采用监测、监视和模拟测试评估全球中风负担和死亡率变化

采用监测、监视和模拟测试评估全球中风负担和死亡率变化

Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modelling

       背景
      

       近来，中风监测和模拟试验的改善使全球范围内中风死亡率和负担得到更可靠的评估。但是，关于全球中风分布情况，以及与其相关的心血管疾病危险因素患病因素，社会人口统计数据和经济特征，知之甚少。

       方法

       采用关键性统计数据（系统性评价所报告的疾病监控情况）和WHO全国疾病负担项目的模拟方法，来评估全国性中风死亡率的风险和负担（以寿命年测量）。

       采用相似方案来制定全国心血管发生率的衡量标准。除糖尿病以外的危险因素和疾病负担的衡量是年龄、性别相关的。

       结果

       在高发病国家和低发病国家之间，中风死亡率和寿命年降低相差有十倍之多。在东欧，北亚，中非和南太平洋地区，中风死亡率和寿命年降低是最高的。心血管风险因素调整后(p<0.0001)，全国人均收入是死亡率和寿命年降低比率主要预测因素(p<0.0001)。

       全国水平心血管风险因素的患病率，通常不能很好地预测全国中风死亡率和负担，但是平均收缩压上升(p=0.028)和体重指数低(p=0.017)预测中风死亡率和更大的中风死亡率(p=0.041)，根据吸烟患者比例可预测吸烟死亡率（p=0.041）和寿命年(p=0.034)。

       名词解释

        中风死亡率和负担在各国间有着巨大的差异，但是低收入国家是最受影响的。目前人口水平衡量心血管风险因素，未能很好地预测中风整体死亡率和负担，不能解释低收入国家中风患者产生的高负担。

Source:www.thelancet.net

《医心评论》编辑：呼唤 翻译  刘瑞琦 校对

Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modelling

Background
Recent improvements in the monitoring and modelling of stroke have led to more reliable estimates of stroke mortality and burden worldwide. However, little is known about the global distribution of stroke and its relations to the prevalence of cardiovascular disease risk factors and sociodemographic and economic characteristics.

Methods
National estimates of stroke mortality and burden (measured in disability-adjusted life years [DALYs]) were calculated from monitoring vital statistics, a systematic review of studies that report disease surveillance, and modelling as part of the WHO Global Burden of Disease programme. Similar methods were used to generate standardised measures of the national prevalence of cardiovascular risk factors. Risk factors other than diabetes and disease burden estimates were age-adjusted and sex-adjusted to the WHO standard population.

Findings
There was a ten-fold difference in rates of stroke mortality and DALY loss between the most-affected and the least-affected countries. Rates of stroke mortality and DALY loss were highest in eastern Europe, north Asia, central Africa, and the south Pacific. National per capita income was the strongest predictor of mortality and DALY loss rates (p<0•0001) even after adjustment for cardiovascular risk factors (p<0•0001). Prevalences of cardiovascular risk factors measured at a national level were generally poor predictors of national stroke mortality rates and burden, although raised mean systolic blood pressure (p=0•028) and low body-mass index (p=0•017) predicted stroke mortality, and greater prevalence of smoking predicted both stroke mortality (p=0•041) and DALY-loss rates (p=0•034).

Interpretation
Rates of stroke mortality and burden vary greatly among countries, but low-income countries are the most affected. Current measures of the prevalence of cardiovascular risk factors at the population level poorly predict overall stroke mortality and burden and do not explain the greater burden in low-income countries.