全球缺血性脑卒中负担、风险因素分析及预测研究，1990-2030 年。
Global Burden, Risk Factor Analysis, and Prediction Study of Ischemic Stroke, 1990-2030.
机构信息
From the Department of Clinical Laboratory (J.F., X.Y., M.Z., Q.M.), Department of Thyroid, Breast and Vascular Surgery (X.L.), Department of Neurovascular Disease (Y.F.), and Department of Anesthesiology and Perioperative Medicine (L.X.), Shanghai Fourth People's Hospital Affiliated to Tongji University School of Medicine; State Key Laboratory of Genetic Engineering and Collaborative Innovation Center for Genetics and Development, School of Life Sciences (Z.L., Y.J.), Taizhou Institute of Health Sciences (Z.L., Y.J., C.S.), Human Phenome Institute (Z.L., Y.J.), Department of Epidemiology and Key Laboratory of Public Health Safety of Ministry of Education, School of Public Health (C.S.), and Shanghai Institute of Infectious Disease and Biosecurity (C.S.), Fudan University; Translational Research Institute of Brain and Brain-Like Intelligence (L.X.); and Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation (L.X.), China.
出版信息
Neurology. 2023 Jul 11;101(2):e137-e150. doi: 10.1212/WNL.0000000000207387. Epub 2023 May 17.
BACKGROUND AND OBJECTIVES
Ischemic stroke (IS), 1 of the 2 main subtypes of stroke, occurs because of brain ischemia caused by thrombosis of a cerebral blood vessel. IS is one of the most important neurovascular causes of death and disability. It is affected by many risk factors, such as smoking and a high body mass index (BMI), which are also critical in the preventive control of other cardiovascular and cerebrovascular diseases. However, there are still few systematic analyses of the current and predicted disease burden and the attributable risk factors of IS.
METHODS
Based on the Global Burden of Disease 2019 database, we used age-standardized mortality rate and disability-adjusted life year to systematically present the geographical distribution and trends of IS disease burden worldwide from 1990 to 2019 by calculating the estimated annual percentage change and to analyze and predict the death number of IS accounted by 7 major risk factors for 2020-2030.
RESULTS
Between 1990 and 2019, the global number of IS deaths increased from 2.04 million to 3.29 million and is expected to increase further to 4.90 million by 2030. The downward trend was more pronounced in women, young people, and high sociodemographic index (SDI) regions. At the same time, a study of attributable risk factors of IS found that 2 behavioral factors, smoking and diet in high sodium, and 5 metabolic factors, including high systolic blood pressure, high low-density lipoprotein cholesterol, kidney dysfunction, high fasting plasma glucose, and a high BMI, are major contributors to the increased disease burden of IS now and in the future.
DISCUSSION
Our study provides the first comprehensive summary for the past 30 years and the prediction of the global burden of IS and its attributable risk factors until 2030, providing detailed statistics for decision-making on the prevention and control of IS globally. An inadequate control of the 7 risk factors would lead to an increased disease burden of IS in young people, especially in low SDI regions. Our study identifies high-risk populations and helps public health professionals develop targeted preventive strategies to reduce the global disease burden of IS.
背景与目的
缺血性脑卒中（IS）是脑卒中的两个主要亚型之一，由脑血管血栓形成导致脑缺血引起。IS 是导致死亡和残疾的最重要的神经血管原因之一。它受许多风险因素的影响，如吸烟和高身体质量指数（BMI），这些因素在预防控制其他心脑血管疾病方面也至关重要。然而，目前对 IS 的疾病负担和可归因风险因素的系统分析仍然较少。
方法
基于 2019 年全球疾病负担数据库，我们使用年龄标准化死亡率和伤残调整生命年来系统地呈现 1990 年至 2019 年全球 IS 疾病负担的地理分布和趋势，通过计算估计的年变化百分比进行分析，并预测 2020-2030 年 7 大主要风险因素导致的 IS 死亡人数。
结果
1990 年至 2019 年，全球 IS 死亡人数从 204 万增加到 329 万，预计到 2030 年将进一步增加到 490 万。在女性、年轻人和高社会人口指数（SDI）地区，下降趋势更为明显。同时，对 IS 归因风险因素的研究发现，2 种行为因素，即吸烟和高钠饮食，以及 5 种代谢因素，包括高血压、低高密度脂蛋白胆固醇、肾功能障碍、高空腹血糖和高 BMI，是导致目前和未来 IS 疾病负担增加的主要因素。
讨论
我们的研究首次全面总结了过去 30 年和 2030 年全球 IS 负担及其归因风险因素的预测情况，为全球 IS 预防和控制的决策提供了详细的统计数据。如果不能充分控制这 7 个风险因素，将导致年轻人，特别是低 SDI 地区 IS 疾病负担增加。我们的研究确定了高危人群，有助于公共卫生专业人员制定有针对性的预防策略，以降低全球 IS 疾病负担。
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