Massing M W, Rywik S L, Jasinski B, Manolio T A, Williams O D, Tyroler H A
Department of Epidemiology, University of North Carolina School of Public Health, Chapel Hill 27514, USA.
Stroke. 1998 Jul;29(7):1366-72. doi: 10.1161/01.str.29.7.1366.
The United States (US) has experienced declines in stroke mortality in contrast to the increases reported for Poland. As part of the Poland and US Agreement on Cardiovascular and Cardiopulmonary Research, stroke mortality trends in Polish and US subpopulations were compared in the context of cross-population differences in competing causes of death and determinants of stroke.
Age-adjusted annual stroke, cardiovascular disease (CVD), non-CVD, and all-cause mortality rates were determined for men and women aged 35 to 64 and 65 to 74 years from 1968 to 1994 for African Americans and US whites and in Poland. Mean annual percent changes of mortality rates were estimated during 1968 to 1980 and 1981 to 1994 with the use of piecewise log-linear regression.
US stroke mortality rates declined 3.7% to 4.8% annually during 1968 to 1980 and 2.0% to 3.1% during 1981 to 1994, with similar declines in each ethnic, gender, and age group. Polish rates increased 3.3% to 5.5% annually for all age-gender groups in Poland during 1968 to 1980. Polish men aged 35 to 64 experienced increasing rates during 1981 to 1994 (1.6% annually), while Polish women and older men experienced slight declines or little change. Only Polish men aged 35 to 64 years exhibited increases in stroke, CVD, and non-CVD mortality rates during both time intervals.
Poland and the US experienced opposing stroke mortality rate trends between 1968 and 1994. These national and ethnic trends occurring in just one generation suggest major effects of lifestyle, socioenvironmental, and/or medical care determinants.
与波兰报告的中风死亡率上升情况相反，美国的中风死亡率呈下降趋势。作为波兰与美国关于心血管和心肺研究协议的一部分，在跨人群死亡竞争原因和中风决定因素存在差异的背景下，对波兰和美国亚人群的中风死亡率趋势进行了比较。
确定了1968年至1994年期间，年龄在35至64岁以及65至74岁的非裔美国人和美国白人以及波兰人的年龄调整后的年度中风、心血管疾病（CVD）、非心血管疾病和全因死亡率。使用分段对数线性回归估计了1968年至1980年以及1981年至1994年期间死亡率的年均百分比变化。
1968年至1980年期间，美国中风死亡率每年下降3.7%至4.8%，1981年至1994年期间下降2.0%至3.1%，各种族、性别和年龄组均有类似下降。1968年至1980年期间，波兰所有年龄性别组的中风死亡率每年上升3.3%至5.5%。1981年至1994年期间，波兰35至64岁的男性中风死亡率呈上升趋势（每年1.6%），而波兰女性和老年男性中风死亡率略有下降或变化不大。只有波兰35至64岁的男性在两个时间段内中风、心血管疾病和非心血管疾病死亡率均呈上升趋势。
1968年至1994年期间，波兰和美国的中风死亡率趋势相反。这些仅在一代人中出现的国家和种族趋势表明生活方式、社会环境和/或医疗保健决定因素具有重大影响。
