英国牛津大学Peter M. Rothwell团队研究了2002-2018年，低龄和高龄与卒中和其他血管事件发病率变化的相关性。相关论文发表在2022年8月9日出版的《美国医学会杂志》上。

一些研究报告了年轻人群（<55岁）中风发病率的增加，但往往仅依赖于管理数据，需要更多基于人群的研究来判定中风趋势。要了解年轻人群中风发病率增加的驱动因素，还需要与老年人的中风趋势以及年轻人其他血管事件的发病率趋势进行比较。

为了确定年轻人群与老年人群卒中和其他重大血管事件发生率的时间变化，2002年4月至2018年3月，研究组进行了一项前瞻性、基于人群的发病率研究，使用英格兰牛津郡94567人的数据。暴露因素为日历时间、病前血管危险因素和职业。主要结局为卒中、短暂性脑缺血发作（TIA）和其他重大血管事件（心肌梗死、心源性猝死和外周血管事件）发生率的变化，按年龄、性别、诊断检查、病因和严重程度分层。

研究组共确定了2429例卒中事件（平均年龄73.6岁；51.3%为女性）。从2002-2010年到2010-2018年，55岁以下参与者的卒中发病率显著增加（发病率比率[IRR]为1.67），但55岁及以上参与者的卒中发生率显著下降（IRR为0.85）。55岁以下患者发病率的显著增加与性别、卒中严重程度、病理亚型和研究变化无关，TIA患者发病率也有显著增加（IRR为1.87），但心肌梗死和其他重大血管事件的发病率无显著增加（IRR为0.73）。

虽然55岁以下参与者的TIA和中风与糖尿病（风险比[RR]为3.47）、高血压（RR为2.52）、当前吸烟（RR为3.38）和肥胖（RR为1.36）显著相关，但从2002-2010年到2010-2018年，在没有这些危险因素的个体中，发病率仍然显著增加。专业人员/管理人员的发病率增长最大（IRR为2.52），部分技能人员/非专业人员的增长最小（IRR为1.17）。55岁以下且无已知血管危险因素的患者中，TIA和中风的比例随时间显著增加（45[30.4%]与115[42.4%]；绝对差异为12.0%），尤其是在有隐源性事件的患者中（10[18.5%]与63[49.2%]，绝对差异为30.7%）。

研究结果表明，通过比较2002-2010年和2010-2018年英国牛津郡的人群，55岁以下的人群中风发病率显著增加，但55岁及以上的人群中风发生率下降。鉴于其他血管事件没有这种差异，需要进一步研究以了解这种差异的原因。

附：英文原文

Title: Association of Younger vs Older Ages With Changes in Incidence of Stroke and Other Vascular Events, 2002-2018

Author: Linxin Li, Catherine A. Scott, Peter M. Rothwell

Issue&Volume: 2022/08/09

Abstract:

Importance  Some studies have reported increasing stroke incidence at younger ages (<55 years) but have often relied only on administrative data, and more population-based studies of adjudicated stroke are required. An understanding of the drivers of any increase in incidence of young stroke also requires comparisons with stroke trends at older ages and with trends in incidence of other vascular events at younger ages.

Objective  To determine temporal changes in incidence of stroke and other major vascular events at younger vs older ages.

Design, Setting, and Participants  Prospective population-based incidence study conducted from April 2002 to March 2018 with a mean catchment population of 94567 in Oxfordshire, England.

Exposures  Calendar time, premorbid vascular risk factors, and occupation.

Main Outcomes and Measures  Changes in incidence of stroke, transient ischemic attack (TIA), and other major vascular events (myocardial infarction, sudden cardiac death, and peripheral vascular events) stratified by age, sex, diagnostic workup, etiology, and severity.

Results  A total of 2429 incident strokes were ascertained (mean age, 73.6 [SD, 14.4] years; 51.3% female). From 2002-2010 to 2010-2018, stroke incidence increased significantly among participants younger than 55 years (incidence rate ratio [IRR], 1.67; 95% CI, 1.31-2.14) but fell significantly among participants aged 55 years or older (IRR, 0.85; 95% CI, 0.78-0.92; P<.001 for difference). The significant increase in incidence at younger than 55 years was independent of sex, stroke severity, pathological subtype, and changes in investigation and was also seen for TIA (IRR, 1.87; 95% CI, 1.36-2.57) but not for myocardial infarction and other major vascular events (IRR, 0.73; 95% CI, 0.58-0.93). Although TIA and stroke at younger than 55 years were significantly associated with diabetes (risk ratio [RR], 3.47; 95% CI, 2.54-4.74), hypertension (RR, 2.52; 95% CI, 2.04-3.12), current smoking (RR, 2.38; 95% CI, 1.92-2.94), and obesity (RR, 1.36; 95% CI, 1.07-1.72), the significant increase in incidence from 2002-2010 to 2010-2018 was still seen in individuals without these risk factors. The increase was greatest in professional/managerial occupations (IRR, 2.52; 95% CI, 1.75-3.62) and least in partially skilled/unskilled occupations (IRR, 1.17; 95% CI, 0.79-1.74). The proportion of TIAs and strokes among those younger than 55 years without known vascular risk factors increased significantly over time (45 [30.4%] vs 115 [42.4%]; absolute difference, 12.0%; 95% CI, 2.6-21.5), especially in patients with cryptogenic events (10 [18.5%] vs 63 [49.2%]; absolute difference, 30.7%; 95% CI, 17.2-44.2; P<.001; P=.002 for heterogeneity).

Conclusions and Relevance  Comparing persons living in Oxfordshire, England, in 2002-2010 vs 2010-2018, there was a significant increase in stroke incidence in those younger than 55 years, but a decrease in those aged 55 years or older. Given the absence of this divergence for other vascular events, further research is needed to understand the causes of this difference.

DOI: 10.1001/jama.2022.12759

Source: https://jamanetwork.com/journals/jama/article-abstract/2795026