Newbury Jonathan, Kleinig Tim, Leyden James, Arima Hisatomi, Castle Sally, Cranefield Jennifer, Paterson Tracey, Jannes Jim, Crotty Maria, Anderson Craig S
1 The University of Adelaide, Adelaide, Australia.
2 Royal Adelaide Hospital, SA Health, Adelaide, Australia.
Int J Stroke. 2017 Feb;12(2):161-168. doi: 10.1177/1747493016670174. Epub 2016 Sep 30.
Background Stroke rates in Australia and New Zealand have been declining since 1990 but all studies have been completed in large urban centers. Aim We report the first Australasian stroke incidence study in a rural population. Methods The authors applied the principle of complete ascertainment, used the WHO standard definition of stroke and classified ischemic stroke by the TOAST criteria. Data were collected from five rural centers defined by postcode of residence, over a 2-year period with 12 months of follow up of all cases. Results There were 217 strokes in 215 individuals in a population of 96,036 people, over 2 years, giving a crude attack rate of 113 per 100,000 per year. The 181 first-ever strokes (83% of total), standardized to the WHO world population, occurred at a rate of 50/100,000 (95% CI: 43-58). The 28-day fatality for first-ever strokes was 24% (95% CI: 18-31) and 77% (95% CI: 71-83) were classified as ischemic (140/181), 15% (95% CI: 10-21) intracerebral hemorrhage, 3% (95% CI: 1-6) due to subarachnoid hemorrhage and 5% (95% CI: 2-9) were unknown. A high proportion of first-ever ischemic strokes (44%) were cardioembolic, mostly (77%) due to atrial arrhythmias. Of the 38 with known atrial arrhythmias prior to stroke, only six (16%) were therapeutically anticoagulated. Conclusions This rural companion study of a recent Australian urban stroke incidence study confirms the downward trend of stroke incidence in Australia, and reiterates that inadequate anticoagulation of atrial arrhythmia remains a preventable cause of ischemic stroke.
背景 自1990年以来，澳大利亚和新西兰的中风发病率一直在下降，但所有研究均在大型城市中心完成。目的 我们报告了在农村人口中进行的第一项澳大拉西亚中风发病率研究。方法 作者应用完全确诊原则，采用世界卫生组织中风的标准定义，并根据TOAST标准对缺血性中风进行分类。在两年期间，从五个由居住邮政编码定义的农村中心收集数据，并对所有病例进行12个月的随访。结果 在96,036人的人群中，两年内215人发生了217次中风，粗发病率为每年每10万人113例。按照世界卫生组织世界人口标准，181例首次中风（占总数的83%）的发生率为50/10万（95%置信区间：43-58）。首次中风的28天死亡率为24%（95%置信区间：18-31），77%（95%置信区间：71-83）被归类为缺血性中风（140/181），15%（95%置信区间：10-21）为脑出血，3%（95%置信区间：1-6）为蛛网膜下腔出血，5%（95%置信区间：2-9）病因不明。首次缺血性中风中有很大一部分（44%）是心源性栓塞，主要（77%）是由于心房心律失常。在中风前已知有心房心律失常的38例患者中，只有6例（16%）接受了治疗性抗凝。结论 这项针对澳大利亚近期城市中风发病率研究的农村配套研究证实了澳大利亚中风发病率的下降趋势，并重申心房心律失常抗凝不足仍然是缺血性中风的一个可预防原因。
