人群脑卒中终生风险的评估合理吗?

Is lifetime risk estimation of stroke in a population reasonable?

《新英格兰医学杂志》刊登《1990—2016年全球、不同区域和国家人群卒中终生风险》研究报告显示:25岁以上中国人群卒中终生风险最高,达39.3%,男性高于女性。这一评估真的合理吗?首先,研究对象“人群”是集合概念,卒中风险评估最终落实在个人,个人一生若出现脑卒中就是100%,若不出现脑卒中就是0,不存在第三个数字;其次,脑卒中发病不仅具有年龄与性别特征,还存在死亡、不同疾病等复杂的竞争风险因素;最后,当研究时间足够长时,由于死亡终生风险为100%,将完全竞争卒中发生,使卒中风险降低为0。因此,需重新审视该研究报告中关于中国人群卒中终生风险评估的合理性。

Chinese people over age 25 have the highest lifetime risk of first stroke(39.3%)and the risk is higher in men than in women,according to a new study entitled“Global,regional,and country-specific lifetime risks of stroke,1990 and 2016”,which was published in the New England Journal of Medicine.Critically,is it reasonable?Firstly,“a population”refers to an integrative concept but not a specific existence of its name exactly.For individual,having a stroke in his life means 100%while having not a stroke means zero.Secondly,age-and gender-specific differences among individuals have a great impact on the risk of stroke.In addition,competing risks of stroke count not only death from any cause other than stroke,but also occurrence of some other diseases.Last but not the least,estimated risk of stroke for anyone,if given enough observation time,will drop to zero after accounting for certain competing risks of death of 100%.In conclusion,reported estimates of lifetime risk of stroke for Chinese people may not be reasonable.