McGovern P G, Pankow J S, Burke G L, Shahar E, Sprafka J M, Folsom A R, Blackburn H
Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis 55454-1015.
Stroke. 1993 Nov;24(11):1640-8. doi: 10.1161/01.str.24.11.1640.
Age-adjusted stroke mortality rates declined approximately 50% between 1970 and 1990 in both the United States and Minnesota, but the reasons for this decline are not clear. This report examines possible improvements in short- and long-term survival of hospitalized definite stroke patients in the Minneapolis-St Paul (the Twin Cities) metropolitan area during this period.
Fifty percent random samples of patients discharged with an acute stroke diagnosis from area hospitals were selected in 1970 (n = 1200), 1980 (n = 1040), and 1985 (n = 896). Trained nurses abstracted pertinent clinical data from the hospital charts. By standardized clinical criteria similar to World Health Organization criteria (without computed tomography data), 376, 442, and 453 definite strokes were established for 1970, 1980, and 1985, respectively.
Age- and sex-adjusted 28-day case fatality of definite stroke improved significantly from 1970 to 1985; the odds ratio (OR) of death within 28 days in 1985 (versus 1970) patients was 0.55 (95% confidence interval [CI], [0.39, 0.77]). Substantial improvements in 28-day mortality were observed both from 1970 to 1980 and from 1980 to 1985, although the latter change was not statistically significant. Further adjustment for predictors of early stroke mortality (such as level of consciousness) somewhat attenuated these results. Age- and sex-adjusted 5-year survival of definite stroke also improved significantly from 1970 to 1985 (OR, 0.72; 95% CI, [0.54, 0.96]), although the improvement was restricted to the 1970 to 1980 time period (OR, 0.76; 95% CI, [0.57, 1.01]). None of the survival trends differed significantly between men and women.
There were marked improvements in survival from 1970 to 1985 among hospitalized stroke patients in the Twin Cities. These improvements occurred almost exclusively in the acute hospitalization phase. Although the advent of computed tomography and improvements in hospital record-keeping during this period prevent an unequivocal conclusion, improved medical care and decreased severity of stroke probably contributed to gains in survival.
1970年至1990年间，美国和明尼苏达州经年龄调整的中风死亡率均下降了约50%，但下降原因尚不清楚。本报告探讨了在此期间明尼阿波利斯-圣保罗（双城）都会区确诊中风住院患者短期和长期生存率可能的改善情况。
分别在1970年（n = 1200）、1980年（n = 1040）和1985年（n = 896），从地区医院中随机抽取50%出院诊断为急性中风的患者样本。训练有素的护士从医院病历中提取相关临床数据。根据类似于世界卫生组织标准（无计算机断层扫描数据）的标准化临床标准，1970年、1980年和1985年分别确诊376例、442例和453例中风。
1970年至1985年，确诊中风患者经年龄和性别调整的28天病死率显著改善；1985年患者28天内死亡的比值比（OR）（与1970年相比）为0.55（95%置信区间[CI]，[0.39, 0.77]）。1970年至1980年以及1980年至1985年期间，28天死亡率均有显著改善，尽管后者的变化无统计学意义。对早期中风死亡率预测因素（如意识水平）进行进一步调整后，这些结果有所减弱。1970年至1985年，确诊中风患者经年龄和性别调整的5年生存率也显著提高（OR，0.72；95% CI，[0.54, 0.96]），尽管改善仅限于1970年至1980年期间（OR, 0.76；95% CI，[0.57, 1.01]）。男性和女性的生存趋势无显著差异。
1970年至1985年，双城住院中风患者的生存率有显著提高。这些改善几乎完全发生在急性住院阶段。尽管在此期间计算机断层扫描的出现和医院记录保存的改善使得无法得出明确结论，但医疗护理的改善和中风严重程度的降低可能有助于生存率的提高。
