From the Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI (T.E.M.).
Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, OH (J.C.K., H.S.).
Stroke. 2020 Apr;51(4):1070-1076. doi: 10.1161/STROKEAHA.120.028910. Epub 2020 Feb 12.
Background and Purpose- Sex differences in stroke incidence over time were previously reported from the GCNKSS (Greater Cincinnati/Northern Kentucky Stroke Study). We aimed to determine whether these differences continued through 2015 and whether they were driven by particular age groups. Methods- Within the GCNKSS population of 1.3 million, incident (first ever) strokes among residents ≥20 years of age were ascertained at all local hospitals during 5 periods: July 1993 to June 1994 and calendar years 1999, 2005, 2010, and 2015. Out-of-hospital cases were sampled. Sex-specific incidence rates per 100 000 were adjusted for age and race and standardized to the 2010 US Census. Trends over time by sex were compared (overall and age stratified). Sex-specific case fatality rates were also reported. Bonferroni corrections were applied for multiple comparisons. Results- Over the 5 study periods, there were 9733 incident strokes (56.3% women). For women, there were 229 (95% CI, 215-242) per 100 000 incident strokes in 1993/1994 and 174 (95% CI, 163-185) in 2015 (<0.05), compared with 282 (95% CI, 263-301) in 1993/1994 to 211 (95% CI, 198-225) in 2015 (<0.05) in men. Incidence rates decreased between the first and last study periods in both sexes for IS but not for intracerebral hemorrhage or subarachnoid hemorrhage. Significant decreases in stroke incidence occurred between the first and last study periods for both sexes in the 65- to 84-year age group and men only in the ≥85-year age group; stroke incidence increased for men only in the 20- to 44-year age group. Conclusions- Overall stroke incidence decreased from the early 1990s to 2015 for both sexes. Future studies should continue close surveillance of sex differences in the 20- to 44-year and ≥85-year age groups, and future stroke prevention strategies should target strokes in the young- and middle-age groups, as well as intracerebral hemorrhage.
背景与目的——此前，GCNKSS（辛辛那提/北肯塔基州卒中研究）的研究报告了随时间推移的卒中发病率存在性别差异。我们旨在确定这些差异是否持续到 2015 年，以及它们是否由特定的年龄组驱动。
方法——在 GCNKSS 的 130 万居民中，通过在所有当地医院对≥20 岁的居民进行调查，确定了 5 个时期内（1993 年 7 月至 1994 年 6 月和 1999 年、2005 年、2010 年和 2015 年的历年）的首发（首次）卒中。对院外病例进行了抽样。按年龄和种族调整后的每 10 万人发病率进行标准化，以 2010 年美国人口普查为标准。通过（整体和年龄分层）比较不同时期的性别趋势来进行分析。还报告了特定性别病例的病死率。对多重比较进行了 Bonferroni 校正。
结果——在 5 个研究期间，共发生 9733 例卒中（56.3%为女性）。女性在 1993/1994 年为每 10 万例事件中有 229 例（95%CI，215-242），而在 2015 年为 174 例（95%CI，163-185）（<0.05），而男性在 1993/1994 年为 282 例（95%CI，263-301），而在 2015 年为 211 例（95%CI，198-225）（<0.05）。在两个性别中，IS 的发病率在研究的第一期和最后一期之间均有所下降，但颅内出血或蛛网膜下腔出血的发病率则没有下降。在两个性别中，65 岁至 84 岁年龄组的卒中发病率在研究的第一期和最后一期之间均显著下降，而 85 岁及以上年龄组仅男性的卒中发病率下降；只有男性在 20 岁至 44 岁年龄组的卒中发病率上升。
结论——总的来说，从 20 世纪 90 年代初到 2015 年，两个性别的卒中发病率均有所下降。未来的研究应继续密切监测 20 岁至 44 岁和≥85 岁年龄组的性别差异，未来的卒中预防策略应针对年轻和中年人群的卒中以及颅内出血。
