Stroke mortality. Statistics and probable causes of death after stroke Stroke statistics in the Russian Federation

Navigation

Causes Leading to Acute Disorder cerebral circulation(ONMK) are diverse:

  • stress;
  • hereditary predisposition;
  • alcohol intake;
  • smoking;
  • improper diet (an abundance of animal fats, salt);
  • cardiovascular diseases (hypertension, atherosclerosis, atrial fibrillation, angina pectoris);
  • other diseases (diabetes, obesity);
  • congenital vascular pathology (AVM, vascular aneurysms);
  • sedentary lifestyle;
  • age-related changes in blood vessels;
  • hormonal imbalance (during the climacteric period in women, the level of estrogen that protects the vessels decreases).

Death from a stroke can occur both in the early post-stroke period and in the process of rehabilitation from hemorrhage.

Stroke mortality statistics

Hemorrhagic (20%) and ischemic (or cerebral infarction, accounting for 80% of cases) variants of stroke are possible. The likelihood of death in the acute period increases with hemorrhagic form.

Mortality rates from stroke directly depend on its type, as well as on the stage of the disease, gender and age of the patient, the presence of concomitant pathology, general condition, timeliness and completeness of treatment. medical care.

According to statistics, in Russia with intracerebral hemorrhage, the mortality rate is higher than with subarachnoid forms. In older patients, mortality is higher. Women die from stroke 10% more often than men.

World statistics

At ischemic form death from stroke occurs more often with atherothombotic, cardioembolic or hemodynamic variants of stroke. Lacunar or microocclusive stroke is rarely the cause of mortality.

A high percentage of deaths are observed from massive or repeated cerebral hemorrhage. The third stroke is often the last. With a massive stroke or cerebral infarction, severe irreversible consequences occur and the chances of survival are reduced.

An unfavorable prognosis appears when the centers for the regulation of respiration and cardiac activity are involved in the pathological process. This is due to the death of neurons in the brain stem or cerebellum. As a result of cardiac arrest and respiration, a person dies.

Clinic

The left hemisphere coordinates the right half of the body, is responsible for analytical skills, thinking, speech.

Extensive ischemic stroke on the left side, the following pathological changes appear:

  • paresis, paralysis on the right;
  • visual disorder of the right eye;
  • motor aphasia (difficulty in pronouncing speech);
  • sensory aphasia (inability to understand someone else's speech);
  • violation of cognitive functions, logical thinking;
  • mental changes.

Patients with left-sided strokes are thought to respond better to treatment.

When the right hemisphere is affected, there is:

  • left-sided paresis, paralysis;
  • deterioration of short-term memory with stored speech;
  • emotional inadequacy;
  • disorder of orientation in space.

Causes of death

The causes of damage to the brain stem structures can be:

  • hemorrhage in the cerebellum and brain stem;
  • ischemia of deep brain structures;
  • hemorrhage in the ventricles of the brain, causing tamponade of the discharge spinal tracts, impaired circulation of cerebrospinal fluid, hydrocephalus, edema and displacement of the brain stem;
  • cerebral edema causes dislocation of brain structures and wedging of the trunk into the foramen magnum of the skull.

The cause of death in stroke can be concomitant pathology, such as myocardial infarction, pulmonary heart failure, and others.

The harbingers of death

There are predictive adverse symptoms indicating a high likelihood of the patient dying.

For example, with signs in the trunk and cerebellum, the death of the patient occurs in 70-80%.

These are the symptoms:

  • disorder of consciousness;
  • early signs characteristic of ischemic stroke - impaired coordination, unsteadiness of gait, sweeping movements;
  • the patient is not able to talk, move, he is only able to open and close the eyelids, the understanding of what is happening is preserved;
  • violation of swallowing, this symptom is characteristic of coma 4 degrees, the prognosis is poor, mortality rate is 90%;
  • there is no control over the movements of the arms, legs, lack of coordination of movements, muscle hypertonicity, convulsive twitching;
  • hyperthermia over 40 0 ​​due to damage to the neurons responsible for thermoregulation, does not respond well to medications, lowering the temperature can be achieved by infusing chilled solutions, putting cold on the head;
  • there is no synchronicity of eye movements, their pendulum-like vibrations appear, a symptom of "doll's eyes";
  • violation of hemodynamic parameters - high blood pressure, tachycardia, there may be arrhythmia, with the appearance of bradycardia, the prognosis worsens even more;
  • pathological types of breathing: Kussmaul (noisy, deep), Cheyne-Stokes (the appearance of deep breaths after shallow breathing), Biota (long breaks between breaths).

These signs before the death of the patient indicate the death of neurons in the vital centers.

With the development of a coma in a patient, the chances of survival drop sharply, with a coma of 3-4 degrees, only 10% of patients remain alive. Patients who managed to survive a coma may die from complications characteristic of bedridden patients.

Here is a list of them:

  • bedsores;
  • congestive pneumonia;
  • pulmonary embolism;
  • genitourinary sepsis;
  • renal failure, dehydration.

The prevention of these complications should begin from the moment of the onset of hemorrhage and continue during the rehabilitation process.

Life support equipment

When a comatose patient is on mechanical ventilation for a long time, the decision to disconnect the device is made by a commission with the consent of the family. Statistics in Russia indicate that after 4 months of being in a coma after a stroke, only a few can get out of it. With adequate care, such patients can be prolonged for several years.

Signs of death

If the patient died of a stroke, then there are signs by which death can be ascertained from the first minutes of its onset:

  • no response to any stimuli;
  • loss of reflexes, including corneal reflexes, dilated pupils, lack of their response to light;
  • a symptom of a cat's eye (when the eyeball is squeezed, the pupil takes on an oval shape), clouding and drying of the cornea;
  • lack of breathing, palpitations.

When signs of clinical death appear, resuscitation is indicated. They should be started immediately, since after 5-10 minutes, irreversible death of brain cells occurs, without the possibility of their restoration.

If resuscitation was not effective, then signs of biological death appear:

  • drop in body temperature;
  • cadaveric spots;
  • rigor mortis;
  • decomposition of tissues.

Statistics for Russia

Death after a stroke can be attributed to a variety of causes. Mortality prevention is aimed at preventing cerebral hemorrhage, which ranks second in Russia due to the death of patients.

»» No. 9-10 "98" »New Medical Encyclopedia

A.A. Skoromets, V.V. Kovalchuk

EPIDEMIOLOGY OF VASCULAR DISEASES OF THE BRAIN

Vascular diseases of the brain (VBD) remain one of the most acute medical and social problems, cause enormous economic damage to society: they are the main cause of emergency hospitalization and long-term disability, occupy the third, and according to some authors - the second place among the causes of mortality in the adult population.

The study of the epidemiology of NWHM is necessary for the successful operation of specialized services and effective fight with this group of diseases.

The results of the first large-scale clinical and epidemiological study of strokes in St. Petersburg are reported by the Chief Neuropathologist of the Health Committee of the St. Doctor of Science, head. Department of Neurology, St. Petersburg State Medical University named after acad. I.P. Pavlova, dr honey... sciences, professor Alexander Anisimovich Skoromets and head. Department of Rehabilitation of Neurovascular Patients, Hospital N 38 named after ON Semashko Vitaly Kovalchuk.

Do you know that:
the prevalence of strokes in the world is 460-560 cases per 100 thousand of the population per year. Among economically developed countries, this indicator is highest in Japan - 569 cases per 100 thousand per year, and the lowest - in Great Britain and the Scandinavian countries - 355-365, in Russia it is 1050;


the frequency of newly diagnosed cases of stroke ranges from 100 to 200 per 100 thousand of the population per year. Among the industrially developed countries this indicator is highest in Japan -213, and the lowest in Canada, France, Denmark -120-125;


mortality rate from stroke in different countries fluctuates within fairly large limits. In 1990, in the countries of Eastern Europe it was 200-250 per 100 thousand of the population, and in the countries of Western Europe 100 per 100 thousand of the population. On average, in economically developed countries since 1970 there has been an annual decrease in the mortality rate from stroke by 7%. For example, in the United States, over the past 10 years, mortality in this type of pathology has decreased by 50%.

At the time of the study, the frequency of strokes in St. Petersburg was 526 per 100 thousand population per year. This indicator was higher in women (614) than in men (416). If we consider the age-specific frequency of strokes, it becomes obvious that only at the age of 80 and older is it higher in women, in other age groups the frequency of acute cerebrovascular accidents (ACVI) is higher in men.

Stroke mortality amounted to 222 per 100 thousand people per year. In women, it is almost twice as high, but again at the expense of the oldest age group. Among men 50-79 years old, the mortality rate is higher: for example, in the group of 60-69 years old, this indicator for males is 3.5 times higher.

Mortality in ischemic stroke was 39%, in hemorrhagic stroke - 71%.

More than a quarter of patients with stroke (28.9%) had a recurrent stroke: 85.00% of them had one previous stroke, 12.50% had two, 1.25% had three, and 1.25% had four.

Essential for both prevention and organization of medical care are data on the most typical time and place of stroke onset.

The vast majority of cases of hemorrhagic strokes occur in the winter months - 41%, and ischemic - in January, March and May. The most vulnerable days of the week were Monday, Tuesday and Friday, the quietest were Sunday and Thursday. Ischemic stroke most often began in the first half of the day - up to 76% of cases. The onset of hemorrhagic stroke was most often noted from 12.00 to 18.00 (56%).

The place of the onset of ischemic stroke was most often the patient's home (77% of cases), hemorrhagic - the street, home (34% each), and work (28%).

One of the main aspects of our research is also the study risk factors.

In fig. 1 shows the percentage various factors for ischemic and hemorrhagic strokes. Table 1 shows the values ​​of the absolute and relative risk of stroke, depending on the presence of certain factors, the reliability of the significance of which is indicated in table. 2.

Fig. 1 Risk factors for stroke

TABLE 1. STROKE PROBABILITY
DEPENDING ON RISK FACTORS

Risk factor ISCHEMIC
STROKE		 HEMORRHAGIC
STROKE

(per 1000 population)

 Rel. risk Abs. risk Rel. risk Abs. risk
Arterial hypertension 3,37 7,1 2,82 53,0
Salt abuse 2,68 5,1 3,17 63,0
Heart diseases 2,67 5,0 1,65 24,8
2,50 4,4 - -
Smoking 2,32 4,1 1,63 23,9
2,06 3,7 - -
Diabetes 2,00 3,0 1,11 2,1
Alcohol abuse 1,25 1,0 1,28 11,9
Obesity 1,08 0,4 - -
Rheumatism 1,04 0,1 - -

TABLE 2. RELIABILITY OF STROKE RISK FACTORS

Risk factor t- CRITERION FOR ISCHEMIC
STROKE		 t- CRITERION FOR HEMORRHAGIC
STROKE
Arterial hypertension 4,5 2,9
Salt abuse 3,8 3,0
Heart diseases 2,9 1,7
Increased serum prothrombin concentration 2,8 -
Smoking 2,3 2,0
Increased serum cholesterol concentration 2,0 -
Increased plasma fibrinogen concentration 1,9 -
Diabetes 1,5 1,3
Drinking alcohol regularly 1,3 1,3
Obesity 0,7 2,0
Rheumatism 0,7 -

In the course of the study, great importance was attached to the rehabilitation of patients, their physical and psychological recovery.

To determine the effectiveness of rehabilitation measures and characterize the level of daily life activity, the Barthel scale was used 1 year after the onset of the disease. According to our data, only 24% of surviving patients showed complete recovery of functions 1 year after suffered a stroke, 15% had minimal recovery, and 11% had no recovery at all, in addition, 28% of patients had satisfactory recovery, 22% - sufficient. Thus, the level of disability 1 year after cerebrovascular accident was 76%.

The following factors greatly influence the degree of recovery of various functions in stroke patients:

  • type of treatment organization (outpatient or inpatient),
  • terms of admission to the hospital,
  • the use of early restorative treatment,
  • stay in specialized rehabilitation and recovery centers and the timing of admission to them.

Considering these factors, it is necessary to note significant shortcomings in the organization of medical care for patients with strokes. So, only 73.9% of patients with stroke were hospitalized, 35.2% of them were admitted to hospitals later than 1 day from the onset of the disease. Early rehabilitation treatment was carried out in only 24.9% of patients.

The situation with rehabilitation and rehabilitation treatment in specialized centers is completely depressing. Only 6.2% of stroke patients were sent for baking to rehabilitation and recovery centers, and it is not uncommon for patients of working age to be referred for rehabilitation treatment (in 8.9% of cases). This is due to the underdevelopment of the network of these institutions, their remoteness from the place of residence of patients, as well as the frequent reluctance of doctors of polyclinics to send patients for rehabilitation treatment. The timeliness of patients' admission to rehabilitation centers has a great influence on the dynamics of neurological disorders and the degree of restoration of various functions of patients. The best results of rehabilitation (Fig. 2) were in patients admitted to rehabilitation hospitals within 1-3 months from the onset of the disease (85.7% of them had a significant and maximum dynamics of neurological disorders). Almost all patients admitted a year or more after the moment of cerebral stroke did not show regression of these disorders.

Rice. 2. Dynamics of neurological disorders in patients after stroke, depending on the duration of hospitalization in rehabilitation and recovery centers (in% of the total)

In conclusion, it should be noted that the incidence and mortality rate of stroke in St. Petersburg is significantly higher than in economically developed countries and in Russia as a whole. Three times more men and six times more women die from a stroke in our city than from myocardial infarction; among deaths due to vascular diseases, every second one - from vascular diseases of the brain, the number of people with disabilities after a stroke is increasing. At the same time, the organization of medical and preventive care for patients with this pathology is far from perfect and requires a qualitative improvement and reorganization.

Do you know that:
in 1990, in age groups over 55, the maximum mortality rate from CVA was observed in Bulgaria, China and countries the former USSR- more than 800; minimum - in Sweden, Australia, France - 200-300, Canada and the USA -190 and 180 per 100 thousand.

the incidence of stroke in Moscow over the past 20 years has increased from 250 to 350 per 100 thousand of the population per year, and in St. Petersburg over 10 years - from 382 to 526.

In recent years, the problem of stroke and cerebrovascular diseases has become the most urgent. In the world, annually, brainstroke overtakes more than fifteen million people. Stroke in the minds of ordinary people is a disease of the elderly. But now the stroke is beginning to get younger every year, more and more strokes are found in thirty to forty-year-old people. It should also be remembered that the older the patient, the higher the risk of developing a stroke. In recent years, the structure of patients who were hospitalized with acute insufficiency of the cardiovascular system has begun to change: there are almost two times more patients with stroke than patients with myocardial infarction. For many years, the outcomes of the disease remain unfavorable: about forty percent of patients die in the first year after the onset of the disease, about eighty percent of people who have suffered a stroke remain permanently disabled. In terms of the number of strokes, Russia ranks second in the world.

Patients who have suffered a stroke, subsequently cannot return to normal life, they remain bedridden for a long time and lose their ability to work. The disease radically changes the family's position. In this regard, the urgent task of timely angiology is the development of effective preventive programs.

Informative and safe methods of conducting ultrasound diagnostics are able to give an idea of ​​the state of the cerebral vessels, they also allow timely detection of critical narrowing of the arteries and atherosclerotic plaques. If necessary, radiopaque angiography and computed tomography are supplemented by doctors' opinions on the state of the tissues and blood vessels of the brain. A modern laboratory can, in the shortest possible time, determine the indicators of cholesterol levels, blood clotting and blood viscosity. This data is necessary in order to be able to identify the prerequisites for stroke.

Many experts have come to the opinion that the choice of treatment is influenced by the presence of atherosclerotic plaques in the carotid arteries, the features and nature of the structure and blood circulation of the cerebral vessels, as well as such concomitant diseases as diabetes mellitus and arterial hypertension.

Of great importance are the operational risk factors that determine the clinical outcomes of invasive manipulation. Each patient should undergo an examination before undergoing surgery. This is necessary in order to reveal the ability of the brain tissue to endure such an operation. If, during the research, a high risk of developing a stroke was identified during the operation, it should be performed under the conditions of temporary bypass surgery. This technique helps to operate even on those people who are seriously ill.

It should be remembered that effective therapy and control over the level of systemic blood pressure are important factors in the survival of sick people.

Cardiovascular disease has always been the leader in the number of deaths, and stroke firmly holds the second place on this list. He also ranks third among all diseases of the nervous system - this is evidenced by WHO statistics. In Russia, about 400 thousand cases of stroke are registered annually, and 35% of them are fatal. And we are talking about people of all ages, not just the elderly, as is commonly believed.

The statistics of the consequences of strokes are disappointing

Today, stroke has no age restrictions, and among the patients of clinics one can even find 5-6-year-old children who have been diagnosed with this terrible diagnosis. The worst thing about this is that at a young age, the most severe type of stroke most often develops - hemorrhagic, accompanied by extensive intracerebral hemorrhages. At a very young age, this is caused by congenital anomalies of the intracerebral vessels.

It is necessary to know what a stroke is from the very early age- about those reasons that serve as provoking factors and preventive measures.

Who is it easier to get sick?

The most frequently recorded ischemic stroke, which accounts for about 80% of the total, and it often causes disability. According to average statistics, only about 13% of patients can recover in full. The rest of the cases end in death or disability. About 30% of those who have suffered a stroke subsequently require outside help, since they are unable to serve themselves.

A certain sequence can be traced with the professional occupations of the sick. The "rating" looks like this:

  • knowledge workers - 40%;
  • physical labor - 33%.
  • people combining mental and physical activity - 27%.

Young people under the age of 40-45 are under attack due to the frantic rhythm modern life- constant stress, lack of rest and a huge amount bad habits including alcohol and drugs. The fact that such an unhealthy lifestyle is considered the norm by most young people is confirmed by a large-scale study that was conducted in the United States between 1995 and 2008. In our country, the situation is not very different for the better.

Nevertheless, the mortality rate of patients of any age from stroke in our country is four times higher than the rates of the same USA and Canada, which in figures looks like this - 175 deaths per 100 thousand cases. At the same time, the percentage of men and women is 39/25, respectively. If we talk about age, then today it no longer plays a key role in the development of stroke - the wrong way of life comes to the fore.

The concept of an unhealthy lifestyle includes not only smoking, alcohol, drugs or overeating. This and the absence of normal physical activity, and ignoring their own diseases, which are already known to man. So, constantly high pressure very quickly leads to the loss of the former elasticity of the vessels of the brain, which is often the cause of hemorrhagic stroke, and various violations of the heart rhythm contribute to thrombosis.

Stroke as a cause of disability

Stroke is one of the leading causes of disability

In Russia, traditionally, a large number of severely disabled people remain after a stroke. This is facilitated by several factors at once. For example, the number of urgently hospitalized patients does not exceed 30% of the total number of patients, the small number of intensive care wards in neurological departments, and the frequent neglect of the need for intensive rehabilitation carried out in specialized centers.

Among other problems contributing to the prevalence of stroke among patients of different ages, there is an insufficient use of neuroimaging methods for the differential diagnosis of the nature of stroke. According to official figures, they are used in no more than 20% of cases, even in large cities and well-equipped hospitals. And they are necessary, since among all strokes, 3.4% occur with subarachnoid, and 16.8% with intracerebral hemorrhage.

After a primary stroke in old age, patients live for 8-9 years, fully serving themselves, but if the violation occurs repeatedly, this period is reduced to two years, and the quality of life is poor.

In elderly patients, ACVA can have several pathogenetic types at once - the diagnosis of each has its own characteristics. Atherothrombotic or hemodynamic types account for about 50%, lacunar strokes account for 22%, cardioembolic stroke "takes" the rest.

Why do young people get sick?

Lately, stroke is more and more common among young people.

In our country, about 20% of all cases of registered cerebrovascular pathologies are people of working age - 20-59 years. Nevertheless, despite a fairly "rejuvenated" stroke, it still tends to "grow up". This is evidenced by the NABI Stroke Registry - according to it, the frequency of strokes triples every decade in almost every region of our country.

Nevertheless, the incidence of stroke is increasing at the age of 15-45 years. Over the past decade, the case rate has increased by about 30%. Moreover, the majority of these patients suffered from arterial hypertension, overweight or diabetes mellitus- such patients, as a rule, did not receive adequate therapy. Ischemic stroke became more common and at the age of 5-14 years - the "increase" was about 31%. The incidence of stroke at the age of 35-47 increased by 37%, and by 30% at the age of 15-34.

In many ways, this trend is due to the lack of full-fledged prevention. Those people who have already suffered a transient ischemic attack or stroke, regardless of their age, need a lot of preventive work aimed at preventing a second attack. This is achieved by strict adherence to the doctor's recommendations, giving up bad habits and maintaining healthy way life.

Epidemiology of stroke in Russia according to the results of the territorial-population register (2009-2010)

The number of people included in the study in 2009 was 1,864,932; In 2009, 3961 cases of stroke occurred in the study area, 1853 cases - in men, which accounted for 47% of all cases of stroke, and 2108 (53%) - in women. The number of people included in the study in 2010 was 3 388 932 people; 8553 cases of stroke occurred, 4038 (47%) - in men, 4515 (53%) - in women. The average age of stroke development was determined in the age range over 25 years and was 68.0 years in 2009, 64.9 years for men and 70.7 years for women. In 2010, similar indicators were 66.7, 63.7 and 69.4 years, respectively. This is significantly lower than in Western populations (72.9 years for men and 77.7 years for women), but I would like to note that for the first time in the entire period of epidemiological studies of stroke in Russia average age stroke development in 2009 exceeded the level of 70 years. In the United States, for example, less than 10% of deaths from diseases of the circulatory system occur before the age of 65; in Russia, according to government statistics, it is 30%. According to previously conducted registers, the average age of stroke development in Russia was 63.1 years for men and 66.3 years for women.

The absolute number of stroke cases in all regions studied increased with age; the maximum number of strokes in men and women occurred at the age of 61-63 and 68-74 years; in the age group 64-67 years, a sharp decrease in the number of strokes was recorded (Fig. 1).

Figure 1. Number of stroke cases (abscissa axis) in men and women, all regions, 2010

The decrease in the number of strokes in men and women aged 64-67 is consistent with the data of the Federal State Statistics Service (ROSSTAT) and is associated with a decrease in the population in this age group, which is due to a sharp decline in the birth rate during the Great Patriotic War (Fig. 2). This fact can serve as a criterion for good data reproducibility.

Figure 2. The size of the male and female population of Russia at the age of 25-99 years (as of January 1, 2002) according to ROSSTAT data

The absolute number of strokes in patients under the age of 67 is higher in men, and at an older age, the incidence of stroke is higher in women, which is consistent with the data of international studies.

Register data 2009-2010 showed that in Russia the main "contribution" to the prevalence of stroke was made by IS, which occurred 5 times more often than IS. The share of AI was 80.0% (80.3 and 79.5% for men and women, respectively) in 2009 and 81.4% (81.3, 82.3%) in 2010 (Table 1) ... The share of HIs, including intracerebral (IUD) and subarachnoid (SAH) hemorrhages, was 13% (13.0, 13.1%) in 2009 and 14% (14.9, 13.3%) in 2010.

Table 1.Prevalence of stroke different types in men and women over the age of 25 in Russia, 2009-2010

Stroke type

Prevalence (% of all cases)

2009 r.

2010 r.

men

women

men

women

Note... SAH - subarachnoid hemorrhage, IUD - intracerebral hemorrhage, NI - undifferentiated stroke

In 2009-2010 there was significant variability in the prevalence of different types of stroke. For example, in 2010, a high prevalence of HI was recorded in men in the Republic of Sakha (Yakutia); SAH cases accounted for 3.36% of all cases, IUD - 25.17%, while in men of the Stavropol Territory there were no cases of SAH during the entire 2010, and IUD were found only in 1.67% of cases.

However, despite the existing differences, in 2009-2010. in the overwhelming majority of territories of Russia, the ratio of AI to GI was 5: 1.

It should be noted that in the register 2001-2003. in comparison with the data of previous studies, an increase in the relative number of cerebral hemorrhages was revealed - the ratio of AI to GI in 2001-2003. was 3.5: 1 compared to 5: 1 in 1970-1980. ...

It can be assumed that the increase in the number of GIs at the turn of the century (register 2001-2003) was due to the difficult economic situation in the country and, therefore, an insufficiently debugged system for correcting arterial hypertension (AH), and the decrease in hemorrhages in 2009-2010. - expanding preventive measures aimed at adequate correction of hypertension, expanding the possibilities of specialized care in the regions.

The prevalence of undifferentiated stroke (NI) in the Russian Federation was 7.07% (6.64, 7.45%) in 2009 and decreased 1.5 times in 2010 - 4.58% (4.78, 4 , 41%). In 2003 this figure was 12.26%.

In 2009, the incidence rates of stroke in Russia, standardized according to the European standard, were 3.52 cases per 1000 population: 3.83 and 3.29 cases in men and women, respectively. In 2010, the incidence of stroke was slightly lower and amounted to 3.28 cases per 1000 population. It should be noted that the incidence rate in men increased by 8% compared to the previous year and amounted to 4.15 per 1000 population, while in women the incidence of stroke in 2010 was 2.74 per 1000 people, showing a record decline in recent decades. - 17% (Table 2).

Table 2. Stroke morbidity and mortality rates from stroke (men; women) in the Russian Federation, 2001-2003 and 2009-2010, standardized according to the European standard.

Epidemiological rate of stroke (per 1000 population per year)

2001 year

2002 year

2003 r.

2009 r.

2010 r.

Morbidity

4,02 (4,25; 3,84)

3,80 (4,04; 3,60)

3,52 (3,83; 3,29)

3,28 (4,15; 2,74)

Mortality

1,47 (1,52; 1,41)

1,42 (1,57;1,30)

1,29 (1,48;1,21)

1,19 (1,13; 1,23)

0,96 (1,18; 0,81)

Over a 10-year period, the incidence decreased by 28%, from 4.02 in 2001 to 3.28 cases per 1000 population in 2010. At the same time, mortality within 28 days from the development of the disease decreased by 65% ​​and amounted to 1 , 47 and 0.96 per 1000 population, respectively. This can serve as a criterion indicating an improvement in the quality of medical care provided to stroke patients during the first 28 days from the onset of the disease. When comparing rates of morbidity and mortality from stroke over the past decade, one can note a downward trend in epidemiological indicators of stroke, which has become more evident in Last year, which is in line with the goals of the national project "Health", adopted in 2009. Nevertheless, the epidemiological indicators of stroke remain higher than in European countries. For example, in the registries of France, a country with a good stroke situation, the incidence is 250 (231-269) cases per 100,000 population, and the death rates have been declining by 2.5-2.9% per year.

Stroke incidence rates in 2009-2010 varied significantly in different regions of the Russian Federation. For example, in 2010, in one of the districts of Tatarstan (Chistopol), the incidence was 6.14 per 1000 population (7.89, 4.94), while in another district of Tatarstan (Nizhnekamsk) the incidence was high - 4.81 (5.54, 4.45), but much lower than in Chistopol. A high incidence was also recorded in the Arkhangelsk region - 5.16 (6.92, 4.17).

In 2010, the low incidence rates were in the Republic of Dagestan (Makhachkala) - 2.18 per 1000 (2.51, 1.92); for 2 years, low rates were stably held in the Altai Territory - 1.39 per 1000 (2.15, 0.94) in 2010 and 2.04 (2.3, 1.86) in 2009 (Fig. 3).

Figure 3. European standardized stroke incidence and stroke death rates in Russia, 2010 (per 1000 population).

In 1985-1995. Within the framework of the international study of stroke using the MONICA registry method in Russia, studies were carried out that showed a clear tendency to an increase in morbidity from the west (Novosibirsk) to the east (Tynda and Anadyr), as well as an increase from west to east in the proportion of patients with HI. In studies 2001-2003 and 2009-2010. such a pattern is no longer traced, which is probably due to the organized work of regional vascular centers throughout the territory of the Russian Federation.

The incidence of primary strokes was 2.6 times higher than the incidence of recurrent strokes in 2009 and 2.8 times higher in 2010 (Table 3). The incidence of recurrent strokes reflects the structure of the incidence of primary strokes and was higher in men in all age groups. Ratio of primary and recurrent stroke cases during 2009-2010 for men it was 3: 1, for women - 3.5: 1.

Table 3. European standardized incidence rates for primary and recurrent strokes and mortality from primary and recurrent strokes in Russia, 2009-2010

Floor

2009 r.

2010 r.

lethality,%

morbidity per 1000 population

lethality,%

Primary stroke

Re-stroke

Primary stroke

Re-stroke

Primary stroke

Re-stroke

Primary stroke

Re-stroke

All sick

2,62

1,01

25,4

23,6

2,46

0,89

21,4

23,2

Men

3,69

0,90

20,7

25,0

3,15

1,01

19,6

24,5

Women

6,52

0,74

29,3

22,3

2,81

0,79

23,0

22,0

International studies show that repeated strokes more often than primary ones develop in hypertensive patients with higher blood pressure and the presence of hypertensive cerebral crises and transient ischemic attacks. The prevalence of hypertension in men with stroke was 97.3% in 2009, in women - 95.8%; in 2010 - 97.5% for men and 94.8% for women.

Mortality in primary strokes in 2009 was 25.4%, in 2010 - 21.4%, with repeated strokes - 23.6 and 23.2% in 2009-2010. respectively.

In most regions, the standardized rates of morbidity and mortality were correlated with each other, i.e. in regions with a relatively high morbidity there was also a high mortality rate (for example, Sverdlovsk and Irkutsk regions, the Republic of Sakha), and in regions with the lowest morbidity, the lowest mortality was recorded (Republic of Dagestan, Altai region, Orenburg region).

It should be noted that this trend did not persist in some territories. For example, in 2009, mortality rates in the Stavropol Territory turned out to be leading with relatively low morbidity rates. This situation is largely due to the fact that in the Stavropol Territory most of the population belongs to older age groups, and the average age of stroke development is 75.2 years (68.7 years for men and 75.4 years for women). It is in the Stavropol Territory that the lowest incidence rates of GI are registered, the incidence rate of IUD was 0.17 per 1000 population (0.18, 0.15), SAK - 0.04 (0.02, 0.06); a similar trend continued in 2010, with no cases of SAH recorded in 2010. A similar situation was recorded in the Krasnodar Territory (Krasnodar) in the 2001-2003 register, adjacent to the Stavropol Territory, with similar climatic and geographic characteristics.

In another case, with a very high incidence of acute cerebrovascular accidents in the Republic of Tatarstan (Chistopol) in 2010 - 5.15 per 1000 (6.61, 4.65) - the average mortality rate in the Russian Federation was recorded - 0.91 per 1000 population (1.28, 0.69).

In the overwhelming majority of regions, the epidemiological indicators of stroke in men were higher than in women. For example, in 2010, the incidence rates of men in Ivanovo, Sakhalin regions and the Republic of Bashkiria were almost 2 times higher than among women in the Republic of Sakha (Yakutia), Orenburg and Irkutsk regions, and the mortality rate among men in these regions was 1 , 5 times higher than that of women. The most pronounced differences in the incidence of stroke in men and women were noted in young and middle age. In the age groups 45-49, 50-54 and 55-59, the incidence in men was 1.8-2.2 times higher than in women. For example, the incidence of stroke in men 55-59 years old was 0.85, and in women - 0.40 cases per 1000 population. Thus, age group 45-59 years of age in men remains the most dangerous in terms of the occurrence of primary stroke, which is consistent with studies of past years and, accordingly, Special attention when carrying out preventive measures, this age category should be given.

With increasing age, the rates in men remained higher than in women, but the differences were not so pronounced. Only at the age of 80 and older was the incidence higher in women. This situation is observed in a number of European registers, for example in the register held in Denmark.

Mortality in patients with stroke during the first 28 days from the onset of the disease was 24.9% in 2009 (in men - 21.9%; in women - 27.6%); in 2010 - 22.47% (20.41 and 24.32%, respectively). These indicators are significantly lower than in the registers of previous decades, for example, in 2001 - 40.37% (36.6% for men and 43.4% for women).

The highest mortality rates were recorded in men and women in the Stavropol Territory - 44.9% (36.3 and 51.7%), the lowest - in the Krasnoyarsk Territory - 10.9% (13.9 and 8.7%) (tab. . 4).

Table 4. Stroke mortality rates (in%) in different regions of the Russian Federation, 2009-2010.

Region

2009 r.

2010 r.

all sick

men

women

all sick

men

women

Altai region

Voronezh region

Ivanovo region

Irkutsk region

Sverdlovsk region

Sakhalin Region

Stavropol region

Republic of Bashkiria

Republic of Karelia

Krasnoyarsk region

Arkhangelsk region

The Republic of Dagestan

The Republic of Sakha (Yakutia)

Republic of Tatarstan

Nizhnekamsk, Tatarstan

Chistopol, Tatarstan

Orenburg region

A decrease in the overall mortality rate was observed in 2010 compared to 2009 in Ivanovo, Sakhalin regions, Stavropol Territory and the Republic of Bashkiria.

The mortality rate in men decreased within 2 years in most regions with the exception of Voronezh and Sverdlovsk regions; women also showed a decrease in mortality in most regions, with the exception of Voronezh, Ivanovo regions and Altai Krai.

Mortality rates in different regions of the country differed, but the differences in mortality were significantly less than in previous studies. This may indicate an improvement in the organization of medical care in regions, including remote ones, and an increase in the percentage of patients treated in a hospital.

In the case of fatal stroke outcomes, the maximum lethality is observed in the first days after the development of a stroke and decreases within 28 days.

The proportion of patients with stroke who received treatment in a hospital in 2010 was 79.81% (78.05 and 78.58%) (Table 5). Even 10 years ago, only about 60% of stroke patients could receive inpatient care (from 38.5 to 81.1% in various cities). In the 1980s, the number of stroke patients receiving hospital treatment was even lower. So, in the 80s, 37% of patients were hospitalized in Leningrad, in cities Vladimir region- 35%, in Novosibirsk - 52%, in Krasnoyarsk - 36%, in Tynda - 71%, while it was also noted that the mortality rate in the hospital was lower than in the treatment at home.

Table 5. Hospitalization of stroke patients in 2010 (all cases of stroke,%)

Region

All sick

Men

Women

Arkhangelsk region

Altai region

Republic of Bashkiria

Ivanovo region

Irkutsk region

Sverdlovsk region

The Republic of Dagestan

Orenburg region

Sakhalin Region

Stavropol region

Republic of Tatarstan

The Republic of Sakha (Yakutia)

According to European registers, in the 1980s, the hospitalization rate in Sweden (Gothenburg) was 88%, in Denmark (Copenhagen) - 79%, in Ireland (Dublin) - 74%, in Finland (Espoo) - 70%. in Yugoslavia (Zagreb) - 83%, in Israel (Zerifin) - 75%. Currently, in the economically developed countries of Europe, Japan, the United States, 93-96% of stroke patients are hospitalized.

Neuroimaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI) tomography were used to differentiate the nature of stroke in 63.1% of stroke patients in 2009 and in 74.2% in 2010.

It should be noted that according to the 2001-2003 register, the use of CT and MRI was noted in no more than 20% of stroke cases, even in large cities.

According to the outlined plans, the second large-scale study of stroke by the register method is being carried out on the territory of the Russian Federation. Reliable data on the main epidemiological indicators of stroke have been obtained, it is possible to compare the indicators of stroke in dynamics, to assess the effectiveness of treatment and prophylactic measures that are widely carried out in the country.

To assess the dynamics of the main epidemiological parameters, the study under the unified registry program will be continued for 5 years, until 2013. This is an energy-intensive and creative work that requires careful implementation, the results of which become visible in years, but their significance cannot be overestimated. Obtaining reliable statistical data will make it possible to adequately plan the volume of medical care provided to the population, reduce morbidity, disability, and improve the quality and life expectancy of the population.


FSBI "Research Institute of Cerebrovascular Pathology and Stroke", Moscow
GBUZSK "Stavropol Regional Clinical Center of Specialized Types of Medical Aid", Stavropol
FSBI "Research Institute of Cerebrovascular Pathology and Stroke", Moscow
Feigin V.L. Epidemiology of cerebral stroke in conditions big city Western Siberia according to the register: Avtoref. dis. ... Cand. honey. sciences. Novosibirsk 1984; 254; Feigin V.L. Epidemiology and prevention of cerebrovascular diseases in Siberia: Author's abstract. diss. Dr. med. sciences. M 1991; 28.
Vinogradova T.E., Chernyavsky A.M., Shprakh V.V. and others. Organization of centers for the register and prevention of stroke in the Regions of Siberia, Kazakhstan and the Far East. X Russian National Congress "Man and Medicine". M 2003; 454; Gafarov V.V., Kozel V.V., Archipenko N.G., Voisitskaya A.A., Feigin V.L. 10-year monitoring of morbidity, mortality and mortality in acute myocardial infarction and cerebral stroke. Therapeutic archive 1993; 65: 4: 9-13; Shmidt E.V., Makinsky T.A. Cerebral stroke. Morbidity and mortality. Journal of neuropathol and psychiatry 1979; 4: 427-432.
Ayriyan N.Yu. Analysis of data from epidemiological monitoring of stroke in the Russian Federation: Author's abstract. dis. ... Cand. honey. sciences. M. 2006; 24; Gusev E.I., Skvortsova V.I., Stakhovskaya L.V., Kilikovsky V.V., Ayriyan N.Yu. Epidemiology of stroke in Russia. Consilium Medicum Magazine. Special issue "Neurology". M 2003; 5-7; Gusev E.I., Skvortsova V.I., Stakhovskaya L.V., Kilikovsky V.V., Ayriyan N.Yu. Epidemiology of stroke in Russia. Materials of the 1st Russian International Congress "Cerebrovascular Pathology and Stroke". Zhurn Nevrol and Psychiat 2003; 114; Skvortsova V.I., Stakhovskaya L.V., Ayriyan N.Yu. Epidemiology of stroke in the Russian Federation. Consilium Medicum Magazine. Application. M 2005; 1: 10-12.
Gusev E.I., Skvortsova V.I. Stroke register: Guidelines for the study. M 2000; 50.
Olsen T.S., Andersen Z.J., Andersen K.K. Stroke in patients aged 100 or more. case-fatality and risk factor profile. Denmark. 20th European Stroke Conference. Abstracts. Hamburg, Germane. Cerebrovascular Diseases 2011; 31: 2; Stegmayr B. Stroke in Community. Umea 1996; 134.
Gusev E.I., Skvortsova V.I., Stakhovskaya L.V., Kilikovsky V.V., Ayriyan N.Yu. Epidemiology of stroke in Russia. Materials of the 1st Russian International Congress "Cerebrovascular Pathology and Stroke". Zhurn Nevrol and Psychiat 2003; 114; Cabral N.L., Longo A.L., Moro C.H.C., Aguiar-Junior J., Goncalves A.R.R. Subarachnoid haemorrhage in Joinville, Brazil 2005 to 2010: incidence and case-fatality trends, Brazil. 20th European Stroke Conference. Abstracts. Hamburg, German. Cerebrovascular Diseases 2011; 31: 2; Ingall T., Asplund K., Mahonen M. et al. A multinational comparison of subarachnoid hemorrhage epidemiology in the WHO MONICA stroke study. Stroke 2000; 31: 1054.
Ayriyan N.Yu. Analysis of data from epidemiological monitoring of stroke in the Russian Federation: Author's abstract. dis. ... Cand. honey. sciences. M. 2006; 24.
Addo J., Bhalla A., Crichton S., McKevitt C., Rudd A.G. Time-trends in case fatality after stroke: analyzes of data from the south London stroke register. C.D.A. United Kingdom. 20 th European Stroke Conference. Abstracts Hamburg, Germane. Cerebrovascular Diseases 2011; 31: 24; Liu L., Ikeda K., Yamori Y. et al. Changes in stroke mortality rates for 1950 to 1997: a great slowdown of decline trend in Japan. Stroke 2001; 32: 1745-1749; Sarti C., Rastenyte D., Cepaitis Z., Tuomilehto J. International trends in mortality from stroke 1968 to 1994. Stroke 2000; 31: 1588-1601; Timsit S., Goas P., Rouhart F., Nowak E. High incidence of stroke in the Brest french stroke population registry France. 20th European Stroke Conference. Abstracts. Hamburg, Germane. Cerebrovascular Diseases 2011; 31: 2.
Feigin V.L. Epidemiology and prevention of cerebrovascular diseases in Siberia: Author's abstract. diss. Dr. med. sciences. M 1991; 28.
Skvortsova V.I., Stakhovskaya L.V., Ayriyan N.Yu. Epidemiology of stroke in the Russian Federation. Consilium Medicum Magazine. Application. M 2005; 1: 10-12
Olsen T.S., Andersen Z.J., Andersen K.K. Stroke in patients aged 100 or more. case-fatality and risk factor profile. Denmark. 20th European Stroke Conference. Abstracts. Hamburg, Germane. Cerebrovascular Diseases 2011; 31: 2.
The team of authors expresses sincere gratitude to the heads of the regional vascular centers who performed a great and responsible work, as well as to all officials who assisted in the study.