Department of Social Medicine and Health Care Organization, Faculty of Public Health, Medical University, Varna, Bulgaria.
National Institute for Stroke and Applied Neurosciences, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand.
Neuroepidemiology. 2022;56(5):333-344. doi: 10.1159/000525880. Epub 2022 Jul 6.
There has been wide recognition of the health divide between Western Europe and the former socialist countries from Central and Eastern Europe. However, these have not been assessed in terms of burden of disease, and the effect of stroke has not been fully elucidated, especially in terms of time trends.
The West-Eastern European stroke burden was analysed using data from the Global Burden of Stroke (GBD) Study 2019 in terms of disability-adjusted life years lost (DALYs) and years of life lost (YLL) over the period 1990-2019 by gender. Data were extracted on a regional (West, Central, and East Europe) and country level for the twenty former socialist countries from Central and East Europe according to GBD regional definitions. We focused on the trends of age-standardized stroke DALY rates across the three decades and compared them with the average rates for West Europe.
All Central and East European countries experienced a decline in all-cause disease burden between 1990 and 2019, and a gap was confirmed between the East, the Central, and the West European region for men but not for women. The age-standardized stroke DALY rates declined in the three European regions and in all twenty Central and East European countries but at a different pace. The stroke DALY rates among women exhibited the greatest decline in the West -59% (95% UI [-60; -57]) followed by the Central European region -48% (95% UI [-53; -42]) and lowest among women in East Europe -37% (95% UI [-43; -29]). The decline in men was even higher than among women -61% (95% UI [-63; -60]), while in Central Europe it was -43% (95% UI [-50; -37]) and in the East -25% (95% UI [-34; -14]), leading to widening of the gap between East, Central, and West Europe in relation to stroke burden. YLL represented more than 70% of stroke DALYs and more than 90% of DALYs for men in East European countries.
The burden of stroke contributes to the European health gap through preventable premature stroke deaths. There are some very successful countries in stroke burden management from both Central (Slovenia, Czech Republic, and Hungary) and East Europe (Estonia), suggesting that closing the health gap between East and West is a realistic aim.
人们已经广泛认识到西欧和中东欧前社会主义国家之间存在健康差距。然而，这些差距并没有从疾病负担的角度进行评估，而且中风的影响也没有得到充分阐明，尤其是在时间趋势方面。
根据全球疾病负担研究 2019 年的数据，从残疾调整生命年（DALYs）和生命损失年（YLL）的角度，分析了 1990 年至 2019 年期间，性别划分的西-东欧地区中风负担。根据全球疾病负担研究的区域定义，从区域（西、中、东欧）和国家层面提取了 20 个中东欧前社会主义国家的数据。我们关注了过去三十年中，三个十年间年龄标准化中风 DALY 率的趋势，并将其与西欧的平均水平进行了比较。
所有中东欧国家在 1990 年至 2019 年间都经历了全因疾病负担的下降，而且在男性中，东欧、中欧和西欧地区之间存在差距，但在女性中则没有。三个欧洲地区和 20 个中东欧国家的年龄标准化中风 DALY 率均有所下降，但下降速度不同。女性中风 DALY 率下降幅度最大，为 -59%（95%UI[-60；-57]），其次是中欧地区为-48%（95%UI[-53；-42]），东欧地区最低为-37%（95%UI[-43；-29]）。男性的降幅甚至高于女性，为 -61%（95%UI[-63；-60]），而在中欧地区为-43%（95%UI[-50；-37]），在东欧地区为-25%（95%UI[-34；-14]），导致东欧、中欧和西欧之间的中风负担差距进一步扩大。YLL 占中风 DALY 的 70%以上，占东欧国家男性中风 DALY 的 90%以上。
中风负担通过可预防的中风过早死亡导致了欧洲健康差距。从中欧（斯洛文尼亚、捷克共和国和匈牙利）和东欧（爱沙尼亚）都有一些在中风负担管理方面非常成功的国家，这表明缩小东欧和西欧之间的健康差距是一个现实的目标。
