NEJM：全球中风风险评估研究1990-2016

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近日研究人员利用主要疾病流行率综合研究数据，考察各个区域、国家和全球中风的终生风险。

研究人员利用全球疾病负担研究(GBD2016)估计25岁以上人群的中风、缺血性中风或出血性中风终生累积风险，并比较1990与2016年的结果差异，以社会人口指数(SDI)进行分层。

研究发现，25岁起终生的中风发病率为24.9%，其中男性为24.7%，女性为25.1%。缺血性脑卒中风险为18.3%，出血性脑卒中风险为8.2%。对于高SDI、中高SDI以及低SDI国家，终生的中风风险为23.5%、31.1%以及13.2%。研究发现，东亚、中欧以及东欧地区的中风风险最高，分别为38.8%、31.7%以及31.6%，而撒哈拉以南非洲的风险最低仅为11.8%。全球中风风险由1990年的22.8%上升至2016年的24.9%，增长了8.9%。

研究发现，25岁以上人群的中风风险约为25%，性别差异不显著，东亚、中欧和东欧地区的中风风险最大。

参考文献

The GBD 2016 Lifetime Risk of Stroke Collaborators. Global, Regional, and Country-Specific Lifetime Risks of Stroke, 1990 and 2016. N Engl J Med, December 20, 2018.

AbstractBACKGROUND:

[size=1.04em]The lifetime risk of stroke has been calculated in a limited number of selected populations. We sought to estimate the lifetime risk of stroke at the regional, country, and global level using data from a comprehensive study of the prevalence of major diseases.

METHODS:

[size=1.04em]We used the Global Burden of Disease (GBD) Study 2016 estimates of stroke incidence and the competing risks of death from any cause other than stroke to calculate the cumulative lifetime risks of first stroke, ischemic stroke, or hemorrhagic strokeamong adults 25 years of age or older. Estimates of the lifetime risks in the years 1990 and 2016 were compared. Countries were categorized into quintiles of the sociodemographic index (SDI) used in the GBD Study, and the risks were compared across quintiles. Comparisons were made with the use of point estimates and uncertainty intervals representing the 2.5th and 97.5th percentiles around the estimate.

RESULTS:

[size=1.04em]The estimated global lifetime risk of stroke from the age of 25 years onward was 24.9% (95% uncertainty interval, 23.5 to 26.2); the risk among men was 24.7% (95% uncertainty interval, 23.3 to 26.0), and the risk among women was 25.1% (95% uncertainty interval, 23.7 to 26.5). The risk of ischemic stroke was 18.3%, and the risk of hemorrhagic stroke was 8.2%. In high-SDI, high-middle-SDI, and low-SDI countries, the estimated lifetime risk of stroke was 23.5%, 31.1% (highest risk), and 13.2% (lowest risk), respectively; the 95% uncertainty intervals did not overlap between these categories. The highest estimated lifetime risks of strokeaccording to GBD region were in East Asia (38.8%), Central Europe (31.7%), and Eastern Europe (31.6%), and the lowest risk was in eastern sub-Saharan Africa (11.8%). The mean global lifetime risk of stroke increased from 22.8% in 1990 to 24.9% in 2016, a relative increase of 8.9% (95% uncertainty interval, 6.2 to 11.5); the competing risk of death from any cause other than stroke was considered in this calculation.

CONCLUSIONS:

[size=1.04em]In 2016, the global lifetime risk of stroke from the age of 25 years onward was approximately 25% among both men and women. There was geographic variation in the lifetime risk of stroke, with the highest risks in East Asia, Central Europe, and Eastern Europe. (Funded by the Bill and Melinda Gates Foundation.).