新西兰创伤性脑损伤的发生率：一项基于人群的研究。

Incidence of traumatic brain injury in New Zealand: a population-based study.

机构信息

National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Studies, Auckland University of Technology, Auckland, New Zealand.

出版信息

Lancet Neurol. 2013 Jan;12(1):53-64. doi: 10.1016/S1474-4422(12)70262-4. Epub 2012 Nov 22.

DOI:10.1016/S1474-4422(12)70262-4

PMID:23177532

Abstract

BACKGROUND

Traumatic brain injury (TBI) is the leading cause of long-term disability in children and young adults worldwide. However, accurate information about its incidence does not exist. We aimed to estimate the burden of TBI in rural and urban populations in New Zealand across all ages and TBI severities.

METHODS

We did a population-based incidence study in an urban (Hamilton) and rural (Waikato District) population in New Zealand. We registered all cases of TBI (admitted to hospital or not, fatal or non-fatal) that occurred in the population between March 1, 2010, and Feb 28, 2011, using multiple overlapping sources of information. We calculated incidence per 100,000 person-years with 95% CIs using a Poisson distribution. We calculated rate ratios [RRs] to compare the age-standardised rates between sex, ethnicity, and residency (urban, rural) groups. We used direct standardisation to age-standardise the rates to the world population.

RESULTS

The total incidence of TBI per 100,000 person-years was 790 cases (95% CI 749-832); incidence per 100,000 person-years of mild TBI was 749 cases (709-790) and of moderate to severe TBI was 41 cases (31-51). Children (aged 0-14 years) and adolescents and young adults (aged 15-34 years) constituted almost 70% of all TBI cases. TBI affected boys and men more than women and girls (RR 1·77, 95% CI 1·58-1·97). Most TBI cases were due to falls (38% [516 of 1369]), mechanical forces (21% [288 of 1369]), transport accidents (20% [277 of 1369]), and assaults (17% [228 of 1369]). Compared with people of European origin, Maori people had a greater risk of mild TBI (RR 1·23, 95% CI 1·08-1·39). Incidence of moderate to severe TBI in the rural population (73 per 100,000 person-years [95% CI 50-107) was almost 2·5 times greater than in the urban population (31 per 100 000 person-years [23-42]).

INTERPRETATION

Our findings suggest that the incidence of TBI, especially mild TBI, in New Zealand is far greater than would be estimated from the findings of previous studies done in other high-income countries. Our age-specific and residency-specific data for TBI incidence overall and by mechanism of injury should be considered when planning prevention and TBI care services.

FUNDING

Health Research Council of New Zealand.

摘要

背景

创伤性脑损伤（TBI）是全球儿童和青年长期残疾的主要原因。然而，关于其发病率的准确信息并不存在。我们旨在估算新西兰城乡所有年龄段和 TBI 严重程度的 TBI 负担。

方法

我们在新西兰的一个城市（汉密尔顿）和一个农村（怀卡托地区）进行了一项基于人群的发病率研究。我们使用多种重叠的信息来源，登记了 2010 年 3 月 1 日至 2011 年 2 月 28 日期间发生在该人群中的所有 TBI（住院或不住院，致命或非致命）病例。我们使用泊松分布计算每 100,000 人年的发病率及其 95%置信区间。我们计算了年龄标准化率比（RRs），以比较性别、族裔和居住（城市、农村）群体之间的年龄标准化率。我们使用直接标准化法将发病率标准化为世界人口。

结果

每 100,000 人年的 TBI 总发病率为 790 例（95%CI 749-832）；轻度 TBI 的发病率为每 100,000 人年 749 例（709-790），中度至重度 TBI 的发病率为每 100,000 人年 41 例（31-51）。儿童（0-14 岁）和青少年和青年成年人（15-34 岁）占所有 TBI 病例的近 70%。TBI 对男孩和男性的影响大于女孩和女性（RR 1.77，95%CI 1.58-1.97）。大多数 TBI 病例是由跌倒（38%[516/1369]）、机械力（21%[288/1369]）、交通事故（20%[277/1369]）和袭击（17%[228/1369]）引起的。与欧洲血统的人相比，毛利人患轻度 TBI 的风险更高（RR 1.23，95%CI 1.08-1.39）。农村人口中度至重度 TBI 的发病率（每 100,000 人年 73 例[95%CI 50-107））几乎是城市人口（每 100,000 人年 31 例[23-42））的 2.5 倍。