英格兰南部两个健康区75岁以下居民中风发病率、治疗及预后的差异

Variations in the incidence, management and outcome of stroke in residents under the age of 75 in two health districts of southern England.

作者信息

Wolfe C D, Taub N A, Bryan S, Beech R, Warburton F, Burney G J

机构信息

Department of Public Health Medicine, United Medical School, Guy's Hospital, London.

出版信息

J Public Health Med. 1995 Dec;17(4):411-8.

PMID:8639340

Abstract

BACKGROUND

The aim of the study was to determine the incidence, outcome and health service resources consumed by stroke care in defined populations.

METHODS

Patients under the age of 75 experiencing their first stroke between August 1989 and July 1991 were assessed at the onset, and at three and 12 months after their stroke. The settings were West Lambeth (WL) and Tunbridge Wells (TW) health authorities in southern England. The main outcome measures used were: age- and sex-specific incidence rates, hospital admission rates, length of stay and use of rehabilitation services. Functional disability was assessed using the Barthel scale.

RESULTS

Four hundred and fifty-six strokes were registered. The annual incidence rates/1000 population aged under 75 years old [with 95% confidence interval (CI)] were 0.77 (0.67-0.87) in WL and 0.66 (0.58-0.75) in TW. The age- and sex-standardized incidence ratios were significantly higher in WL (126; 95% CI 110-144) than in TW (84%; 95% CI 74-95) (p < 0.001). There were independent associations of incidence with age group (p < 0.001), sex (p < 0.001) and ethnic group (p < 0.001). One year case-fatality was 36% (80/225). At one year, 11% (14) of surviving patients were moderately to severely disabled and 23% (28) mildly disabled. Seventy-one percent (326) of patients were admitted to hospital and the average health service cost per case was pound 3800 in WL and pound 2650 in TW, 93% of the cost being for in-patient care.

CONCLUSION

The study has demonstrated a significantly increased incidence of stroke in an inner-city district compared with a district in rural southern England. It has also established ethnic group as a significant independent risk factor for stroke in the United Kingdom. The cost of care to the health services is considerable, and largely reflects nursing costs in hospital rather than effective treatment packages for stroke.

摘要

背景

本研究旨在确定特定人群中中风护理的发病率、结局以及所消耗的卫生服务资源。

方法

对1989年8月至1991年7月期间首次发生中风的75岁以下患者在发病时、中风后3个月和12个月进行评估。研究地点为英格兰南部的西兰贝斯（WL）和汤布里奇韦尔斯（TW）卫生当局。所使用的主要结局指标包括：特定年龄和性别的发病率、住院率、住院时间以及康复服务的使用情况。使用巴氏量表评估功能残疾情况。

结果

共登记了456例中风病例。75岁以下人群的年发病率/每1000人口[95%置信区间（CI）]在WL为0.77（0.67 - 0.87），在TW为0.66（0.58 - 0.75）。年龄和性别标准化发病率在WL（126；95%CI 110 - 144）显著高于TW（84%；95%CI 74 - 95）（p < 0.001）。发病率与年龄组（p < 0.001）、性别（p < 0.001）和种族组（p < 0.001）存在独立关联。一年病死率为36%（80/225）。一年时，存活患者中有11%（14例）为中度至重度残疾，23%（28例）为轻度残疾。71%（326例）的患者住院，WL每例患者的平均卫生服务成本为3800英镑，TW为2650英镑，93%的成本用于住院护理。