建模存在竞争风险的脑卒中患者的生存情况。

Modeling Survival in Patients With Brain Stroke in the Presence of Competing Risks.

机构信息

Department of Statistics and Epidemiology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.

Department of Statistics and Epidemiology and Road Traffic Injury Research Center, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran.

出版信息

J Prev Med Public Health. 2021 Jan;54(1):55-62. doi: 10.3961/jpmph.20.463. Epub 2020 Dec 7.

DOI:10.3961/jpmph.20.463

PMID:33618500

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7939750/

Abstract

OBJECTIVES

After heart disease, brain stroke (BS) is the second most common cause of death worldwide, underscoring the importance of understanding preventable and treatable risk factors for the outcomes of BS. This study aimed to model the survival of patients with BS in the presence of competing risks.

METHODS

This longitudinal study was conducted on 332 patients with a definitive diagnosis of BS. Demographic characteristics and risk factors were collected by a validated checklist. Patients' mortality status was investigated by telephone follow-up to identify deaths that may be have been caused by stroke or other factors (heart disease, diabetes, high cholesterol, etc.). Data were analyzed by the Lunn-McNeil approach at alpha=0.1.

RESULTS

Older age at diagnosis (59-68 years: adjusted hazard ratio [aHR], 2.19; 90% confidence interval [CI], 1.38 to 3.48; 69-75 years: aHR, 5.04; 90% CI, 3.25 to 7.80; ≥76 years: aHR, 5.30; 90% CI, 3.40 to 8.44), having heart disease (aHR, 1.65; 90% CI, 1.23 to 2.23), oral contraceptive pill use (women only) (aHR, 0.44; 90% CI, 0.24 to 0.78) and ischemic stroke (aHR, 0.52; 90% CI, 0.36 to 0.74) were directly related to death from BS. Older age at diagnosis (59-68 years: aHR, 21.42; 90% CI, 3.52 to 130.39; 75-69 years: aHR, 16.48; 90% CI, 2.75 to 98.69; ≥76 years: aHR, 26.03; 90% CI, 4.06 to 166.93) and rural residence (aHR, 2.30; 90% CI, 1.15 to 4.60) were directly related to death from other causes. Significant risk factors were found for both causes of death.

CONCLUSIONS

BS-specific and non-BS-specific mortality had different risk factors. These findings could be utilized to prescribe optimal and specific treatment.

摘要

目的

心脏病之后，脑卒（BS）是全球第二大常见死因，这凸显了了解 BS 结局的可预防和可治疗风险因素的重要性。本研究旨在建立存在竞争风险的 BS 患者生存模型。

方法

本纵向研究纳入了 332 例明确诊断为 BS 的患者。通过验证后的清单收集人口统计学特征和风险因素。通过电话随访调查患者的死亡率，以确定可能由卒中或其他因素（心脏病、糖尿病、高胆固醇等）导致的死亡。采用 Lunn-McNeil 方法在 alpha=0.1 水平进行数据分析。

结果

诊断时年龄较大（59-68 岁：调整后的危险比 [aHR]，2.19；90%置信区间 [CI]，1.38 至 3.48；69-75 岁：aHR，5.04；90%CI，3.25 至 7.80；≥76 岁：aHR，5.30；90%CI，3.40 至 8.44）、患有心脏病（aHR，1.65；90%CI，1.23 至 2.23）、口服避孕药（仅女性）（aHR，0.44；90%CI，0.24 至 0.78）和缺血性卒中（aHR，0.52；90%CI，0.36 至 0.74）与 BS 死亡直接相关。诊断时年龄较大（59-68 岁：aHR，21.42；90%CI，3.52 至 130.39；75-69 岁：aHR，16.48；90%CI，2.75 至 98.69；≥76 岁：aHR，26.03；90%CI，4.06 至 166.93）和农村居住（aHR，2.30；90%CI，1.15 至 4.60）与其他原因导致的死亡直接相关。两种原因导致的死亡都有显著的风险因素。