| Background:Stroke,as a global health problem,has become the primary disease threatening the health of our residents,bringing huge disease burden and economic losses to our residents every year.However,throughout the country,there has not been a monitoring of the incidence of stroke in the whole population.Only local(Tianjin is one of them)has a stroke monitoring system,but it is not clear how the operation of these disease monitoring systems is.Therefore,the evaluation of the onset monitoring system is of great significance for government departments to improve their work in disease surveillance.Objective:To calculate the mortality/incidence(M/I)of stroke by using the Disease Surveillance Point System(DSP)and incidence surveillance system(ISS)of stroke in Tianjin from 2007 to 2015,and to correct the stroke mortality/incidence(M/I)of stroke by DisMod model,thereby to evaluate the level of missed stroke in stroke surveillance system in Tianjin and describe its incidence trend.Provide basis for improving Tianjin's stroke surveillance system,and also provide a reference for estimating the incidence of stroke in stroke in other regions.Content:Using the DSP and ISS of stroke in Tianjin from 2007 to 2015 to construct a database of incidence and mortality analysis of stroke,and analyze and describe the characteristics of death and incidence of stroke according to the constructed database;Using direct method and DisMod method to calculate the mortality-to-incidence ratio(M/I)of stroke,compares the differences,and estimates the missed rate and incidence rate of the stroke surveillance system in Tianjin.Methods:Firstly,SAS9.4 was used to clean the data from the Disease Surveillance Point System(DSP)and incidence surveillance system(ISS)of stroke in Tianjin,and the data after washing was divided into cerebral infarction and cerebral hemorrhage,then calculate the crude incidence,crude mortality and standardized incidence,standardized mortality of cerebral infarction and cerebral hemorrhage.Then,according to the crude incidence and crude mortality of cerebral infarction and cerebral hemorrhage,the incidence and death composition were calculated,and the exponential curve was used to fit the standardized incidence and standardized mortality of cerebral infarction and cerebral hemorrhage.And use the Joinpoint model for sensitivity analysis.then,the direct method was used to calculate the mortality/incidence ratio(M/I)of cerebral infarction and cerebral hemorrhage,and 95%confidence interval,respectively the"crude incidence rate,crude mortality rate,remission rate and RR value"of cerebral infarction and cerebral hemorrhage were input into the DisModII model as parameters,and the mortality/incidence(M/I)value of DisMod method was calculated by using the output incidence and mortality.SAS9.4 calculates the 95%confidence interval of its M/I value,and compares whether the 95%confidence interval of the M/I value calculated by the direct method and the DisMod method is statistically different.Finally,the M/I value of stroke calculated using the DisMod method and the number of original stroke deaths were used to estimate the rate of underreporting and incidence of stroke surveillance data.Results:1.The composition of incidence and death of stroke.In 2007-2013,the incidence of cerebral infarction showed a slow upward trend(from 84%to 90%),and it was basically stable at around 90%after 2013.The mortality of cerebral infarction and cerebral hemorrhage showed little change and remained.At around 50%.2.Epidemiological characteristics of death in stroke.The crude death rate of stroke in Tianjin from 2007 to 2015 was between 85/100,000 and 137/100,000,and the male(97/100,000-153/100,000)was higher than female(72/100,000-120/10).The standardized mortality rate showed a downward trend.The equation for exponential curve fitting was y=e182.684-0.0885x(p<0.0001),and the result of Joinpoint model was APC=-8.47%(P<0.05),also showing a downward trend.From the standardized mortality of cerebral infarction and cerebral hemorrhage,regardless of cerebral infarction(male,y=e197.9107-0.0963x,p<0.0001;female,y=e214.3870-0.1047x,P<0.0001)or cerebral hemorrhage(male,y=e145.1725-0.0701x,P<0.0001;female,y=e162.28934-0.0791x,P<0.0001)showed a downward trend.The results of the Joinpoint models showed that cerebral infarction(male,APC=-9.30%,P<0.05;female,APC==-10.09%,P<0.05)and cerebral hemorrhage(male,APC=-6.22%,P<0.05;female,APC=-7.48%,P<0.05)showed a downward trend,consistent with the results of the exponential curve fit.3.Epidemiological characteristics of incidence in stroke.The crude incidence rate ofstroke in Tianjin from 2007 to 2015 was between 394/100,000 and 639/100,000,and the male(473/100,000-769/100,000)was higher than female(314/100,000-508/10).The standardization incidence rate is increasing,the equation of the exponential curve fitting is y=e-65.46567+0.03563x(p<0.0001))and the result of Joinpoint model APC=3.63%(P<0.05),also showing an upward trend.From the standard incidence of cerebral infarction and cerebral hemorrhage,cerebral infarction(male,y=e-73.1835+0.0395x,P<0.0001;female,y=e-67.1635+0.0363x,P<0.0001)showed an upward trend,Cerebral hemorrhage(male,y=e66.5573-0.0310x,P<0.0001;female,y=e83.9710-0.0399x,P<0.0001)showed a downward trend.The results of the Joinpoint model showed that cerebral infarction(male,APC)=4.04%,P<0.05;female,APC=3.66%,P<0.05)showed an upward trend,cerebral hemorrhage(male,APC=-3.06%,P<0.05;female,APC=-3.88%,P<0.05)showed a downward trend.It is consistent with the results of the exponential curve fit.4.The M/I characteristics of cerebral infarction calculated by direct method and DisMod method.The M/I 95%confidence interval calculated by the direct method and the DisMod method overlaps in the total value and in all age groups.There is no statistical difference between the two methods.The cerebral infarction is not underreported in the Tianjin Stroke Incidence Surveillance System.There is no need to correct for the M/I of cerebral infarction.The M/I females with cerebral infarction calculated by direct method(0.09-0.26)were higher than males(0.07-0.21).Except for women over 85 years old in 2007 and 2008.,the M/I of cerebral infarction was greater than 1 in people over 40 years old.And with the increase of age,the M/I is less than 0.1 before the age of 70,and the M/I is the largest at the age of 85,the maximum for men is 0.55,and that for women is 0.81,which is 0.66.From different ages,except for M/I in some age groups in 2007 and 2008,which exceeded 95%CI,M/I in all other years were within the confidence limit of 95%CI,The M/I values of different age groups in different ages of cerebral infarction were basically stable.5.The M/I characteristics of cerebral hemorrhage calculated by direct method and DisMod method.The M/I value of cerebral hemorrhage calculated by direct method fluctuated greatly.With the increase of age,the M/I value of cerebral hemorrhage increased accordingly.From the age of 70,the M/I mean value was greater than 1,the M/I mean value over 85 years old is the largest,with a maximum of 3.01 for men and 3.42 for women,a total of 3.21.The M/I values calculated by the direct method and the DisMod method did not coincide with the total value and the age group over 70 years old,and overlapped in the age group under 70 years old.There were statistical differences between the two methods,and the cerebral hemorrhage occurred in Tianjin stroke.There is a false negative in the surveillance system,and the missing report needs to be corrected.After DisMod method to correct M/I of cerebral hemorrhage,the mean M/I of cerebral hemorrhage was 0.76(95%CI,0.68-0.84),and the mean M/I of cerebral hemorrhage was 0.73(95%CI,0.66-0.80).),the total mean is 0.74(95%CI,0.74-0.80).The M/I of cerebral hemorrhage increased with age.The M/I mean value was greater than 1 from the age of 80,but it was very close to 1,and the M/I mean value was the highest at the age of 85.The maximum male was 1.16 and the female was 1.17.The total is 1.16.6.Quality and estimated incidence characteristics of cerebral hemorrhage surveillance data in Tianjin.The cerebral hemorrhage surveillance system in Tianjin was generally underreported from 2007 to 2014.The underreporting rate was from 5.58%(2014)to 27.28%(2010),while the overall overstatement in 2015 was 8.89%.From different ages,regardless of gender and total situation,underreporting mainly occurs in the age group over 65 years old,while overstatement mainly occurs in the age group under 65 years old;among them,the total underreporting rate is 60-64 years old in 2013.The lowest age group was 1.01%,and the highest was ?85 age group in 2013,which was 68.98%.The total high-reporting rate was the lowest in the 40-44 age group in 2008,which was 5.72%.In 2014,the 45-49 age group was the highest.52.7%.The incidence of cerebral hemorrhage in Tianjin from 2007 to 2015 was estimated by the DisMod method.The crude incidence rate was between 53/100,000 and 88/100,000;the equation for exponential curve fitting was y=e146.2264-0.07061x(P=0.0005),the result of the Joinpoint model was APC=-6.82%(P<0.05),which was consistent with the results of the exponential curve fitting.Conclusion:1.Before 2013,the incidence composition of cerebral infarction gradually increased,and it stabilized at around 90%after 2013.The mortality of cerebral infarction and cerebral hemorrhage showed little change,and remained at about 50%.2.From 2007 to 2015,the incidence of cerebral infarction showed an upward trend,and mortality showed a downward trend,while the incidence and mortality of cerebral hemorrhage showed a downward trend.3.The surveillance data of cerebral infarction in Tianjin is not underreported.The M/I value of cerebral infarction in different age groups is basically stable.Therefore,the M/I value of cerebral infarction can be used as an indicator of the quality of surveillance system data.Provide a reference for the estimation of the disease for other places where only cause of death is monitored.4.The overall surveillance system for cerebral hemorrhage in Tianjin has been underreported in 2007-2014,and the overall report was high in 2015.5.The standardized incidence of cerebral hemorrhage estimated by DisMod method showed a downward trend,and the corrected incidence of cerebral hemorrhage decreased more.At the same time,the method of estimating the incidence of cerebral hemorrhage by DisMod method was also used for other methods.Provide a reference for the estimation of regional cerebral hemorrhage. |
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