Shahar E, McGovern P G, Sprafka J M, Pankow J S, Doliszny K M, Luepker R V, Blackburn H
Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis 55454-1015.
Stroke. 1995 Jan;26(1):1-6. doi: 10.1161/01.str.26.1.1.
The underlying reasons for the decline in stroke mortality in the United States are not well understood and have been the subject of ongoing debate. This study was undertaken to determine whether survival of hospitalized stroke patients has changed during the 1980s, thereby contributing to the decline in stroke mortality during that period.
For the years 1980, 1985, and 1990, we obtained listings of discharge diagnoses from hospitals in the Minneapolis-St Paul metropolitan area and identified all hospitalizations with a discharge diagnosis code of acute cerebrovascular disease according to the International Classification of Diseases, 9th Revision. A 50% random sample of men and women aged 30 to 74 years was selected in each survey for detailed medical record abstraction. Standardized sets of criteria for stroke were then used to validate acute stroke events throughout the 1980s. Each of the three period cohorts of hospitalized stroke patients (1980, 1985, and 1990) was followed for at least 2 years for all-cause mortality end point.
A total of 1853 patients met minimal criteria for acute stroke: 564 patients in 1980, 598 patients in 1985, and 691 patients in 1990. Controlling for age, the odds of death within 2 years after stroke were approximately 40% lower in 1990 than in 1980. The relative odds of 2-year death in 1990 (versus 1980) were 0.65 (95% confidence interval, 0.47 to 0.89) and 0.60 (95% confidence interval, 0.42 to 0.85) for men and women, respectively. The improved survival was evident in the short term (28 days) as well as for stroke patients who survived that period. Analysis according to stroke subtype revealed that improved survival of ischemic stroke and specifically of stroke with no apparent cardioembolic source largely accounted for the overall trend. The prognosis of stroke patients who were admitted in a comatose state has not changed during that decade.
Despite the absence of any clear major advances in acute stroke therapy, survival of stroke patients substantially improved during the 1980s. The underlying reasons for this unexpected yet remarkable trend remain uncertain but may include improved supportive and rehabilitative care of stroke victims as well as a change in the natural history of the disease.
美国卒中死亡率下降的潜在原因尚未完全明确，一直是持续争论的话题。本研究旨在确定20世纪80年代住院卒中患者的生存率是否发生了变化，从而导致了该时期卒中死亡率的下降。
我们获取了1980年、1985年和1990年明尼阿波利斯 - 圣保罗大都市地区医院的出院诊断清单，并根据《国际疾病分类》第九版确定了所有出院诊断代码为急性脑血管疾病的住院病例。每次调查中选取了年龄在30至74岁之间的男性和女性各50%的随机样本进行详细的病历摘要。然后使用标准化的卒中标准对整个20世纪80年代的急性卒中事件进行验证。对三个时期的住院卒中患者队列（1980年、1985年和1990年）均随访至少2年，以全因死亡率作为终点。
共有1853例患者符合急性卒中的最低标准：1980年有564例患者，1985年有598例患者，1990年有691例患者。在控制年龄后，1990年卒中后2年内死亡的几率比1980年降低了约40%。1990年（与1980年相比）男性和女性2年死亡的相对几率分别为0.65（95%置信区间，0.47至0.89）和0.60（95%置信区间，0.42至0.85）。在短期（28天）以及度过该时期存活的卒中患者中，生存率的提高都很明显。根据卒中亚型分析显示，缺血性卒中，特别是无明显心源性栓塞源的卒中患者生存率的提高在很大程度上解释了总体趋势。在这十年间，昏迷入院的卒中患者的预后没有变化。
尽管急性卒中治疗方面没有任何明显的重大进展，但20世纪80年代卒中患者的生存率有了显著提高。这一意外但显著趋势的潜在原因仍不确定，但可能包括对卒中患者改善的支持性和康复性护理以及疾病自然史的变化。
