自发性脑出血随时间推移的发病率和长期生存率：一项系统评价和荟萃分析。
Incidence and Long-Term Survival of Spontaneous Intracerebral Hemorrhage Over Time: A Systematic Review and Meta-Analysis.
作者信息
Li Xianqi, Zhang Li, Wolfe Charles D A, Wang Yanzhong
机构信息
School of Life Course and Population Sciences, King's College London, London, United Kingdom.
National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), Guy's and St Thomas' NHS Foundation Trust and King's College London, London, United Kingdom.
出版信息
Front Neurol. 2022 Mar 10;13:819737. doi: 10.3389/fneur.2022.819737. eCollection 2022.
BACKGROUND AND PURPOSE
Recent epidemiological data indicate that the absolute number of hemorrhagic stroke cases increased by 47% between 1990 and 2010 and continued to cause high rates of death and disability. The last systematic review and meta-analysis of incidence and long-term survival of intracerebral hemorrhage (ICH) were published 11 and 7 years ago, respectively, and lacked comparison between different income groups, therefore, a more up to date analysis is needed. We aim to investigate the ICH incidence and long-term survival data in countries of different income groups.
MATERIALS METHODS
We systematically searched Ovid Medline for population-based longitudinal studies of first-ever spontaneous ICH published from January 2000 to December 2020. We performed meta-analyses on the incidence and survival rate in countries of 4 different income groups with random-effects models (severe inconsistency). The was used to measure the heterogeneity. Heterogeneity was further investigated by conducting the meta-regression on the study mid-year. Time trends of the survival rate were assessed by weighted linear regression.
RESULTS
We identified 84 eligible papers, including 68 publications reporting incidence and 24 publications on the survival rate. The pooled incidence of ICH per 100,000 per person-years was 26.47 (95% : 21.84-32.07) worldwide, 25.9 (95% : 22.63-29.63) in high-income countries (HIC), 28.45 (95% : 15.90-50.88) in upper-middle-income countries, and 31.73 (95% : 18.41-54.7) in lower-middle-income countries. The 1-year pooled survival rate was from 50% (95% : 47-54%; = 4,380) worldwide to 50% (95% : 47-54%) in HIC, and 46% (95% : 38-55%) in upper-middle income countries. The 5-year pooled survival rate was 41% (95% : 35-48%; = 864) worldwide, 41% (95% : 32-50%) in high-income and upper-middle countries. No publications were found reporting the long-term survival in lower-middle-income and low-income countries. No time trends in incidence or survival were found by meta-regression.
CONCLUSION
The pooled ICH incidence was highest in lower-middle-income countries. About half of ICH patients survived 1 year, and about two-fifths survived 5 years. Reliable population-based studies estimating the ICH incidence and long-term survival in low-income and low-middle-income countries are needed to help prevention of ICH.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=170140, PROSPERO CRD42020170140.
背景与目的
近期流行病学数据表明，1990年至2010年间出血性中风病例的绝对数量增加了47%，并且继续导致高死亡率和高致残率。上一次关于脑出血（ICH）发病率和长期生存率的系统评价和荟萃分析分别发表于11年前和7年前，且缺乏不同收入组之间的比较，因此，需要进行更近期的分析。我们旨在调查不同收入组国家的ICH发病率和长期生存数据。
材料与方法
我们系统检索了Ovid Medline中2000年1月至2020年12月发表的基于人群的首次自发性ICH纵向研究。我们采用随机效应模型（严重不一致）对4个不同收入组国家的发病率和生存率进行荟萃分析。使用I²来衡量异质性。通过对研究中间年份进行荟萃回归进一步研究异质性。通过加权线性回归评估生存率的时间趋势。
结果
我们确定了84篇符合条件的论文，其中68篇报告发病率，24篇报告生存率。全球每10万人年ICH的合并发病率为26.47（95%可信区间：21.84 - 32.07），高收入国家（HIC）为25.9（95%可信区间：22.63 - 29.63），中高收入国家为28.45（95%可信区间：15.90 - 50.88），中低收入国家为31.73（95%可信区间：18.41 - 54.7）。全球1年合并生存率为50%（95%可信区间：47 - 54%；n = 4380），HIC为50%（95%可信区间：47 - 54%），中高收入国家为46%（95%可信区间：38 - 55%）。全球5年合并生存率为41%（95%可信区间：35 - 48%；n = 864），高收入和中高收入国家为41%（95%可信区间：32 - 50%）。未发现有报告中低收入和低收入国家长期生存情况的出版物。通过荟萃回归未发现发病率或生存率的时间趋势。
结论
中低收入国家的ICH合并发病率最高。约一半的ICH患者存活1年，约五分之二的患者存活5年。需要开展可靠的基于人群的研究来估计低收入和中低收入国家的ICH发病率和长期生存率，以助力ICH的预防。
系统评价注册
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=170140，PROSPERO CRD42020170140。
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