Hospital of University, University of São Paulo, São Paulo, Brazil.
J Stroke Cerebrovasc Dis. 2012 Nov;21(8):832-8. doi: 10.1016/j.jstrokecerebrovasdis.2011.04.017. Epub 2011 Jun 25.
Case fatality rate is considered a main determinant of stroke mortality trends. We applied the World Health Organization's Stroke STEPS to identify case fatality rates in a community hospital in Brazil. We evaluated all patients with first-ever stroke seeking acute care at the hospital's emergency ward between April 2006 and December 2008 to verify early and late case fatality according to stroke subtype. We used years of formal education as a surrogate for socioeconomic status. Of 430 first-ever stroke events, 365 (84.9%) were ischemic and 65 (15.1%) were intracerebral hemorrhage. After 1 year, we adjudicated 108 deaths (86 ischemic; 22 hemorrhagic). Age-adjusted case fatality rates for ischemic stroke and intracerebral hemorrhage were 6.0% v 19.8% at 10 days, 10.6% v 22.1% at 28 days, 17.6% v 29.1% at 6 months, and 21.0% v 31.5% at 1 year. Illiteracy or no formal education was a predictor of death at 6 months (odds ratio [OR], 4.31; 95% confidence interval [CI] 1.34-13.91) and 1 year (OR, 4.21; 95% CI, 1.45-12.28) in patients with ischemic stroke, as well as at 6 months (OR, 3.19; 95% CI, 1.17-8.70) and 1 year (OR, 3.30; 95% CI, 1.30-8.45) for all stroke patients. Other variables, including previous cardiovascular risk factors and acute medical care, did not change this association to a statistically significant degree. In conclusion, case fatality, particularly up to 6 months, was higher in hemorrhagic stroke, and lack of formal education was associated with increased stroke mortality.
病死率被认为是中风死亡率趋势的主要决定因素。我们应用世界卫生组织的中风 STEPS 方案，在巴西的一家社区医院确定病死率。我们评估了 2006 年 4 月至 2008 年 12 月期间在医院急诊室寻求急性护理的所有首次中风患者，以根据中风亚型确定早期和晚期病死率。我们使用正规教育年限作为社会经济地位的替代指标。在 430 例首次中风事件中，365 例（84.9%）为缺血性中风，65 例（15.1%）为颅内出血。1 年后，我们判定 108 例死亡（86 例缺血性；22 例出血性）。缺血性中风和颅内出血的年龄调整病死率在 10 天为 6.0% v 19.8%，28 天为 10.6% v 22.1%，6 个月为 17.6% v 29.1%，1 年为 21.0% v 31.5%。在缺血性中风患者中，文盲或未接受正规教育是 6 个月（比值比 [OR]，4.31；95%置信区间 [CI]，1.34-13.91）和 1 年（OR，4.21；95% CI，1.45-12.28）死亡的预测因素，在所有中风患者中，也是在 6 个月（OR，3.19；95% CI，1.17-8.70）和 1 年（OR，3.30；95% CI，1.30-8.45）死亡的预测因素。其他变量，包括先前的心血管危险因素和急性医疗护理，并没有使这种关联在统计学上有显著变化。总之，出血性中风的病死率较高，特别是在 6 个月内，而缺乏正规教育与中风死亡率的增加有关。
