Labarthe Darwin R, Howard George, Safford Monika M, Howard Virginia J, Judd Suzanne E, Cushman Mary, Kissela Brett M
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill., USA.
Neuroepidemiology. 2016;47(2):96-102. doi: 10.1159/000449102. Epub 2016 Sep 15.
Is the high stroke mortality in the Southeastern parts of the United States driven by differences in stroke incidence or case-fatality? This question remains unanswered. Differences in incidence would underscore the need for stroke prevention, while differences in case fatality would call for improved stroke care.
Quartiles of US counties were defined by stroke mortality, and this gradient was related with stroke incidence and stroke case fatality in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study, where 1,317 incident stroke events (of which 242 were fatal) occurred among 29,650 participants.
There was a significant (p = 0.0025) gradient of fatal stroke events in REGARDS (quartile 4 vs. quartile 1 (Q4/Q1) hazard ratio 1.95, 95% CI 1.35-2.81), demonstrating the consistency of REGARDS with national mortality data. The gradient for incident stroke (fatal + nonfatal) was also significant (p = 0.0023; Q4/Q1 hazard ratio 1.29, 95% CI 1.10-1.52). The gradient for stroke case-fatality was marginally significant (p = 0.058), though the OR for Q4/Q1 (1.71, 95% CI 1.13-2.25) was large.
Both stroke incidence and case-fatality in REGARDS appear to be contributing, underscoring the need for strengthening both stroke prevention and acute stroke care in order to reduce the disparity.
美国东南部地区较高的卒中死亡率是由卒中发病率差异还是病死率差异导致的？这个问题仍未得到解答。发病率差异将凸显预防卒中的必要性，而病死率差异则需要改善卒中治疗。
根据卒中死亡率对美国各县进行四分位划分，在卒中地理和种族差异原因（REGARDS）研究中，将这种梯度与卒中发病率和卒中病死率相关联，该研究中29,650名参与者发生了1,317例新发卒中事件（其中242例死亡）。
REGARDS研究中致命性卒中事件存在显著（p = 0.0025）梯度（四分位4与四分位1（Q4/Q1）风险比1.95，95%置信区间1.35 - 2.81），表明REGARDS研究与国家死亡率数据一致。新发卒中（致命 + 非致命）的梯度也很显著（p = 0.0023；Q4/Q1风险比1.29，95%置信区间1.10 - 1.52）。卒中病死率梯度边缘显著（p = 0.058），尽管Q4/Q1的比值比（1.71，95%置信区间1.13 - 2.25）较大。
REGARDS研究中的卒中发病率和病死率似乎都有影响，这凸显了加强卒中预防和急性卒中治疗以减少差异的必要性。
