PDF(Pubmed)
Abstract：
Previous studies have reported a substantial between-country variation in the case fatality rates (CFRs) of aneurysmal subarachnoid hemorrhage (SAH). However, contrary to comparisons among countries, nationwide comparisons within countries that focus on populations with equal access to health care and include out-of-hospital deaths in analyses are lacking. Thus, we aimed to investigate whether the SAH CFRs vary between geographic regions within Finland.
We identified all hospitalized and nonhospitalized (sudden-death) cases with aneurysmal SAH in Finland during 1998-2017 through 2 externally validated nationwide registers. According to the municipality of residence, we divided the cases with SAH into 5 geographic regions: Southern, Central, Western, Northern, and Eastern Finland, each served by a University Central Hospital with a neurosurgical service. In addition to overall 30-day CFRs, we computed sudden death rates and 30-day CFRs after hospitalization for each region. Using logistic and Poisson regression models, we calculated regional age-adjusted, sex-adjusted, and year-adjusted odds ratios and annual percent changes with 95% CIs for CFRs.
During 1998-2017, we identified a total of 9,443 cases with SAH, of which 3,484 (36.9%) occurred in Southern Finland. In comparison with the overall 30-day CFR of Southern Finland (35.1%), the age-adjusted, sex-adjusted, and study year-adjusted odds of SAH death were 32% (16%-50%) higher in Central Finland (42.7%), 39% (23%-58%) higher in Eastern Finland (43.4%), and 52% (33%-74%) higher in Western Finland (47.1%). The regional differences were present among both sexes, in all age groups, in sudden death rates, and in 30-day CFRs after hospitalization. Between 1998 and 2017, the overall 30-day CFRs decreased in Central (2.4% [1.0%-3.8%] per year) and Southern (1.2% [0.2%-2.2%] per year) Finland, whereas CFRs remained stable in the other regions. In the last 4 years of the study period (2014-2017), Southern Finland had the lowest 30-day CFR (16.5%) among hospitalized patients.
SAH CFRs seem to vary significantly even within a country with relatively equal access to health care. Future studies with detailed individual-level data are needed to explore whether health inequities explain the reported findings.
We identified all hospitalized and nonhospitalized (sudden-death) cases with aneurysmal SAH in Finland during 1998-2017 through 2 externally validated nationwide registers. According to the municipality of residence, we divided the cases with SAH into 5 geographic regions: Southern, Central, Western, Northern, and Eastern Finland, each served by a University Central Hospital with a neurosurgical service. In addition to overall 30-day CFRs, we computed sudden death rates and 30-day CFRs after hospitalization for each region. Using logistic and Poisson regression models, we calculated regional age-adjusted, sex-adjusted, and year-adjusted odds ratios and annual percent changes with 95% CIs for CFRs.
During 1998-2017, we identified a total of 9,443 cases with SAH, of which 3,484 (36.9%) occurred in Southern Finland. In comparison with the overall 30-day CFR of Southern Finland (35.1%), the age-adjusted, sex-adjusted, and study year-adjusted odds of SAH death were 32% (16%-50%) higher in Central Finland (42.7%), 39% (23%-58%) higher in Eastern Finland (43.4%), and 52% (33%-74%) higher in Western Finland (47.1%). The regional differences were present among both sexes, in all age groups, in sudden death rates, and in 30-day CFRs after hospitalization. Between 1998 and 2017, the overall 30-day CFRs decreased in Central (2.4% [1.0%-3.8%] per year) and Southern (1.2% [0.2%-2.2%] per year) Finland, whereas CFRs remained stable in the other regions. In the last 4 years of the study period (2014-2017), Southern Finland had the lowest 30-day CFR (16.5%) among hospitalized patients.
SAH CFRs seem to vary significantly even within a country with relatively equal access to health care. Future studies with detailed individual-level data are needed to explore whether health inequities explain the reported findings.
摘要：
目的：先前的研究报道了动脉瘤性蛛网膜下腔出血（SAH）的病死率（CFRs）在国家之间的差异很大。然而,与各国之间的比较相反，缺乏在国家范围内进行的全国性比较，这些比较侧重于平等获得医疗保健的人群，并在分析中包括院外死亡。因此，我们的目的是调查SAHCFRs在芬兰各地理区域之间是否存在差异.
方法：我们通过两个外部验证的全国性登记，确定了1998-2017年芬兰所有住院和非住院（猝死）动脉瘤性SAH病例。根据居住城市，我们将SAH病例分为五个地理区域：南部，中央,西方,北方,芬兰东部,每个都由大学中心医院提供神经外科服务。除了30天的CFR，我们计算了每个地区的猝死率和住院后30天的CFRs.使用Logistic和泊松回归模型，我们计算了区域年龄-，sex-,以及年度调整后的赔率比和年度百分比变化，CFR的置信区间为95%。
结果：在1998-2017年期间，我们共确定了9443例SAH，其中3484（36.9%）发生在芬兰南部。与芬兰南部的总体30天CFR（35.1％）相比，年龄-，sex-,在芬兰中部（42.7%），研究年份调整后的SAH死亡几率高出32%（16-50%），芬兰东部地区（43.4%）高出39%（23-58%），西芬兰（47.1%）高出52%（33-74%）。男女之间存在地区差异，在所有年龄组中，以及住院后30天的猝死率。在1998年至2017年期间，芬兰中部（每年2.4％[1.0-3.8％]）和南部（每年1.2％[0.2-2.2％]）的总体30天CFR下降，而其他地区的CFR保持稳定。在研究期间的最后四年(2014-2017年)，在住院患者中，芬兰南部的30天CFR最低（16.5%）。
结论：SAHCFRs似乎即使在相对平等的国家/地区也有很大差异。未来的研究需要详细的个人水平的数据，以探索健康不平等是否解释报告的发现。
方法：我们通过两个外部验证的全国性登记，确定了1998-2017年芬兰所有住院和非住院（猝死）动脉瘤性SAH病例。根据居住城市，我们将SAH病例分为五个地理区域：南部，中央,西方,北方,芬兰东部,每个都由大学中心医院提供神经外科服务。除了30天的CFR，我们计算了每个地区的猝死率和住院后30天的CFRs.使用Logistic和泊松回归模型，我们计算了区域年龄-，sex-,以及年度调整后的赔率比和年度百分比变化，CFR的置信区间为95%。
结果：在1998-2017年期间，我们共确定了9443例SAH，其中3484（36.9%）发生在芬兰南部。与芬兰南部的总体30天CFR（35.1％）相比，年龄-，sex-,在芬兰中部（42.7%），研究年份调整后的SAH死亡几率高出32%（16-50%），芬兰东部地区（43.4%）高出39%（23-58%），西芬兰（47.1%）高出52%（33-74%）。男女之间存在地区差异，在所有年龄组中，以及住院后30天的猝死率。在1998年至2017年期间，芬兰中部（每年2.4％[1.0-3.8％]）和南部（每年1.2％[0.2-2.2％]）的总体30天CFR下降，而其他地区的CFR保持稳定。在研究期间的最后四年(2014-2017年)，在住院患者中，芬兰南部的30天CFR最低（16.5%）。
结论：SAHCFRs似乎即使在相对平等的国家/地区也有很大差异。未来的研究需要详细的个人水平的数据，以探索健康不平等是否解释报告的发现。
