中国脑卒中流行病学特征及其发展趋势
全国脑血管病防治研究办公室 北京市神经外科研究所 (100050)
【摘要】
背景：在我国脑卒中已成为当今严重危害中老年人生命与健康的主要公共卫生问题。调查显示：在我国城市居民中脑卒中死亡居于首位，农村居于第二位。脑卒中死亡十几年间有明显的上升趋势。全国脑卒中发病率在120-180/10万人口，每年新发病例大于200万。每年脑卒中死亡率在80-130/10万人口，每年死亡病例大于150万。脑卒中患病率在400-700/10万人口，全国脑卒中存活患者达到600-700万人，列为世界范围的前列。
结果与分析：比较国外类似性研究，我国心脑血管疾病发病率与死亡率与欧美国家有如下不同特点：
1. 我国脑卒中在世界范围内属于高发病率地区，甚至高出欧美等国家。美国以冠心病为主要死亡原因，我国却以脑卒中为主要死亡原因，二者相差四倍。
, 百拇医药
2. 我国脑卒中地域特征为：北方地区高南方地区低。患病率、发病率城市高于农村，死亡率截然相反农村高出城市。脑卒中死亡高出心肌梗死的2-3倍。
3. 我国高血压患病率高出美国，城乡高血压控制率却很低仅为15.6%、5.4%，显示出高血压的管理水平及力度的不足，是高血压诱发脑卒中的明确危险因素。
4. 我国社区人群血清胆固醇水平和体重指数低于国外类似性研究而出血性卒中高出西方国家，达到32%-49%。
中国七城市脑卒中发病率死亡率患病率比较(1/10万)
地区 发病率 死亡率 患病率
北京 370 281 1285
, 百拇医药
哈尔滨 441 370 1249
银 川 252 187 824
长 沙 232 80 846
广 州 162 80 576
上 海 157 104 615
, http://www.100md.com
成 都 136 59 456
对策： 社区人群脑卒中及其危险因素的综合性干预。在我国北京、上海、长沙和北京房山农村四个示范社区40余万人群中进行的大规模心脑血管病综合性防治研究获得了令人鼓舞的阶段性成果。三城市干预社区脑卒中平均发病率和死亡率分别比对照社区降低16.6%(P<0.01)和14.8%(P<0.01)北京农村干预社区脑卒中平均发病率和死亡率分别比对照社区降低18.7%(P<0.01)和17.7%(P<0.01)。成本效益分析，总效益比约4:1即每投入1元人民币用于干预性研究，可节省4元钱心脑血管疾病支出费用。因此积极开展和实施综合性干预研究，可以有效地降低心脑血管病发病率和死亡率，是降低心脑血管疾病危害的根本出路。
关键词：脑卒中 流行特征 干预研究
, http://www.100md.com
Epidemiological characteristics and trends of stroke in China
WU Shengping WANG Wenzhi
Beijing Neurosurgical Institute
Background：Stroke, which became harmful to the lives and health of the middle-aged and aged, is an important issue in the field of public health in China. Surveys showed that the top cause of death was from stroke in urban residents, the second cause of death in rural residents. The mortality rate of stroke increases in recent decade years. The incidence, mortality and prevalence rates of stroke were respectively 120～180/100000, 80～130/100000 and 400～700/100000. It is estimated that more than 2 million new cases of stroke occur annually, 1.5 million patients die annually, and 6～7 million patients with dysfunction survived in China.
, 百拇医药
Results and Analyses：In comparison with the studies from USA and European countries, China had unique epidemiological characteristics of cardiovascular diseases: 1. Higher incidence rate of stroke in China than in USA and European countries; it was the major cause of death from coronary heart disease (CHD) in USA, but the major cause of death from stroke in China, that was about 4 times higher than in USA. 2. Higher incidence and mortality rates of stroke in northern areas than in Southern areas of China; higher prevalence and incidence rates in urban than rural areas; The mortality rate of stroke was 2～3 times higher than that of myocardial infarction (MI). 3. The prevalence rate of hypertension was higher in China than in USA. The control rates of hypertension were respectively 15.6% in urban areas and 5.4% in rural areas, which denoted the poor power of management in China. 4. The serum cholesterol (CHO) and body mass index (BMI) were lower in Chinese population in comparison with studies from foreign countries; The ratios of hemorrhagic stroke in total stroke were 32%～49%, which was higher in China than in western countries.
, http://www.100md.com
Strategies A comprehensive intervention trial of stroke and its risk factors was carried out in Beijing, Shanghai, Changsha urban and Fangshan rural model communities, covering 400,000 people. The trial achieved inspiring results. The average incidence and mortality rates respectively decreased 16.6% (P<0.01) and 14.8% (P<0.01) in three urban communities, and 18.7% (P<0.01) and 17.7% (P<0.01) in Fangshan rural community. According to cost-effective analysis, one yuan RMB paid for the prevention of stroke could save 4 yuan RMB paid for the treatment of stroke. Accordingly, to initiate the campaign of comprehensive prevention and treatment of stroke in community may effectively lower the incidence and mortality rates of cardio-cerebro-vascualr diseases. It is an effective and fundamental way for lessening the harm of cardiovascular diseases.
, http://www.100md.com
【Key words】stroke epidemiological characteristics intervention trial
Nanjing Stroke Registry Program
XU Gelin, LIU Xinfeng,Department of Neurology Jinling Hospital Nanjing University
Why a registry?
◆To get epidemiological information of stroke in the registry area
◆To detect new or novel risk factors of stroke
, http://www.100md.com
◆To identify those areas where quality improvement initiatives are most necessary
◆To develop a tracking system to monitor improvements in the delivery of acute stroke care
◆To monitor the adherence to evidence based guidelines
The Founding of Nanjing Stroke Registry Program
◆August, 1999～July, 2001, Dr. Xinfeng Liu participated the Lausanne Stroke Registry Project (Switzerland).
, 百拇医药
◆July, 2002, Dr. Liu suggested to establish a hospital based stroke program in Nanjing, China.
◆November, 2002, the blueprint of the stroke registry program was made in a local stroke meeting. An application was submitted after the meeting.
◆January, 2003, the Nanjing stroke registry program was approved and a special fund was allocated.
The Founding of Nanjing Stroke Registry Program (cont)
, http://www.100md.com
◆July, 2003, the prototypes of the program was made by a group of experts from multi-discipline (e.g. Neurologists, psychiatrists, psychologists, statisticians, programmers and administrative personnel).
◆December, 2003, the computer-program was finalized.
◆January, 2004, the Nanjing Stroke Registry Program was inaugurated and case selecting started on.
◆To date, more then 200 stroke cases have been registered.
, 百拇医药
The City of Nanjing
◆Population: 2 600 000
◆Area: 950 square kilometers
◆Ethnic: dominated by Han (98.6%)
minorities (1.4%), further dominated by Hui
◆Climate: subtropical monsoon
◆GDP per capita: 3000 USD
Participating Hospitals
, 百拇医药
◆Nanjing University, School of Medicine
◆Jinling Hospital
◆Second Jiangning Hospital
◆De’an Hospital
◆Heping Hospital
Improvement vs. Research
Aim to improve stroke care
◆Increase to 100% the proportion of cases seen by an ED physician within 10 min of arrival
, http://www.100md.com
◆Increase to 100% the proportion of cases having a neurologist consult within 15 minutes of arrival, if arrival < 180 min from symptom onset
◆Increase to 100% the proportion of cases with CT completed by 25 minutes, if arrival < 180 min from symptom onset
◆Increase to 100% the proportion of cases with a documented NIHSS, if arrival < 180 min from symptom onset
◆Increase to 100% the proportion of cases having dysphagia screening prior to oral intake
, 百拇医药
◆Increase to 100% the proportion of cases discharged on antithrombotics without documented contraindications
◆Increase to 100% the proportion of cases with A-fib discharged on anticoagulants
◆Increase to 100% the proportion of smokers who receive cessation counseling
Improvement vs. Research
Clinical Research
◆Collecting epidemiological and demographical data of stroke
, 百拇医药
◆Detecting new or novel risk factor to stroke
◆Evaluating the physical and psychological effects of stroke
◆Assessing the efficiency of treatment and intervention
◆Clinical trial
◆Effect-cost research
◆Eliminate bias
The process of registry
◆Case eligibility evaluation
, 百拇医药
◆Consent form signed by patients or their guardians
◆Demographical and epidemiological data collection
◆Medical and family history recording
◆Physical and Neurological Examinations
◆Neuroimaging studies
◆Neuropsychometric testing
◆Following up
◆Data extracting and processing
, http://www.100md.com
Eligibility evaluation
Inclusion criteria
◆aged 18 or older
◆dwelled in Nanjing for more then 2 years
◆Chinese speaking (Mandarin or Cantonese)
◆a cerebrovascular event in recent 3 months
Close of a case in registry
◆deceased
◆moved out of the area
◆no longer willing to participate the registry
◆lost contact for more than 18 months, 百拇医药(吴升平 王文志)
【摘要】
背景：在我国脑卒中已成为当今严重危害中老年人生命与健康的主要公共卫生问题。调查显示：在我国城市居民中脑卒中死亡居于首位，农村居于第二位。脑卒中死亡十几年间有明显的上升趋势。全国脑卒中发病率在120-180/10万人口，每年新发病例大于200万。每年脑卒中死亡率在80-130/10万人口，每年死亡病例大于150万。脑卒中患病率在400-700/10万人口，全国脑卒中存活患者达到600-700万人，列为世界范围的前列。
结果与分析：比较国外类似性研究，我国心脑血管疾病发病率与死亡率与欧美国家有如下不同特点：
1. 我国脑卒中在世界范围内属于高发病率地区，甚至高出欧美等国家。美国以冠心病为主要死亡原因，我国却以脑卒中为主要死亡原因，二者相差四倍。
, 百拇医药
2. 我国脑卒中地域特征为：北方地区高南方地区低。患病率、发病率城市高于农村，死亡率截然相反农村高出城市。脑卒中死亡高出心肌梗死的2-3倍。
3. 我国高血压患病率高出美国，城乡高血压控制率却很低仅为15.6%、5.4%，显示出高血压的管理水平及力度的不足，是高血压诱发脑卒中的明确危险因素。
4. 我国社区人群血清胆固醇水平和体重指数低于国外类似性研究而出血性卒中高出西方国家，达到32%-49%。
中国七城市脑卒中发病率死亡率患病率比较(1/10万)
地区 发病率 死亡率 患病率
北京 370 281 1285
, 百拇医药
哈尔滨 441 370 1249
银 川 252 187 824
长 沙 232 80 846
广 州 162 80 576
上 海 157 104 615
, http://www.100md.com
成 都 136 59 456
对策： 社区人群脑卒中及其危险因素的综合性干预。在我国北京、上海、长沙和北京房山农村四个示范社区40余万人群中进行的大规模心脑血管病综合性防治研究获得了令人鼓舞的阶段性成果。三城市干预社区脑卒中平均发病率和死亡率分别比对照社区降低16.6%(P<0.01)和14.8%(P<0.01)北京农村干预社区脑卒中平均发病率和死亡率分别比对照社区降低18.7%(P<0.01)和17.7%(P<0.01)。成本效益分析，总效益比约4:1即每投入1元人民币用于干预性研究，可节省4元钱心脑血管疾病支出费用。因此积极开展和实施综合性干预研究，可以有效地降低心脑血管病发病率和死亡率，是降低心脑血管疾病危害的根本出路。
关键词：脑卒中 流行特征 干预研究
, http://www.100md.com
Epidemiological characteristics and trends of stroke in China
WU Shengping WANG Wenzhi
Beijing Neurosurgical Institute
Background：Stroke, which became harmful to the lives and health of the middle-aged and aged, is an important issue in the field of public health in China. Surveys showed that the top cause of death was from stroke in urban residents, the second cause of death in rural residents. The mortality rate of stroke increases in recent decade years. The incidence, mortality and prevalence rates of stroke were respectively 120～180/100000, 80～130/100000 and 400～700/100000. It is estimated that more than 2 million new cases of stroke occur annually, 1.5 million patients die annually, and 6～7 million patients with dysfunction survived in China.
, 百拇医药
Results and Analyses：In comparison with the studies from USA and European countries, China had unique epidemiological characteristics of cardiovascular diseases: 1. Higher incidence rate of stroke in China than in USA and European countries; it was the major cause of death from coronary heart disease (CHD) in USA, but the major cause of death from stroke in China, that was about 4 times higher than in USA. 2. Higher incidence and mortality rates of stroke in northern areas than in Southern areas of China; higher prevalence and incidence rates in urban than rural areas; The mortality rate of stroke was 2～3 times higher than that of myocardial infarction (MI). 3. The prevalence rate of hypertension was higher in China than in USA. The control rates of hypertension were respectively 15.6% in urban areas and 5.4% in rural areas, which denoted the poor power of management in China. 4. The serum cholesterol (CHO) and body mass index (BMI) were lower in Chinese population in comparison with studies from foreign countries; The ratios of hemorrhagic stroke in total stroke were 32%～49%, which was higher in China than in western countries.
, http://www.100md.com
Strategies A comprehensive intervention trial of stroke and its risk factors was carried out in Beijing, Shanghai, Changsha urban and Fangshan rural model communities, covering 400,000 people. The trial achieved inspiring results. The average incidence and mortality rates respectively decreased 16.6% (P<0.01) and 14.8% (P<0.01) in three urban communities, and 18.7% (P<0.01) and 17.7% (P<0.01) in Fangshan rural community. According to cost-effective analysis, one yuan RMB paid for the prevention of stroke could save 4 yuan RMB paid for the treatment of stroke. Accordingly, to initiate the campaign of comprehensive prevention and treatment of stroke in community may effectively lower the incidence and mortality rates of cardio-cerebro-vascualr diseases. It is an effective and fundamental way for lessening the harm of cardiovascular diseases.
, http://www.100md.com
【Key words】stroke epidemiological characteristics intervention trial
Nanjing Stroke Registry Program
XU Gelin, LIU Xinfeng,Department of Neurology Jinling Hospital Nanjing University
Why a registry?
◆To get epidemiological information of stroke in the registry area
◆To detect new or novel risk factors of stroke
, http://www.100md.com
◆To identify those areas where quality improvement initiatives are most necessary
◆To develop a tracking system to monitor improvements in the delivery of acute stroke care
◆To monitor the adherence to evidence based guidelines
The Founding of Nanjing Stroke Registry Program
◆August, 1999～July, 2001, Dr. Xinfeng Liu participated the Lausanne Stroke Registry Project (Switzerland).
, 百拇医药
◆July, 2002, Dr. Liu suggested to establish a hospital based stroke program in Nanjing, China.
◆November, 2002, the blueprint of the stroke registry program was made in a local stroke meeting. An application was submitted after the meeting.
◆January, 2003, the Nanjing stroke registry program was approved and a special fund was allocated.
The Founding of Nanjing Stroke Registry Program (cont)
, http://www.100md.com
◆July, 2003, the prototypes of the program was made by a group of experts from multi-discipline (e.g. Neurologists, psychiatrists, psychologists, statisticians, programmers and administrative personnel).
◆December, 2003, the computer-program was finalized.
◆January, 2004, the Nanjing Stroke Registry Program was inaugurated and case selecting started on.
◆To date, more then 200 stroke cases have been registered.
, 百拇医药
The City of Nanjing
◆Population: 2 600 000
◆Area: 950 square kilometers
◆Ethnic: dominated by Han (98.6%)
minorities (1.4%), further dominated by Hui
◆Climate: subtropical monsoon
◆GDP per capita: 3000 USD
Participating Hospitals
, 百拇医药
◆Nanjing University, School of Medicine
◆Jinling Hospital
◆Second Jiangning Hospital
◆De’an Hospital
◆Heping Hospital
Improvement vs. Research
Aim to improve stroke care
◆Increase to 100% the proportion of cases seen by an ED physician within 10 min of arrival
, http://www.100md.com
◆Increase to 100% the proportion of cases having a neurologist consult within 15 minutes of arrival, if arrival < 180 min from symptom onset
◆Increase to 100% the proportion of cases with CT completed by 25 minutes, if arrival < 180 min from symptom onset
◆Increase to 100% the proportion of cases with a documented NIHSS, if arrival < 180 min from symptom onset
◆Increase to 100% the proportion of cases having dysphagia screening prior to oral intake
, 百拇医药
◆Increase to 100% the proportion of cases discharged on antithrombotics without documented contraindications
◆Increase to 100% the proportion of cases with A-fib discharged on anticoagulants
◆Increase to 100% the proportion of smokers who receive cessation counseling
Improvement vs. Research
Clinical Research
◆Collecting epidemiological and demographical data of stroke
, 百拇医药
◆Detecting new or novel risk factor to stroke
◆Evaluating the physical and psychological effects of stroke
◆Assessing the efficiency of treatment and intervention
◆Clinical trial
◆Effect-cost research
◆Eliminate bias
The process of registry
◆Case eligibility evaluation
, 百拇医药
◆Consent form signed by patients or their guardians
◆Demographical and epidemiological data collection
◆Medical and family history recording
◆Physical and Neurological Examinations
◆Neuroimaging studies
◆Neuropsychometric testing
◆Following up
◆Data extracting and processing
, http://www.100md.com
Eligibility evaluation
Inclusion criteria
◆aged 18 or older
◆dwelled in Nanjing for more then 2 years
◆Chinese speaking (Mandarin or Cantonese)
◆a cerebrovascular event in recent 3 months
Close of a case in registry
◆deceased
◆moved out of the area
◆no longer willing to participate the registry
◆lost contact for more than 18 months, 百拇医药(吴升平 王文志)