Shahar E, McGovern P G, Pankow J S, Doliszny K M, Smith M A, Blackburn H, Luepker R V
Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis 55454-1015, USA.
Stroke. 1997 Feb;28(2):275-9. doi: 10.1161/01.str.28.2.275.
The decline in stroke mortality it the United States may have resulted from declining incidence improved survival of stroke patients, or both. We previously reported that stroke patients who were 30 to 74 years old and were treated in Minneapolis/St Paul hospitals in 1990 survived longer than did their counterparts in 1980. In the present study, we examined trends in the rate of hospitalized stroke in Minneapolis/ St Paul between 1980 and 1990.
For 1980, 1985, and 1990, we obtained lists of discharge codes (International Classification of Diseases, 9th revision) from Minneapolis/St Paul hospitals, identified hospitalizations for acute cerebrovascular disease, and randomly selected 50% of the cases for medical record abstraction. We counted stroke events in five different ways, which were based on discharge codes as well as diagnostic criteria, and computed age adjusted stroke rates for each year. Stroke mortality in the population was computed for 1960 through 1994.
Among men, all five measures of hospitalized stroke attack rate indicated a decline between 1980 and 1985, which ranged from 5% to > 20%. Among women, there was a sharp contrast between trends that relied on discharge codes and trends that relied on diagnostic criteria: the former indicated a decline (4% to 19%), whereas the latter indicated some increase. For the second half of the 1980s, most measures of stroke attack rate in men, all measures of stroke attack rate in women, and measures of stroke incidence in both sexes did not indicate a decline in stroke occurrence in the population. Mortality from stroke among 30- to 74-year-old residents of Minneapolis/St Paul, which declined rapidly during the 1970s and early 1980s, declined slowly, if at all, during the second half of the 1980s and early 1990s.
The incidence of stroke may have declined among 30- to 74-year-old residents of Minneapolis/St Paul in the early 1980s. However, we found little indication of such a trend between 1985 and 1990, a period of slow decline or no decline in stroke mortality in that population.
美国卒中死亡率的下降可能是由于发病率降低、卒中患者生存率提高或两者共同作用所致。我们之前报道过，1990年在明尼阿波利斯/圣保罗医院接受治疗的30至74岁卒中患者比1980年的同龄人存活时间更长。在本研究中，我们调查了1980年至1990年间明尼阿波利斯/圣保罗住院卒中发生率的趋势。
我们获取了1980年、1985年和1990年明尼阿波利斯/圣保罗医院的出院编码列表（国际疾病分类，第9版），确定急性脑血管疾病的住院病例，并随机抽取50%的病例进行病历摘要。我们以五种不同方式计算卒中事件，这些方式基于出院编码以及诊断标准，并计算每年的年龄调整卒中率。计算了1960年至1994年该人群的卒中死亡率。
在男性中，所有五种住院卒中发作率测量指标均显示1980年至1985年期间有所下降，降幅在5%至20%以上。在女性中，依赖出院编码的趋势与依赖诊断标准的趋势形成鲜明对比：前者显示下降（4%至19%），而后者显示有所上升。在20世纪80年代后半期，男性的大多数卒中发作率测量指标、女性的所有卒中发作率测量指标以及两性的卒中发病率测量指标均未表明该人群中卒中发生率下降。明尼阿波利斯/圣保罗30至74岁居民的卒中死亡率在20世纪70年代和80年代初迅速下降，但在80年代后半期和90年代初下降缓慢，甚至可能没有下降。
20世纪80年代初，明尼阿波利斯/圣保罗30至74岁居民的卒中发病率可能有所下降。然而，我们发现1985年至1990年期间几乎没有这种趋势的迹象，在此期间该人群的卒中死亡率下降缓慢或没有下降。
