摘要
背景 慢性病已成为影响人群健康的主要公共卫生问题,我国的慢性病患者数量持续增加,死亡病例数也逐年递增,患者疾病负担正逐渐加重.掌握慢性病疾病负担的变化情况,对慢性病的防控工作意义重大,但目前鲜见针对云南省农村常见慢性病疾病负担变化的研究.目的 分析云南省农村居民 2011 年和 2021 年 5 种常见慢性病[高血压、冠心病、脑卒中、哮喘和慢性阻塞性肺疾病(COPD)]疾病负担的变化情况.方法 采用重复横断面设计,分别于2011年和2021年采用多阶段分层随机抽样方法选取云南省8 400名和7 700名≥35岁的农村居民为研究对象,收集研究对象现场问卷调查和体格检查数据,以及 5 种常见慢性病的死因数据;采用主成分分析法,选取文化程度、家庭人均年收入和医疗服务可及性 3 个变量构建社会经济地位(SEP)指标,利用各变量系数计算SEP综合得分,并依据SEP综合得分的四分位数将社会经济地位分为低、中等偏下、中等偏上和高4个等级;采用伤残调整寿命年(DALY)测量 5 种慢性疾病的疾病负担大小.结果 与 2011 年比较,2021 年云南省农村居民的高血压(25.14%与 41.57%)、脑卒中(1.03%与 2.52%)和COPD(9.23%与 12.60%)的总体患病率均升高(P均<0.05),且男性、女性和各个社会经济地位人群的患病率也升高(P<0.05);冠心病(2.02%与 2.30%)和哮喘(1.36%与 1.61%)的总体患病率无明显变化(P>0.05),但男性和高社会经济地位人群的冠心病患病率、男性和中等偏上社会经济地位人群的哮喘患病率却升高(P<0.05);男性 2021 年 5 种慢性病的患病率均高于女性(P<0.05);2021 年不同社会经济地位人群的COPD患病率呈递减趋势(χ2趋势=6.801,P<0.001).此外,冠心病(10.45与18.18)、脑卒中(12.80与23.20)、哮喘(4.54与 9.10)和COPD(35.99 与 49.07)的每千人口DALY均升高,高血压(1.38 和 1.26)降低;其中以COPD的每千人口DALY和伤残所致生命损失年(YLD)较高,脑卒中的每千人口早死所致生命损失年(YLL)较高.结论 云南省农村居民2021年5种常见慢性病的患病率和疾病负担与2011年比较,以升高为主,且2021年COPD的疾病负担最重,男性和低社会经济地位人群是未来慢性病防控的重点人群.应采取有针对性的预防和控制策略,降低慢性病对人群健康的危害.
Abstract
Background Chronic diseases have become a major public health problem affecting the health of the population,and the number of patients with chronic diseases in China continues to increase,as well as the increasing number of deaths due to chronic disease by year,and the increasing burden of disease on patients gradually.Understanding the changes in the burden of chronic diseases is of great importance for the prevention and control of chronic diseases.However,there is a lack of research on the changes in the burden of common chronic diseases in rural Yunnan Province.Objective To examine the changes in the disease burden of five common chronic diseases[hypertension,coronary heart disease(CHD),stroke,asthma,and chronic obstructive pulmonary disease(COPD)]among rural residents in Yunnan Province in 2011 and 2021.Methods A repeated cross-sectional design was used to select 8 400 and 7 700 rural residents aged≥35 years in Yunnan Province using multistage stratified random sampling method in 2011 and 2021 as the research subjects,respectively.Data were collected from on-site questionnaires and physical examinations of study participants,as well as data on the causes of death of five common chronic diseases.Principal component analysis was used to construct a socioeconomic position(SEP)indicator by selecting three variables including education level,annual household income per capita and accessibility to medical services,the coefficients of the variables were used to calculate the SEP composite score,and the SEP was classified into four grades of low,medium-low,medium-high and high based on the quartiles of the SEP composite score.Disability-adjusted life year(DALY)was used to measure the magnitude of the disease burden for five chronic diseases.Results Compared with 2011,the overall prevalence of hypertension(25.14%vs.41.57%),stroke(1.03%vs.2.52%),and COPD(9.23%vs.12.60%)in rural Yunnan Province in 2021 increased(P<0.05),as well as the prevalence for males,females,and participants with all SEP grades(P<0.05);the overall prevalence of CHD(2.02%vs.2.30%)and asthma(1.36%vs.1.61%)did not change significantly(P>0.05),while an increase was found in the prevalence of CHD among males and those with high SEP grade,and in the prevalence of asthma among males and those with medium-high SEP grade(P<0.05).In 2021,the prevalence of all 5 chronic diseases was higher in males than in females(P<0.05),and there was a decreasing trend in the prevalence of COPD by different grades of SEP in 2021(χ2trend=6.801,P<0.001).In addition,an increase was found in DALY per 1 000 population of CHD(10.45 vs.18.18),stroke(12.80 vs.23.20),asthma(4.54 vs.9.10),and COPD(35.99 vs.49.07),while a decrease was found in DALY per 1 000 population of hypertension(1.38 vs.1.26).COPD presents higher DALY per 1 000 population and years of life disability(YLD)per 1 000 population,while stroke presents higher years of life lost(YLL)per 1 000 population among the five chronic diseases.Conclusion The prevalence and disease burden of five common chronic diseases among rural residents in Yunnan Province in 2021 were mainly higher than 2011,and the disease burden of COPD was the heaviest in 2021,with males and those with low SEP grade being the key populations for future prevention and control of chronic diseases.Targeted prevention and control strategies should be adopted to reduce its harm to the health of population.
基金项目
国家自然科学基金资助项目(72064026)
云南省创新团队培育计划(202005AE160002)
维普
万方数据