Curtin Health Innovation Research Institute, Curtin University, GPO Box U1987, Perth, Western Australia.
Stroke. 2011 Jun;42(6):1515-21. doi: 10.1161/STROKEAHA.110.601799. Epub 2011 Apr 14.
Despite the disproportionate burden of cardiovascular disease among indigenous Australians, information on stroke is sparse. This article documents the incidence and burden of stroke (in disability-adjusted life years) in indigenous and non-indigenous people in Western Australia (1997-2002), a state resident to 15% of indigenous Australians comprising 3.4% of the population of Western Australia.
Indigenous and non-indigenous stroke incidence and excess mortality rates were estimated from linked hospital and mortality data, with adjustment for nonadmitted events. Nonfatal burden was calculated from nonfatal incidence, duration (modeled from incidence, excess mortality, and remission), and disability weights. Stroke death counts formed the basis of fatal burden. Nonfatal and fatal burden were summed to obtain disability-adjusted life years, by indigenous status.
The total burden was 55 099 and 2134 disability-adjusted life years in non-indigenous and indigenous Western Australians, respectively. The indigenous to non-indigenous age-standardized stroke incidence rate ratio (≥15 years) was 2.6 in males (95% CI, 2.3-3.0) and 3.0 (95% CI, 2.6-3.5) in females, with similar rate ratios of disability-adjusted life years. The burden profile differed substantially between populations, with rate ratios being highest at younger ages.
The differential between indigenous and non-indigenous stroke burden is considerable, highlighting the need for comprehensive intersectoral interventions to reduce indigenous stroke incidence and improve outcomes. Programs to reduce risk factors and increase access to culturally appropriate stroke services are required. The results here provide the quantitative basis for policy development and monitoring of stroke outcomes.
尽管心血管疾病在澳大利亚原住民中负担不成比例，但有关中风的信息却很少。本文记录了西澳大利亚州（1997-2002 年）原住民和非原住民中风的发病率和负担（以残疾调整生命年表示），该州有 15%的原住民居住，占西澳大利亚州人口的 3.4%。
从关联的医院和死亡率数据中估算了原住民和非原住民的中风发病率和超额死亡率，并对未入院的事件进行了调整。非致命负担是根据非致命发病率、持续时间（根据发病率、超额死亡率和缓解情况建模）和残疾权重计算得出的。中风死亡人数构成了致命负担的基础。通过原住民身份，将非致命和致命负担相加以获得残疾调整生命年。
非原住民和原住民西澳大利亚人中的总负担分别为 55099 人和 2134 残疾调整生命年。男性（≥15 岁）原住民与非原住民的标准化中风发病率比率为 2.6（95%可信区间，2.3-3.0），女性为 3.0（95%可信区间，2.6-3.5），残疾调整生命年的比率也相似。人口之间的负担状况差异很大，在年龄较小的人群中，比率更高。
原住民和非原住民中风负担之间的差异相当大，突出表明需要采取全面的跨部门干预措施来降低原住民中风的发病率并改善结果。需要制定减少风险因素和增加获得文化适宜的中风服务的方案。这里的结果为政策制定和监测中风结果提供了定量依据。
