Ahmed O I, Orchard T J, Sharma R, Mitchell H, Talbot E
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania.
Stroke. 1988 Feb;19(2):181-4. doi: 10.1161/01.str.19.2.181.
Mortality rates for stroke in 1971, 1974, 1977, and 1980 were obtained for residents of Allegheny County in western Pennsylvania. Hospital case fatality ratios were also obtained in the same 4 years for those discharged with the diagnosis of stroke (ICD 430-438 of the Eighth and Ninth Revisions of the International Classification of Disease) in two large hospitals (greater than 400 beds). Age-adjusted mortality rates per 100,000 population have declined significantly in this period for the whole county as well as for the four sex-race groups. Case fatality ratio in the two hospitals of the study has decreased from 19.6 to 11%. A change in the severity of the disease manifested by a reduction in the number of comatose patients has occurred, and this reduction in comatose patients was responsible for greater than 80% of the decline in case fatality ratio. Coma appears to be the best predictor of mortality among hospitalized stroke cases (r = 0.6, p less than 0.00001). The recent introduction of computed tomography for the diagnosis of stroke in the late 1970s was accompanied by a twofold increase in the survivorship of stroke patients. However, this increase in survivorship may reflect selection bias and is based on ecological association. Further studies are needed to examine the role of computed tomography in improving survival.
我们获取了宾夕法尼亚州西部阿勒格尼县居民在1971年、1974年、1977年和1980年的中风死亡率。同时，我们也获取了这4年里两家大型医院（床位超过400张）中被诊断为中风（国际疾病分类第八版和第九版的ICD 430 - 438）并出院患者的医院病死率。在此期间，全县以及四个性别 - 种族组每10万人口的年龄调整死亡率都显著下降。研究中的两家医院的病死率从19.6%降至11%。疾病严重程度发生了变化，表现为昏迷患者数量减少，而昏迷患者数量的减少导致了病死率下降的80%以上。昏迷似乎是住院中风病例死亡率的最佳预测指标（r = 0.6，p < 0.00001）。20世纪70年代末计算机断层扫描技术被用于中风诊断后，中风患者的生存率提高了两倍。然而，这种生存率的提高可能反映了选择偏倚，且基于生态关联。需要进一步研究来考察计算机断层扫描技术在提高生存率方面的作用。
