From the Institute of Clinical Epidemiology and Biometry, University of Würzburg, Germany (V.R., S.W., P.U.H.).
Department of Public Health and Policy, Institute of Psychology, Health, and Society, University of Liverpool, United Kingdom (M.O.).
Stroke. 2018 Nov;49(11):2577-2583. doi: 10.1161/STROKEAHA.118.023193.
Background and Purpose- Data on recent time trends in stroke mortality by subtypes and regions are lacking for Germany. We investigated sex- and age-standardized trends in stroke mortality in Germany for different stroke subtypes from 1998 to 2015 and assessed potential regional variations between the former Eastern and former Western part of Germany. Methods- Mortality and population data from the German Federal Statistical Office were used to calculate sex- and age-standardized mortality rates for hemorrhagic stroke, ischemic stroke, and total strokes from 1998 to 2015 for all age groups. Joinpoint regression was used to examine trends and its changes. Estimations were stratified for Eastern and Western part of Germany. Results- From 1998 to 2015, age-standardized total stroke mortality decreased by >50% in men (from 78.0 to 34.1 per 100 000) and women (from 62.1 to 28.4 women per 100 000). The decrease was more pronounced for ischemic stroke mortality (rate change: men, -66%; women, -63%) than for hemorrhagic stroke mortality (men, -40%; women, -31%). Total and ischemic stroke mortality declined more in Eastern than in Western part of Germany. From 1998 to 2015, there were no differences in the decline between the regions in hemorrhagic stroke mortality. Total stroke mortality was higher in Eastern compared with Western part of Germany throughout the study period. Differences in subtype- and sex-specific mortality between the regions decreased from 1998 to 2015. Conclusions- Between 1998 and 2015, stroke mortality declined substantially in Germany with differing time trends in stroke subtypes between sexes and regions. Differences in stroke mortality rates between East and West Germany are negligible 24 years after the German reunification.
背景与目的- 缺乏德国近期不同亚型和地区卒中死亡率的时间趋势数据。我们研究了 1998 年至 2015 年德国不同卒中亚型的标准化死亡率趋势，并评估了前东德和前西德之间潜在的区域差异。
方法- 使用德国联邦统计局的死亡率和人口数据，计算了 1998 年至 2015 年所有年龄段人群的出血性卒中、缺血性卒中和总卒中的标准化死亡率。采用 Joinpoint 回归分析了趋势及其变化。对东德和西德进行分层估计。
结果- 1998 年至 2015 年，男性（从 78.0 降至 34.1/10 万）和女性（从 62.1 降至 28.4/10 万）的年龄标准化总卒中死亡率下降了>50%。缺血性卒中死亡率的下降更为明显（男性，-66%；女性，-63%），而出血性卒中死亡率的下降较小（男性，-40%；女性，-31%）。与西德相比，东德的总卒中和缺血性卒中死亡率下降更为明显。1998 年至 2015 年，东德和西德之间出血性卒中死亡率的下降没有差异。整个研究期间，东德的总卒中死亡率均高于西德。1998 年至 2015 年，不同地区之间亚组和性别特异性死亡率的差异逐渐缩小。
结论- 1998 年至 2015 年，德国的卒中死亡率大幅下降，不同性别和地区的卒中亚型的时间趋势不同。德国统一 24 年后，东西德之间的卒中死亡率差异可以忽略不计。
