残疾人群中的早发性卒中：一项2008年至2017年韩国全国数据库研究
Early-onset stroke among people with disabilities: a national database study in South Korea from 2008 to 2017.
作者信息
Yang Hee Soo, Kim So Young, Jo Min Jae, Kim Yeon Yong, Park Jong Hyock
机构信息
Department of Medicine, College of Medicine, Chungbuk National University, Cheongju, South Korea.
Institute of Health & Science Convergence, Chungbuk National University, Cheongju, South Korea.
出版信息
Lancet Reg Health West Pac. 2023 Jun 13;38:100819. doi: 10.1016/j.lanwpc.2023.100819. eCollection 2023 Sep.
BACKGROUND
This study investigated 10-year trend in the incidence and prevalence of ischemic, hemorrhagic, and overall strokes according to the severity and type of disability between people with and without disabilities.
METHODS
This serial cross-sectional analysis was conducted using national health information data during a 10-year period from 2008 to 2017. Age-standardized incidence and prevalence were analyzed for each year, according to the presence, severity, and type of disability. The odds ratio (OR) of stroke was examined using multivariable logistic regression after adjusting for socio-demographic and clinical variables collected in 2017.
FINDINGS
In total, 413,398,084 people were enrolled between 2008 and 2017. In 2017, 43,552,192 people aged 19 or older were included and 5.8% was disabled. For 10 years, age-standardized incidence of ischemic and hemorrhagic stroke decreased significantly regardless of the presence of disability. However, age-standardized incidence of stroke in disabled were almost 2.5 times higher than the non-disabled in 2017. Stroke occurs 20 years earlier in people with disabilities than in those without disabilities. In 2017, people with disabilities had higher odds of stroke compared to those without disability (OR = 4.11, 95% confidence interval [CI]: 4.06-4.16), particularly among those with severe disabilities (OR = 4.75, 95% CI: 4.67-4.84). People with major internal organ impairment showed the highest incidence of stroke (OR = 5.95, 95% CI: 5.73-6.17). The main risk factors for stroke presented in this study were disability factors, chronic diseases, and advanced age.
INTERPRETATION
People with disabilities are at a greater risk of developing stroke incidence. Developing a public health policy and identifying the risk factors for stroke in people with disabilities would be beneficial.
FUNDING
This work was supported by a National Research Foundation of Korea (NRF) grant funded by the Ministry of Education (No. 2022R1I1A3070074).
背景
本研究调查了10年间有无残疾人群中缺血性、出血性及总体卒中的发病率和患病率随残疾严重程度和类型的变化趋势。
方法
本系列横断面分析使用了2008年至2017年期间的国家健康信息数据。根据残疾的存在情况、严重程度和类型，对每年的年龄标准化发病率和患病率进行分析。在对2017年收集的社会人口学和临床变量进行调整后，使用多变量逻辑回归分析卒中的比值比（OR）。
结果
2008年至2017年期间共纳入413398084人。2017年，纳入了43552192名19岁及以上的人，其中5.8%有残疾。10年来，无论有无残疾，缺血性和出血性卒中的年龄标准化发病率均显著下降。然而，2017年残疾人群的卒中年龄标准化发病率几乎是非残疾人群的2.5倍。残疾人群发生卒中的时间比非残疾人群早20年。2017年，与非残疾人群相比，残疾人群发生卒中的几率更高（OR = 4.11，95%置信区间[CI]：4.06 - 4.16）, 尤其是重度残疾人群（OR = 4.75，95% CI：4.67 - 4.84）。主要内脏器官受损的人群卒中发病率最高（OR = 5.95，95% CI：5.73 - 6.17）。本研究中卒中的主要危险因素为残疾因素、慢性病和高龄。
解读
残疾人群发生卒中的风险更高。制定公共卫生政策并确定残疾人群卒中的危险因素将大有裨益。
资助
本研究得到了韩国国家研究基金会（NRF）由教育部资助的一项拨款（编号：2022R1I1A3070074）。
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