Farzadfard Mohammad Taghi, Thrift Amanda G, Amiri Amin, Kapral Moira K, Hashemi Peyman, Sposato Luciano A, Salehi Maryam, Shoeibi Ali, Hoseini Alireza, Mokhber Naghmeh, Azarpazhooh Mahmoud Reza
Department of Neurology, Ghaem hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Stroke and Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.
J Stroke Cerebrovasc Dis. 2018 Apr;27(4):1085-1089. doi: 10.1016/j.jstrokecerebrovasdis.2017.11.018. Epub 2018 Feb 9.
Despite recent declines in stroke mortality in high-income countries, the incidence and mortality of stroke have increased in many low- and middle-income countries. Population-based information on stroke in such countries is a research priority to address this rising trend. This study was designed to evaluate 5-year stroke mortality and its associated factors.
During a 12-month period beginning from November 2006, 624 patients with first-ever stroke (FES) living in Mashhad, Iran, were recruited and followed longitudinally. Kaplan-Meier analyses were used to determine the cumulative risk of death. Prognostic variables associated with death were assessed using a Cox proportional hazard, backward logistic regression model.
The 5-year cumulative risk of death was 53.8% for women and 60.5% for men (log rank = .1). The most frequent causes of death were stroke (41.2%), myocardial infarction/vascular diseases (16.4%), and pneumonia (14.2%). In multivariable Cox proportional hazard analysis, male gender (hazard ratio [HR]: 1.29, 95% confidence interval [CI]: 1.01-1.64), age (HR: 1.04, 95% CI: 1.03-1.05, per 1-year increase), National Institute of Health Stroke Scale score at admission (HR: 1.11, 95% CI: 1.09-1.12, per 1-point increase), atrial fibrillation (HR: 1.78, CI: 1.24-2.54), and education < 12 years (HR: 1.61, 95% CI: 1.08-2.4) were associated with greater 5-year case fatality.
Long-term case fatality following stroke in Iran is greater than that observed in many high-income countries. Targeting strategies to reduce the poor outcome following stroke, such as treating AF, is likely to reduce this disparate outcome.
尽管近期高收入国家的卒中死亡率有所下降，但许多低收入和中等收入国家的卒中发病率和死亡率却有所上升。基于人群的此类国家卒中信息是应对这一上升趋势的研究重点。本研究旨在评估5年卒中死亡率及其相关因素。
从2006年11月开始的12个月期间，招募了居住在伊朗马什哈德的624例首次发生卒中（FES）的患者，并对其进行纵向随访。采用Kaplan-Meier分析确定累积死亡风险。使用Cox比例风险向后逻辑回归模型评估与死亡相关的预后变量。
女性的5年累积死亡风险为53.8%，男性为60.5%（对数秩检验P = 0.1）。最常见的死亡原因是卒中（41.2%）、心肌梗死/血管疾病（16.4%）和肺炎（14.2%）。在多变量Cox比例风险分析中，男性（风险比[HR]：1.29，95%置信区间[CI]：1.01 - 1.64）、年龄（HR：1.04，95% CI：1.03 - 1.05，每增加1岁）、入院时美国国立卫生研究院卒中量表评分（HR：1.11，95% CI：1.09 - 1.12，每增加1分）、心房颤动（HR：1.78，CI：1.24 - 2.54）以及教育年限<12年（HR：1.61，95% CI：1.08 - 2.4）与5年病死率较高相关。
伊朗卒中后的长期病死率高于许多高收入国家。针对降低卒中后不良结局的策略，如治疗房颤，可能会减少这种差异结局。
