北京社区卒中后老年人生存率的队列研究

目的 探讨北京社区卒中后老年人的生存率并评价其死亡风险比。方法1997年，采用按类分层、分阶段随机抽取区（县）、街道（乡）、居委会（自然村），按照整群抽样原则获得研究样本，对其进行问卷调查。基线获得有效调查样本2788人，其中男1356人，女1432人，年龄为60—98岁。此样本分别于2000年7月和2004年10月进行全面追踪随访，记录死亡、失访的时间和原因。结果卒中组年死亡率为7．77／100人年，非卒中组为4．51／100人年（X^2=27．69，P〈0．001），差异有统计学意义。截至随访期末，卒中组累积生存率为57％，非卒中组为72％（u=29．24，P〈0．001），差异有统计学意义；随着时间的延长，卒中组的累积生存率明显低于非卒中组，即卒中组的1、2、3、5年累积生存率分别为86％、78％、73％和64％，均低于非卒中组的94％、89％、85％和78％；经Cox回归分析，调整性别、年龄、高血压病、冠心病、糖尿病、肿瘤及其他慢性病史等因素后，卒中的死亡风险比为1．869（95％CI：1．530～2．283），归因危险度（AR）为3．95，归因危险度比率（ARP）为46．5％。结论社区卒中后老年人的生存率明显降低。卒中是老年人死亡的重要因素之一，全社会应重视卒中的预防。

Prognosis of post-stroke elderly:a community-based cohort study

Objective To investigate the survival rate and to estimate their hazard ratio of death in the post-stroke elderly in the communities of Beijing. Methods The study samples were collected from districts （or counties）, subdistricts （or townships） and residents committees （or natural villages） in 1997 using stratified classification, multistage random sampling according to the principles of cluster sampling. The individuals were questionnaired. A total of 2788 valid samples were obtained. These samples were followed up comprehensively in 2000 and 2004, respectively; the time and reasons of death and lost to follow-up were documented. Results The year mortality in stroke group was 7.77/100 person-years, and in non-stroke group was 4.51/100 person-years（x^2 = 27.69 ,P 〈0.001 ）. The difference was statistically significant. The cumulative survival rate was 57% in the stroke group up to the end of the follow-up period, and it was 72% （ u =29.24, P 〈0.001 ） in the non-stroke group. The difference was statistically significant. With the extension of time, the cumulative survival rate in the stroke group was significantly lower than that in the nonstroke group： the survival rates of 1, 2, 3, and 5 years in the stroke group were 86% , 78% , 73%, and 64%, respectively. They were all lower than 94%, 89%, 85% , and 78% in the non-stroke group. After adjusting for age, sex, hypertension, coronary heart disease, diabetes, tumor and other chronic diseases with Cox regression, the mortality risk ratio of stroke was 1. 869 （95% CI： 1. 530 -2.283 ）. The attributable risk （AR） was 3.95, and the attributable risk proportion（ARP） was 46.5%. Conclusions The survival rate of the post-stroke elderly in the communities was significantly decreased. Stroke is one of the important factors of the death in the elderly. So the whole society should pay attention to the prevention of stroke.