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世界核心医学期刊文摘（神经病学分册） 2005年第12期1卷 1-2页

作者： Wolfe c.D.A. Smeeton N.c. coshall c. 郭俊 Division of Health and Soc.al c.re King's College London London SE1 3QD United Kingdom

Objec.ives: To identify ethnic.differenc.s in survival after stroke and examine the fac.ors that influenc. survival. Design: Population based stroke register with follow-up. Settings: South London stroke register. Partic.pants: 2321 patients with first stroke registered between January 1995 and Dec.mber 2002. Main outc.me measures: Soc.odemographic.fac.ors, risk fac.ors for stroke and their management, severity of stroke, and ac.te servic. provision fac.ors. Survival analysis with Kaplan-Meier c.rves, log rank test, and c.x’s proportional hazard model with stratific.tion. Results: In univariable analyses of survival, outc.me was better for blac. people than white people (median 33.7 v 20.0 months). After stratific.tion by soc.oec.nomic.status, type of stroke, and Glasgow c.ma sc.re, and adjustment for other potential c.nfounders, being blac. was generally assoc.ated with better survival, taking into ac.ount the interac.ion between ethnic.ty and age, and ethnic.ty and prior Barthel sc.re. Of the risk fac.ors for stroke c.nsidered, c.rrent smoking (hazard ratio 1.21, 95%c.nfidenc. interval 1.01 to 1.45, P = 0.044), untreated atrial fibrillation (1.36, 1.08 to 1.72, P = 0.009), untreated diabetes (1.53, 1.05 to 2.22, P = 0.027), and treated diabetes (1.61, 1.27 to 2.03, P c.ated with reduc.d survival. c.nc.usion: In general, blac. patients in a south London population with first ever stroke are more likely to survive than white patients, the exc.ptions being in those aged c.re c.ors that have the potential to be modified, inc.uding the appropriate treatment of existing health problems, have a strong impac. on survival.

关键词：随访研究首次卒中卒中类型卒中危险因素急性期中位生存时间风险度处理因素心房纤颤单变量分析

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卒中护理供给是否存在不均衡性:城市内已注册卒中病例的分析

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世界核心医学期刊文摘（神经病学分册） 2005年第7期1卷 60-61页

作者： Mc.evitt c. coshall c. Tilling K. Wolfe c. 李一明 Department of Public.Health Sc.enc.s King's College London Capital House 42 Weston Street London SE13QD United Kingdom Dr.

Bac.ground and Purpose:There is evidenc. of unequal ac.ess to health c.re int erventions even where universal health systems operate. We investigated assoc.at ions between patients’soc.odemographic.c.arac.eristic. and the provision of ac. te and longer-term stroke c.re in a multiethnic.urban ***:We us ed data from 1635 patients with first-ever stroke, c.llec.ed by a population-b ased stroke register from 1995 to 2000. Using multivariable analyses, c.ntrolled for soc.odemographic.and c.inic.l fac.ors, we investigated ac.ess to 22 evidenc.e-based c.mponents of c.re. Results:1392 patients(85.1%) were admitted to hos pital; of these, 354 (25.4%) were admitted or transferred to a stroke unit. Of those with c.inic.l need, 607 (70.7%) rec.ived physic.l therapies; 477 (59.8%) rec.ived speec. and language therapy. Older age was assoc.ated with lower odds of hospitalization (odds ratio [OR], 0.50; 95%c., 0.32 to 0.77, P=0.02) and dia gnostic.brain imaging (OR,0.15; 95%c., 0.08 to 0.30, P c.iving physic.l therapy (OR, 4.24;95%c., 1.22 to 14.73,P c. et hnic.ty was assoc.ated with higher odds of stroke unit admission (OR, 1.59; 95% c., 1.01 to 2.49, P c.ation between soc.oec.nomic.status and admission to hospital and stroke unit. Gender was assoc.ated only wit h treatment of hypertension before stroke. c.nc.usions:Provision of individual c.mponents of c.re over 1 year varied for spec.fic.soc.odemographic.c.tegories, but there was no c.nsistent pattern of in equality. c.inic.l dec.sion-making pr oc.sses are likely to influenc. these patterns. Further information about c.inic.ian and patient roles in dec.sion making is required.

关键词：卒中治疗健康护理物理治疗城市群体住院率人口统计 admission 临床决策 gnostic admitted

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