Trend change of ischemic stroke incidence and mortality between 2012 and 2018 in Chongqing
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摘要:
目的 了解重庆市缺血性脑卒中发病死亡趋势变化，为开展脑卒中防治提供建议。 方法 2012—2018年缺血性脑卒中个案资料来源于重庆市心脑血管疾病监测，采用SPSS 25.0软件分析计算发病率、标化发病率、死亡率、标化死亡率、构成比。不同地区、不同性别发病率与死亡率的比较采用χ2检验。率的趋势变化采用年度变化百分比(annual percent change, APC)表示。 结果 2012年重庆市缺血性脑卒中发病率、标化发病率分别为172.78/10万、140.80/10万，2018年发病率、标化发病率分别为186.63/10万、139.17/10万，APC分别为1.71%、0.80%，变化趋势差异无统计学意义(均有P>0.05)。缺血性脑卒中发病率男性高于女性，城市高于农村(均有P < 0.05)。农村地区缺血性脑卒中发病率以年均6.29%的速度上升(t=2.83, P=0.037)。缺血性脑卒中死亡率与标化死亡率分别由2012年17.89/10万、16.11/10万上升至2018年的39.03/10万、26.12/10万，分别以年均15.37%(t=6.68, P=0.001)与7.79%(t=5.43, P < 0.001)的速度上升。缺血性脑卒中死亡率男性高于女性(均有P < 0.05)。农村地区缺血性脑卒中死亡率与标化死亡率分别以年均14.91%(t=8.72, P < 0.001)与12.86%(t=7.63，P=0.001)上升。 结论 重庆市缺血性脑卒中发病率与死亡率较高，发病率相对稳定，死亡率上升，男性与农村是缺血性脑卒中防治重点。 Abstract:Objective To understand the trend change of ischemic stroke incidence and mortality between 2012 and 2018 in Chongqing, so as to provide suggestions for ischemic stroke prevention and control. Methods Cases of the ischemic stroke, were collected from the surveillance system of cardiovascular and stroke from 2012 to 2018 in Chongqing. Indicators including incidence, age standardization incidence rate(ASIR), mortality, age standardized mortality rate(ASMR), and proportion of ischemic stroke were analyzed by SPSS 25.0. The differences of the ischemic stroke incidence and mortality were compared by Chi-square test between male and female, urban and rural area. The trend change of the incidence and mortality of ischemic stroke were indicated by annual change percent (APC). Results The incidence and ASIR of ischemic stroke were 172.78/100 000 and 140.80/100 000 in 2012, Chongqing. The incidence and ASIR of ischemic stroke were 186.63/100 000 and 139.17/100 000 in 2018, Chongqing. APC of incidence and ASIR were 1.71% and 0.80%. And the trend changes of the incidence and ASIR had no significance (all P>0.05). The incidence of ischemic stroke in male was higher than that in female (all P < 0.05). The incidence of ischemic stroke in urban area was higher than that in rural area (all P < 0.05). The incidence of ischemic stroke increased by 6.29% annually in rural area (t=2.83, P=0.037). The mortality and ASMR of ischemic stroke increased from 17.89/100 000, 16.11/100 000 in 2012 to 39.03/100 000, 26.12/100 000 in 2018 significantly. And its APC were 15.37% (t=6.68, P=0.001) and 7.79% (t=5.43, P < 0.001). The mortality of ischemic stroke in male were higher than that in female(all P < 0.05). The mortality and ASMR of ischemic stroke increased by 14.91% (t=8.72, P < 0.001) and 12.86% (t=7.63, P=0.001) in rural area significantly. Conclusion The incidence and mortality of ischemic stroke in Chongqing were high. The incidence of ischemic stroke was stable in Chongqing. However, the mortality of ischemic stroke increased rapidly in Chongqing. The male and rural area were crucial for ischemic stroke prevention and control. -
Key words:
- Ischemic stroke /
- Incidence /
- Mortality /
- Annual percent change
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表 1 2012—2018年重庆市缺血性脑卒中发病率变化趋势
Table 1. The trend of ischemic stroke incidence during 2012 and 2018 in Chongqing, China
变量 2012年 2013年 2014年 2015年 2016年 2017年 2018年 APC(%) t值 P值 男性 发病数(例) 24 690 31 098 29 049 27 526 27 863 36 961 29 982 发病率(/10万) 169.01 208.52 193.27 183.14 183.99 239.43 193.33 2.33 1.08 0.328 标化发病率(/10万) 143.14 170.49 154.08 148.56 149.41 196.44 150.15 1.41 0.64 0.548 构成比(%) 60.16 64.28 62.02 59.05 56.86 59.73 61.46 女性 发病数(例) 21 257 27 652 24 194 23 190 23 431 32 078 25 162 发病率(/10万) 152.11 190.23 168.13 161.15 159.95 213.18 165.07 1.51 0.65 0.547 标化发病率(/10万) 119.61 146.07 125.8 122.49 120.7 162.4 118.23 0.50 0.19 0.855 构成比(%) 64.98 69.27 65.57 63.24 60.63 64.46 64.66 χ2值a 8.69 9.77 15.44 14.17 15.67 14.89 18.52 P值 0.003 0.002 ＜0.001 ＜0.001 ＜0.001 ＜0.001 ＜0.001 城市 发病数(例) 17 814 21 788 19 615 16 424 17 153 19 405 18 695 发病率(/10万) 238.87 287.79 259.09 216.94 207.96 232.8 224.29 -2.96 1.59 0.173 标化发病率(/10万) 218.27 249.62 225.08 189.17 167.2 203.6 195.43 -3.63 21.74 0.142 构成比(%) 72.74 76.05 72.57 70.3 69.1 71.39 72.43 农村 发病数(例) 28 133 36 962 33 628 34 292 34 141 49 635 36 449 发病率(/10万) 128.98 155.38 150.95 156.35 167.68 223.93 172.62 6.29 2.83 0.037 标化发病率(/10万) 98.96 118.31 112.48 119.16 123.58 171.53 123.65 5.55 2.15 0.084 构成比(%) 54.19 59.63 58.79 57.08 54.39 58.57 59.73 χ2值b 53.42 66.66 59.50 34.46 23.25 4.55 29.50 P值 ＜0.001 ＜0.001 ＜0.001 ＜0.001 ＜0.001 0.033 ＜0.001 合计 发病数(例) 45 947 58 750 53 243 50 716 51 294 69 039 55 144 发病率(/10万) 172.78 199.52 180.97 172.39 181.18 226.47 186.63 1.71 0.94 0.388 标化发病率(/10万) 140.8 157.8 139.74 135.39 141.99 178.98 139.17 0.80 0.41 0.699 构成比(%) 62.3 66.54 63.58 60.89 58.52 61.84 62.88 注：a表示男性与女性发病率比较；b表示城市与农村发病率比较。 
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表 2 2012—2018年重庆市缺血性脑卒中年龄别发病率变化趋势
Table 2. The trend of age-specific incidence of ischemic stroke during 2012 and 2018 in Chongqing, China
年龄(岁) 2012年 2013年 2014年 2015年 2016年 2017年 2018年 APC(%) t值 P值 0~＜5 发病数(例) 5 1 2 10 13 42 5 发病率(/10万) 0.35 0.09 0.14 0.65 0.89 2.45 0.29 32.58 1.44 0.210 5~＜15 发病数(例) 3 8 4 11 5 29 4 发病率(/10万) 0.11 0.26 0.14 0.36 0.19 0.86 0.12 11.18 0.74 0.495 15~＜30 发病数(例) 47 90 95 99 71 139 62 发病率(/10万) 0.87 1.48 1.53 1.62 1.26 2.21 1.04 4.19 0.67 0.532 30~＜45 发病数(例) 982 1 231 1 150 1 112 902 1 139 791 发病率(/10万) 15.38 19.21 18.41 18.00 15.87 17.86 13.02 -2.76 1.13 0.310 45~＜60 发病数(例) 6 507 8 159 7 240 6 672 6 017 8 236 6 943 发病率(/10万) 120.76 115.08 102.02 95.10 93.26 113.78 100.76 -2.27 1.30 0.250 60~＜70 发病数(例) 12 435 16 067 14 198 13 256 12 577 17 179 发病率(/10万) 470.52 522.04 453.1 427.92 428.79 538.64 427.3 -1.00 0.51 0.629 70~＜80 发病数(例) 16 045 19 883 18 108 17 258 17 636 23 939 发病率(/10万) 1 146.05 1 278.61 1 137.73 1 096.85 1 137.15 1 468.58 1 087.94 0.40 0.19 0.854 ≥80 发病数(例) 9 923 13 310 12 447 12 298 14 073 18 336 发病率(/10万) 1 901.23 2 218.48 1 936.01 1 935.05 2 245.09 2 781.89 2 165.52 3.56 1.57 0.178
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表 3 2012—2018年重庆市缺血性脑卒中死亡率变化趋势
Table 3. The trend of ischemic stroke mortality during 2012 and 2018 in Chongqing, China
变量 2012年 2013年 2014年 2015年 2016年 2017年 2018年 APC(%) t值 P值 男性 死亡数(例) 3 176 3 912 4 673 4 980 5 315 5 404 6 010 死亡率(/10万) 21.74 26.23 31.09 33.13 35.10 35.01 38.75 9.09 6.27 0.002 标化死亡率(/10万) 18.69 22.25 25.50 27.21 27.55 28.99 29.93 7.47 5.78 0.002 构成比(%) 19.71 22.59 23.21 24.60 26.85 27.72 29.58 女性 死亡数(例) 2 582 3 192 3 908 4 216 4 603 4 626 5 206 死亡率(/10万) 18.48 21.96 27.16 29.30 31.42 30.74 34.15 9.97 5.98 0.002 标化死亡率(/10万) 13.63 16.16 19.26 20.74 20.94 21.75 22.41 8.00 5.18 0.004 构成比(%) 22.63 25.49 26.04 28.47 30.35 31.23 33.67 χ2值a 6.15 8.54 6.25 5.86 5.52 6.49 6.67 P值 0.013 0.003 0.012 0.015 0.019 0.011 0.010 城市 死亡数(例) 2 056 2 747 2 730 2 409 2 483 2 171 2 214 死亡率(/10万) 27.57 36.28 36.06 31.82 30.10 26.05 26.56 -3.34 1.41 0.217 标化死亡率(/10万) 24.21 30.76 30.77 27.04 22.93 22.10 22.44 -4.11 1.83 0.127 构成比(%) 33.32 37.92 36.28 36.96 40.28 39.62 41.93 农村 死亡数(例) 3 702 4 357 5 851 6 787 7 435 7 859 9 001 死亡率(/10万) 17.52 19.91 26.78 31.06 34.51 35.48 40.15 14.91 8.72 ＜0.001 标化死亡率(/10万) 13.57 15.44 19.86 23.18 24.76 26.49 27.32 12.86 7.63 0.001 构成比(%) 17.34 19.28 21.19 23.79 25.82 27.26 29.52 χ2值b 53.42 25.00 12.89 1.02 5.90 12.81 17.55 P值 ＜0.001 ＜0.001 ＜0.001 0.314 0.015 ＜0.001 ＜0.001 合计 死亡数(例) 5 758 7 104 8 581 9 196 9 918 10 030 11 215 死亡率(/10万) 17.89 18.88 25.79 32.64 36.76 36.49 39.03 15.37 6.68 0.001 标化死亡率(/10万) 16.11 19.13 22.38 24.00 24.23 25.35 26.12 7.79 5.43 0.003 构成比(%) 20.92 23.81 24.42 26.24 28.37 29.23 31.35 注：a表示男性与女性发病率比较；b表示城市与农村发病率比较。
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表 4 2012—2018年重庆市缺血性脑卒中年龄别死亡率变化趋势
Table 4. The trend of age-specific mortality of ischemic stroke during 2012 and 2018 in Chongqing, China
年龄(岁) 2012年 2013年 2014年 2015年 2016年 2017年 2018年 APC(%) t值 P值 0~＜5 死亡数(例) 0 0 0 0 0 0 0 死亡率(/10万) 0.00 0.00 0.00 0.00 0.00 0.00 0.00 5~＜15 死亡数(例) 1 2 0 0 1 1 0 死亡率(/10万) 0.03 0.06 0.00 0.00 0.03 0.03 0.00 15~＜30 死亡数(例) 4 7 8 13 5 8 8 死亡率(/10万) 0.07 0.12 0.13 0.21 0.08 0.13 0.13 5.65 0.77 0.474 30~＜45 死亡数(例) 67 66 57 76 69 64 57 死亡率(/10万) 0.96 1.03 0.92 1.23 1.11 1.00 0.90 -0.20 0.10 0.923 45~＜60 死亡数(例) 396 440 511 545 471 461 538 死亡率(/10万) 6.74 6.23 7.25 7.74 6.66 6.36 7.50 1.01 0.59 0.578 60~＜70 死亡数(例) 887 1 047 1 182 1 276 1 312 1 331 1 460 死亡率(/10万) 30.76 34.14 38.00 41.02 40.81 41.65 44.17 5.76 6.23 0.002 70~＜80 死亡数(例) 1 823 2 166 2 745 2 911 2 947 3 058 3 264 死亡率(/10万) 119.33 139.76 173.73 184.24 173.36 187.24 182.43 6.82 3.42 0.019 ≥80 死亡数(例) 2 580 3 376 4 078 4 374 5 113 5 107 5 888 死亡率(/10万) 453.03 564.63 638.95 685.49 744.14 773.32 813.23 9.53 7.31 0.001
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