Raine Rosalind, Wong Wun, Ambler Gareth, Hardoon Sarah, Petersen Irene, Morris Richard, Bartley Mel, Blane David
Department of Epidemiology and Public Health, University College London, London WC1E 6BT.
BMJ. 2009 Apr 16;338:b1279. doi: 10.1136/bmj.b1279.
To determine the extent to which secondary drug prevention for patients with stroke in routine primary care varies by sex, age, and socioeconomic circumstances, and to quantify the effect of secondary drug prevention on one year mortality by sociodemographic group.
Cohort study using individual patient data from the health improvement network primary care database.
England.
12 830 patients aged 50 or more years from 113 general practices who had a stroke between 1995 and 2005 and who survived the first 30 days after the stroke.
Multivariable associations between odds of receiving secondary prevention after a stroke, and sex, age group, and socioeconomic circumstances; hazard ratios for all cause mortality from 31 days after the stroke and within the first year among patients receiving treatment and by social group; and probabilities of one year mortality for social factors of interest and treatment.
Only 25.6% of men and 20.8% of women received secondary prevention. Receipt of secondary prevention did not vary by socioeconomic circumstances or by sex. Older patients were, however, substantially less likely to receive treatment. The adjusted odds ratio for 80-89 year olds compared with 50-59 year olds was 0.53 (95% confidence interval 0.41 to 0.69). This was because older people were less likely to receive lipid lowering drugs-for example, the adjusted odds ratio for 80-89 year olds compared with 50-59 year olds was 0.44 (95% confidence interval 0.33 to 0.59). Secondary prevention was associated with a 50% reduction in mortality risk (adjusted hazard ratio 0.50, 95% confidence interval 0.42 to 59). On average, mortality within the first year was 5.7% for patients receiving treatment compared with 11.1% for patients not receiving treatment. There was little evidence that the effect of treatment differed between the social groups examined.
Under-treatment among older people with stroke in routine primary care cannot be justified given the lack of evidence on variations in effectiveness of treatment by age.
确定在常规初级保健中，中风患者二级药物预防在性别、年龄和社会经济状况方面的差异程度，并按社会人口学分组量化二级药物预防对一年死亡率的影响。
使用来自健康改善网络初级保健数据库的个体患者数据进行队列研究。
英国。
来自113家全科诊所的12830名年龄在50岁及以上的患者，他们在1995年至2005年间发生中风，且在中风后的前30天存活下来。
中风后接受二级预防的几率与性别、年龄组和社会经济状况之间的多变量关联；中风后31天及第一年内在接受治疗的患者中按社会群体划分的全因死亡率的风险比；以及感兴趣的社会因素和治疗的一年死亡率概率。
只有25.6%的男性和20.8%的女性接受了二级预防。二级预防的接受情况在社会经济状况或性别方面没有差异。然而，老年患者接受治疗的可能性明显较低。80 - 89岁患者与50 - 59岁患者相比，调整后的比值比为0.53（95%置信区间0.41至0.69）。这是因为老年人接受降脂药物的可能性较小——例如，80 - 89岁患者与50 - 59岁患者相比，调整后的比值比为0.44（95%置信区间0.33至0.59）。二级预防与死亡风险降低50%相关（调整后的风险比0.50，95%置信区间0.42至0.59）。平均而言，接受治疗的患者第一年死亡率为5.7%，未接受治疗的患者为11.1%。几乎没有证据表明在所研究的社会群体中治疗效果存在差异。
鉴于缺乏关于治疗效果随年龄变化的证据，常规初级保健中中风老年患者治疗不足的情况是不合理的。
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