From the Department of Neurology (G.T., A.P., A.T., A.K., C.P., K.V., I.H.), Department of Neurosurgery (T.B.), Department of Radiology (M.M.), Second Department of Internal Medicine (N.P., I.K., E.M.), and First Department of Internal Medicine (P.S.), University Hospital of Alexandroupolis, Democritus University of Thrace, School of Medicine, Greece; Second Department of Neurology, Attikon Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece (G.T., A.H.K.); 1st Department of Internal Medicine, Hypertension Excellence Center, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece (M.P., P.Z.); Department of Neurology, School of Medicine, University of Ioannina, Greece (A.H.K.); and Didymoteicho General Hospital, Greece (A.A.).
Stroke. 2018 Feb;49(2):288-295. doi: 10.1161/STROKEAHA.117.019524. Epub 2018 Jan 15.
Data are scarce on both stroke incidence rates and outcomes in Greece and in rural areas in particular. We performed a prospective population-based study evaluating the incidence of first-ever stroke in the Evros prefecture, a region of a total 147 947 residents located in North Eastern Greece.
Adult patients with first-ever stroke were registered during a 24-month period (2010-2012) and followed up for 12 months. To compare our stroke incidence with that observed in other studies, we standardized our incidence rate data according to the European Standard Population, World Health Organization, and Segi population. We also applied criteria of data quality proposed by the Monitoring Trends and Determinants in Cardiovascular Disease project. Stroke diagnosis and classification were performed using World Health Organization criteria on the basis of neuroimaging and autopsy data.
We prospectively documented 703 stroke cases (mean age: 75±12 years; 52.8% men; ischemic stroke: 80.8%; intracerebral hemorrhage: 11.8%; subarachnoid hemorrhage: 4.4%; undefined: 3.0%) with a total follow-up time of 119 805 person-years. The unadjusted and European Standard Population-adjusted incidences of all strokes were 586.8 (95% confidence interval [CI], 543.4-630.2) and 534.1 (95% CI, 494.6-573.6) per 100 000 person-years, respectively. The unadjusted incidence rates for ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage were 474.1 (95% CI, 435-513), 69.3 (95% CI, 54-84), and 25.9 (95% CI, 17-35) per 100 000 person-years, respectively. The corresponding European Standard Population-adjusted incidence rates per 100 000 person-years were 425.9 (95% CI, 390.9-460.9), 63.3 (95% CI, 49.7-76.9), and 25.8 (95% CI, 16.7-34.9) for ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage, respectively. The overall 28-day case fatality rate was 21.3% (95% CI, 18.3%-24.4%) for all strokes and was higher in hemorrhagic strokes than ischemic stroke (40.4%, 95% CI, 31.3%-49.4% versus 16.2%, 95% CI, 13.2%-19.2%).
This is the largest to date population-based study in Greece documenting one of the highest stroke incidences ever reported in South Europe, highlighting the need for efficient stroke prevention and treatment strategies in Northeastern Greece.
有关希腊和农村地区的中风发病率和结果的数据都很匮乏。我们进行了一项前瞻性的基于人群的研究，评估了位于希腊东北部的埃夫罗斯州的首次中风发病率，该地区共有 147947 名居民。
在 24 个月的时间内（2010-2012 年）登记首次发生中风的成年患者，并对其进行了 12 个月的随访。为了将我们的中风发病率与其他研究中的观察结果进行比较，我们根据欧洲标准人口、世界卫生组织和塞吉人口对发病率数据进行了标准化。我们还应用了监测心血管疾病趋势和决定因素项目提出的数据质量标准。中风的诊断和分类采用世界卫生组织的标准，基于神经影像学和尸检数据。
我们前瞻性地记录了 703 例中风病例（平均年龄：75±12 岁；52.8%为男性；缺血性中风：80.8%；颅内出血：11.8%；蛛网膜下腔出血：4.4%；未定义：3.0%），总随访时间为 119805 人年。未经调整和欧洲标准人群调整后的所有中风的发病率分别为 586.8（95%可信区间[CI]，543.4-630.2）和 534.1（95% CI，494.6-573.6）/100000 人年。未经调整的缺血性中风、颅内出血和蛛网膜下腔出血的发病率分别为 474.1（95% CI，435-513）、69.3（95% CI，54-84）和 25.9（95% CI，17-35）/100000 人年。相应的欧洲标准人群调整后发病率分别为 425.9（95% CI，390.9-460.9）、63.3（95% CI，49.7-76.9）和 25.8（95% CI，16.7-34.9）/100000 人年，分别为缺血性中风、颅内出血和蛛网膜下腔出血。所有中风的 28 天病死率为 21.3%（95% CI，18.3%-24.4%），出血性中风的病死率高于缺血性中风（40.4%，95% CI，31.3%-49.4% 与 16.2%，95% CI，13.2%-19.2%）。
这是迄今为止在希腊进行的最大规模的基于人群的研究，记录了南欧有史以来最高的中风发病率之一，突显了在希腊东北部地区需要制定有效的中风预防和治疗策略。
