Goulart Alessandra Carvalho
MD, PhD. Clinical Epidemiologist and Researcher, Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo (HU-USP), São Paulo (SP), Brazil.
Sao Paulo Med J. 2016 Nov-Dec;134(6):543-554. doi: 10.1590/1516-3180.2016.024227092016.
: Stroke has a high burden of disability and mortality. The aim here was to evaluate epidemiology, risk factors and prognosis for stroke in the EMMA Study (Study of Stroke Mortality and Morbidity).
: Prospective community-based cohort carried out in Hospital Universitário, University of São Paulo, 2006-2014.
: Stroke data based on fatal and non-fatal events were assessed, including sociodemographic data, mortality and predictors, which were evaluated by means of logistic regression and survival analyses.
: Stroke subtype was better defined in the hospital setting than in the local community. In the hospital phase, around 70% were first events and the ischemic subtype. Among cerebrovascular risk factors, the frequency of alcohol intake was higher in hemorrhagic stroke (HS) than in ischemic stroke (IS) cases (35.4% versus 12.3%, P < 0.001). Low education was associated with higher risk of death, particularly after six months among IS cases (odds ratio, OR, 4.31; 95% confidence interval, CI, 1.34-13.91). The risk of death due to hemorrhagic stroke was greater than for ischemic stroke and reached its maximum 10 days after the event (OR: 3.31; 95% CI: 1.55-7.05). Four-year survival analysis on 665 cases of first stroke (82.6% ischemic and 17.4% hemorrhagic) showed an overall survival rate of 48%. At four years, the highest risks of death were in relation to ischemic stroke and illiteracy (hazard ratio, HR: 1.83; 95% CI: 1.26-2.68) and diabetes (HR: 1.45; 95% CI: 1.07-1.97). Major depression presented worse one-year survival (HR: 4.60; 95% CI: 1.36-15.55).
: Over the long term, the EMMA database will provide additional information for planning resources destined for the public healthcare system.
中风具有很高的致残率和死亡率。本研究旨在评估艾玛研究（中风死亡率和发病率研究）中中风的流行病学、危险因素和预后情况。
2006年至2014年在圣保罗大学医院进行的基于社区的前瞻性队列研究。
评估基于致命和非致命事件的中风数据，包括社会人口统计学数据、死亡率和预测因素，并通过逻辑回归和生存分析进行评估。
中风亚型在医院环境中比在当地社区中定义得更好。在医院阶段，约70%为首次发病事件且为缺血性亚型。在脑血管危险因素中，出血性中风（HS）患者的酒精摄入量频率高于缺血性中风（IS）患者（35.4%对12.3%，P<0.001）。低教育程度与较高的死亡风险相关，尤其是缺血性中风患者在六个月后（优势比，OR，4.31；95%置信区间，CI，1.34 - 13.91）。出血性中风导致的死亡风险高于缺血性中风，且在事件发生后10天达到最高（OR：3.31；95%CI：1.55 - 7.05）。对665例首次中风病例（82.6%为缺血性，17.4%为出血性）进行的四年生存分析显示总体生存率为48%。在四年时，最高的死亡风险与缺血性中风和文盲（风险比，HR：1.83；95%CI：1.26 - 2.68）以及糖尿病（HR：1.45；95%CI：1.07 - 1.97）有关。重度抑郁症患者的一年生存率较差（HR：4.60；95%CI：1.36 - 15.55）。
从长远来看，艾玛数据库将为规划公共医疗系统的资源提供更多信息。
