（95%置信区间：120 - 170）；年龄调整后的Segi率为每年152/10万（95%置信区间132 - 172）。三分之二的FES病例被收治到医疗机构（第一步：“住院”病例），其余150例（32.8%）要么在院外死亡，要么在家中或养老院接受治疗（第二步：社区中的致命事件和第三步：社区中的非致命事件）。456例FES病例中有407例（89%）通过CT（计算机断层扫描）支持心血管疾病诊断：366例（80.2%）为缺血性心血管疾病，81例（17.7%）为出血性心血管疾病，9例（1%）类别未明确。平均年龄为66岁，标准差±13.60，女性比男性年龄大（平均年龄68.9岁，标准差±13.12对63.4岁，标准差±13.53）。单独或多种组合存在高血压（血压超过140/90 mmHg）的病例有378例（82.8%）。FES中风后28天的病死率为29.8%。在320名存活患者中，38.5%有中度至重度残疾。
世界卫生组织中风监测步骤工具易于使用，适用于社区调查。这些数据对于规划中风预防宣传活动很有用，这些活动涉及饮食、运动、血压控制和轻微中风的早期症状等方面的公众意识和教育。
