From the Department of Emergency Medicine (T.E.M.), Alpert Medical School of Brown University; Department of Epidemiology (T.E.M.), Brown University School of Public Health, Providence, RI; Division of Biostatistics and Epidemiology (L.D., J.C.K.), Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati; Department of Neurology and Rehabilitation Medicine (M.H., D.W., S.F., F.D.L.R.L.R., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), University of Cincinnati College of Medicine; UC Gardner Neuroscience Institute (S.F., P.K., M.L.F., E.A.M., S.D., K.B.W., J.P.B., B.K., D.O.K.), Cincinnati, OH; Miami Neuroscience Institute (F.D.L.R.L.R.), Baptist Health South Florida, FL; Neurology Program (S.R.M.), Veterans Health Administration and Department of Neurology, Baylor College of Medicine, Houston, TX; Department of Emergency Medicine (O.A.), Washington University, St. Louis, MO; Department of Neurology (J.M.), Indiana University School of Medicine, Indianapolis; Department of Neurology (E.C.), University of Chicago, IL; Department of Neurology (A.J.), Yale School of Medicine, New Haven, CT; University of Kansas Medical Center (S.S.), Kansas City; Soroka Medical Center (M.S.), Beersheba, Israel; and Department of Neurology (D.O.K.), University of Michigan, Ann Arbor.
Neurology. 2024 Feb 13;102(3):e208077. doi: 10.1212/WNL.0000000000208077. Epub 2024 Jan 10.
Understanding the current status of and temporal trends of stroke epidemiology by age, race, and stroke subtype is critical to evaluate past prevention efforts and to plan future interventions to eliminate existing inequities. We investigated trends in stroke incidence and case fatality over a 22-year time period.
In this population-based stroke surveillance study, all cases of stroke in acute care hospitals within a 5-county population of southern Ohio/northern Kentucky in adults aged ≥20 years were ascertained during a full year every 5 years from 1993 to 2015. Temporal trends in stroke epidemiology were evaluated by age, race (Black or White), and subtype (ischemic stroke [IS], intracranial hemorrhage [ICH], or subarachnoid hemorrhage [SAH]). Stroke incidence rates per 100,000 individuals from 1993 to 2015 were calculated using US Census data and age-standardized, race-standardized, and sex-standardized as appropriate. Thirty-day case fatality rates were also reported.
Incidence rates for stroke of any type and IS decreased in the combined population and among White individuals (any type, per 100,000, 215 [95% CI 204-226] in 1993/4 to 170 [95% CI 161-179] in 2015, = 0.015). Among Black individuals, incidence rates for stroke of any type decreased over the study period (per 100,000, 349 [95% CI 311-386] in 1993/4 to 311 [95% CI 282-340] in 2015, = 0.015). Incidence of ICH was stable over time in the combined population and in race-specific subgroups, and SAH decreased in the combined groups and in White adults. Incidence rates among Black adults were higher than those of White adults in all time periods, and Black:White risk ratios were highest in adults in young and middle age groups. Case fatality rates were similar by race and by time period with the exception of SAH in which 30-day case fatality rates decreased in the combined population and White adults over time.
Stroke incidence is decreasing over time in both Black and White adults, an encouraging trend in the burden of cerebrovascular disease in the US population. Unfortunately, however, Black:White disparities have not decreased over a 22-year period, especially among younger and middle-aged adults, suggesting the need for more effective interventions to eliminate inequities by race.
了解不同年龄段、不同种族及不同卒中亚型的卒中流行病学现状和时间趋势，对于评估过去的预防效果以及规划未来的干预措施以消除现存的不平等至关重要。本研究旨在调查 22 年间的卒中发病率和病死率变化趋势。
本项基于人群的卒中监测研究共纳入俄亥俄州南部/肯塔基州北部 5 个县人群中 20 岁及以上成年人在急性护理医院中确诊的所有卒中病例。研究于 1993 年至 2015 年每 5 年在全年内开展一次，通过这种方式对卒中流行病学的时间趋势进行了评估，分析指标包括年龄、种族（黑人或白人）和亚型（缺血性卒中和颅内出血或蛛网膜下腔出血）。采用美国人口普查数据计算了 1993 年至 2015 年期间每 10 万人的卒中发病率，并根据需要进行了年龄标准化、种族标准化和性别标准化。同时还报告了 30 天病死率。
在整个人群和白人个体中，任何类型的卒中及缺血性卒中发病率均呈下降趋势（每 10 万人发病率，1993/4 年至 2015 年分别为 215（95%CI 204-226）和 170（95%CI 161-179）， = 0.015）。黑人个体中，任何类型的卒中发病率在研究期间呈下降趋势（每 10 万人发病率，1993/4 年至 2015 年分别为 349（95%CI 311-386）和 311（95%CI 282-340）， = 0.015）。整个人群及各种族亚组的颅内出血发病率在研究期间保持稳定，蛛网膜下腔出血发病率在整个人群及白人成年人中呈下降趋势。在所有时间段，黑人成年人的发病率均高于白人成年人，且在年轻和中年人群中，黑人与白人的发病风险比最高。除了蛛网膜下腔出血外，不同种族和不同时间段的病死率相似，在整个人群及白人成年人中，30 天病死率随时间呈下降趋势。
在黑人和白人成年人中，卒中发病率呈下降趋势，这是美国人群中脑血管疾病负担的一个可喜趋势。然而，不幸的是，22 年间，黑人和白人之间的差异并没有缩小，尤其是在年轻和中年人群中，这表明需要采取更有效的干预措施来消除种族差异。
