不同危险因素人群的社区脑卒中干预效果评估

目的评价社区脑卒中干预在不同危险因素人群中的效果。方法1987年在北京和长沙两城市各选择2个不相邻、框架人口约为1万的自然人群,分别作为干预和对照社区,从2个社区35岁以上人群中分别选取2700名既往无脑卒中病史的居民作为队列人群,进行脑卒中危险因素基线调查,两城市共入选干预队列5319人,对照队列5506人。在干预队列,对筛查出的高危对象进行社区干预,对照队列的人群则顺其原有医疗不予干预。干预时间为12年。结果干预队列脑卒中发病的危险比对照队列低22%(HR=0.78,95%CI:0.66～0.92)。无论居民是否有脑卒中的危险因素,干预队列脑卒中发病率都低于对照队列,无论教育水平如何、是否肥胖或超重,脑卒中发病率均有明显降低,但是在男性、吸烟和饮酒者中脑卒中发病率在干预组和对照组比较其差异无统计学意义。干预队列脑卒中死亡率明显低于对照队列(HR=0.27,95%CI:0.17～0.42)。脑卒中死亡率在不同危险因素水平均有明显的降低(P<0.05)。结论经过长期的社区干预,不仅可以降低高危人群脑卒中的发病和死亡危险,无危险因素的社区居民也受益。但是男性、吸烟和饮酒者的干预还亟待加强。

Evaluation on a community-based intervention program among people with differenct risk factors of stroke

Objective To evaluate the effect of a long-term community-based intervention program on risk factors of stroke among people with different risk factors.Methods In 1987,2 geographically separated communities with 10 000 registered residents of each,were selected as either intervention or control communities in Beijing and Changsha.A cohort containing 2700 subjects at the age of 35 years or older,and free of stroke were sampled from each community.The baseline survey was conducted to screen the subjects at high risk for intervention and there were 5319 and 5506 subjects enrolled in intervention and control cohorts,respectively.Then,a program for controlling the risk factors of stroke was initiated in the intervention cohort and health education was provided to the whole intervention community.A follow-up survey was conducted in 1999.The information on incidence and mortality of stroke was collected.Results Comparing with the control cohort,the risk of incidence and mortality of stroke decreased by 22%(HR= 0.78,95% CI:0.66-0.92)and 73%(HR=0.27,95% CI:0.17-0.42)in intervention cohort.The risks of stroke were lower in intervention cohort than in control cohort among almost all of the sub-groups with or without risk factors of stroke except for being male,current smokers and current alcohol drinkers.The risk of death caused hy stroke decreased significantly in those with or without the risk factors of stroke. Conclusion The long-term community intervention on the risk factors of stroke could effectively reduce the risk of ineidence and mortality of stroke among people with or without the risk factors of stroke.More attention should be paid to the males and those who smoke or drink alcohol.