Institute of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Department of Environmental and Occupational Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania.
PLoS One. 2019 Jul 10;14(7):e0219392. doi: 10.1371/journal.pone.0219392. eCollection 2019.
There is a lack of reliable epidemiological data on long-term survival trends of first-ever stroke patients in Lithuanian population.
To evaluate trends in long-term survival after stroke and to determine the influence of some sociodemographic and lifestyle factors, time and subtype of stroke, and stroke care on survival.
All stroke events included in Kaunas stroke register database were ascertained and validated according to the standardized criteria outlined by the WHO MONICA Project. The study included all patients in Kaunas (Lithuania) city aged 25 to 64 years who experienced a stroke between 1986 and 2011. Death time was confirmed by the Office for National Death Statistics. Estimates of stroke long-term survival data and factors influencing survival changes were made by applying the Kaplan-Meier and Cox regression analysis.
During the study period, 4,129 persons aged 25-64 years suffered from a first-ever stroke: 2,215 (53.6%) of them were men and 1,914 (46.4%)-women. Ischemic stroke was significantly more frequent in males than in females (80.6% and 78.6%, respectively, p<0.05) and subarachnoid hemorrhage was more common in women than in men (9.0% and 7.0% respectively, p <0.05). Of all first-ever stroke patients, 3,272 (79.2%) survived 1 year and 2,905 (70.4%) survived 5 years after stroke onset. The 1- and 5-years survival rate after a first-ever stroke in women was significantly higher as compared with that in men (Log-rank test p = 0.0001). The older (55-64 year) persons had poorer 1-year and 5-years survival rate as compared with persons in the younger (25-54 years) age group (Log-rank test p = 0.0001). Among persons with a first-ever stroke who had their stroke in 2007-2011, 1- and 5-year survival rate was higher compared with that in persons who had had a stroke in 1986-1990 and in 1997-2001 (Log-rank test p = 0.0001). The persons with a first-ever ischemic stroke had a better chance to survive first 1- and 5-years after stroke compared with persons who had intracerebral or subarachnoid haemorrhage. Only female gender was associated with higher 1- and 5-year survival rate after first-ever stroke. The older age, previous myocardial infarction and diabetes mellitus were associated with lower 1- and 5-year survival rate after first-ever stroke.
This population-based study of patients with first-ever stroke demonstrated that the long-term survival was better in women than men, and improved significantly in both men and women during the past decade. Long-term survival was better of those with first-ever ischemic stroke and of younger age- 25 to 54 years.
立陶宛人群中首次发生中风患者的长期生存趋势缺乏可靠的流行病学数据。
评估中风后长期生存趋势，并确定一些社会人口统计学和生活方式因素、中风时间和类型以及中风护理对生存的影响。
根据世界卫生组织 MONICA 项目规定的标准化标准，确定并验证了 Kaunas 中风登记数据库中包含的所有中风事件。该研究包括 1986 年至 2011 年间在立陶宛考纳斯市年龄在 25 至 64 岁之间经历中风的所有患者。死亡时间由国家死亡统计办公室确认。通过应用 Kaplan-Meier 和 Cox 回归分析来估计中风长期生存数据和影响生存变化的因素。
在研究期间，4129 名 25-64 岁的人患有首次中风：其中 2215 人（53.6%）为男性，1914 人（46.4%）为女性。男性的缺血性中风明显比女性更常见（分别为 80.6%和 78.6%，p<0.05），蛛网膜下腔出血在女性中更为常见，而在男性中则更为常见（分别为 9.0%和 7.0%，p<0.05）。所有首次中风患者中，3272 人（79.2%）在中风后 1 年存活，2905 人（70.4%）在中风后 5 年存活。女性首次中风后 1 年和 5 年的生存率明显高于男性（对数秩检验 p=0.0001）。与年轻（25-54 岁）年龄组相比，年龄较大（55-64 岁）的人 1 年和 5 年生存率较低（对数秩检验 p=0.0001）。在 2007-2011 年发生首次中风的人中，1 年和 5 年的生存率高于 1986-1990 年和 1997-2001 年发生中风的人（对数秩检验 p=0.0001）。首次发生缺血性中风的人在中风后 1 年和 5 年内的存活机会要好于发生颅内或蛛网膜下腔出血的人。只有女性性别与首次中风后的 1 年和 5 年生存率较高相关。年龄较大、既往心肌梗死和糖尿病与首次中风后的 1 年和 5 年生存率较低相关。
这项基于人群的首次中风患者研究表明，女性的长期生存状况优于男性，而且在过去十年中，男女的长期生存状况均有显著改善。首次发生缺血性中风和年龄在 25 至 54 岁之间的人长期生存状况更好。
