上海市奉贤区居民医学可避免死亡分析

[目的]调查分析了奉贤区1975-2017年居民医学可避免死亡情况,为提升卫生服务的系统绩效提供参考依据。[方法]采用ACCESS 2013软件和上海市奉贤区居民健康档案生命统计信息系统录入和整理1975-2017年该区户籍人口和医学可避免死亡疾病分年龄组及分性别组数据,并进行趋势分析和对比分析。[结果]1975-2017年奉贤区标化医学可避免死亡率从每千人2. 20下降到每千人0. 55,下降了75. 0%。男性从2. 38%下降到0. 65%,下降72. 69%;女性从2. 06%下降到0. 42%,下降79. 61%。构成比上升明显的疾病有,缺血性心脏病、内分泌疾病(包括糖尿病)、脑血管疾病,2017年分别为24. 88%、8. 52%、42. 15%。构成比下降明显的疾病有某些传染病和寄生虫病、肺炎。2017年,医学可避免死亡率和死亡比例均以65-74岁为各年龄组最高,分别达5. 07%和38. 15%。[结论]奉贤区标化医学可避免死亡率总体呈下降趋势;脑血管疾病、缺血性心脏病、内分泌疾病、构成比上升较快;医学可避免死亡率和死亡比例以65-74岁组最高。     

上海市部分疾病死亡水平变化对平均寿命变化的贡献

目的定量分析上海市部分疾病死亡水平变化对平均寿命变化的贡献。方法将影响人群健康的问题分为感染类疾病、肿瘤、脑血管疾病、伤害以及其他疾病5类。应用去死因寿命方法分析1953—1999年上海市居民死亡登记资料,定量估计疾病别实际死亡水平变化对平均寿命的影响,并用趋势卡方作标化死亡率趋势分析,用Pearson相关分析描述社会经济因素与寿命变化的关系。结果1953—1999年间,上海市居民感染类疾病的粗死亡率、地区别、性别标化死亡率呈下降趋势;市区居民伤害粗死亡率上升,其分性别标化率上升趋势显著,郊县居民则变化方向相反,其分性别标化率未见显著趋势变化;上海市居民肿瘤、脑血管疾病粗死亡率上升显著,其地区别、性别标化死亡率呈下降趋势或未见趋势变化。1979年后感染性疾病死亡率变化对上海市区人群平均寿命上升的贡献率在33%左右,高于其他3类非传染性疾病。而郊县男性伤害和感染类疾病的死亡率变化对平均寿命上升的贡献率分别达40.26%和25.18%。脑血管疾病死亡率变化对郊县男性平均寿命上升的影响是负向的。郊县女性的伤害和感染类疾病的死亡率变化对郊县女性平均寿命上升的贡献率最高,达21.60%和12.55%。1996年肿瘤死亡率对人群平均寿命的潜在影响最显著,其次为脑血管疾病,伤害居第3位,感染类疾病居末位。上海市医疗资源水平与居民平均寿命上升相关性较好。结论上海市控制感染类疾病成效显著,潜在疾病控制策略应以肿瘤、脑血管疾病及伤害为重点。基于死亡风险竞争分析的去死因寿命分析有助于建立疾病控制规划的平均寿命目标。     

2006-2012年沈北新区居民脑血管病死亡趋势分析

目的 了解沈阳市沈北新区居民脑血管病死亡特征,为相关部门制定防治策略提供科学依据.方法 分析沈北新区2000-2012年居民脑血管疾病的死亡资料,对脑血管疾病患者的年龄、性别、死因构成、死亡率变化特点及潜在寿命损失年数,进行了描述性分析.结果 2006-2012年沈北新区居民脑血管病死亡共计3 448人,死亡率为160.69/10万,粗死亡率呈逐年上升趋势,但标化死亡率呈下降趋势.男性脑血管病死亡率（187.15/10万）显著高于女性（133.94/10万）.潜在寿命损失年数从2006年的1 342.5人年,上升至2012年的2 315.0人/年.60岁以上人口脑血管病死亡率呈急剧上升趋势.结论 人口老龄化将加剧脑血管病死亡的疾病负担,控制男性和60岁以上人群脑血管疾病的发生和发展,有助于减少脑血管疾病负担.     

2010年潍坊市居民死亡情况分析

[目的]了解潍坊市居民死亡水平、死亡原因及其对期望寿命的影响,为制定有效的预防措施提供依据。[方法]对2010年潍坊市居民死亡资料进行分析。[结果]2010年潍坊市居民死亡率为618．50／10万,标化率为394．16／10万。男性为693．13／10万,女性为542．70／10万;0～14岁为47．92／10万,15～34岁为64．71／10万,35～54岁为213．39／10万,55～74岁为1135．19／10万,≥75岁为7674．83／10万;最高的是高密市（744．28／10万）和寿光市（672．98／10万）,最低的是奎文区（393．44／10万）和坊子区（417．66／10万）。死亡率最高的前5位死因依次为心脏病、恶性肿瘤、脑血管疾病、呼吸系统疾病、损伤与中毒,合计死亡48794例,占全部死因死亡总数的90．37％。2010年居民平均期望寿命为77．95岁,男性为75．63岁,女性为80．14岁。各种死因累计减寿329207人年,减寿率为37．71‰。减寿年数最大的前5位死因依次是损伤与中毒、恶性肿瘤、心脏病、脑血管疾病和呼吸系统疾病。[结论]潍坊市居民死亡率处于一般水平,慢性病、损伤与中毒是主要死因。     

中国人群的意外伤害水平和变化趋势

笔者通过全国疾病监测系统的数据，描述了中国人群意外伤害的流行变化趋势，指出中国人群伤害所致死亡占总死亡的比例，以及伤害的特点，详细分析了各种伤害在不同年龄段、不同性别和不同地区的差异。中国人群的自杀死亡率非常高，经漏报调整后的死亡率达19．58／10万；并且女性高于男性，尤其是20～34岁女性，占女性自杀死亡的46．70％；60岁以上人群的自杀者，占总人群的29．72％。车祸的死亡率一直呈上升趋势，由1991年的9．82／10万（943人死亡）上升到1995年的14．32／10万（1492人死亡），平均每年以9．89％的速度上升。0～14岁的儿童，淹死是其主要死因，淹死人数占总淹死人数的56．58％，其中46．48％是1～4岁的孩子。     

开平市2010-2011年居民死因分析

目的了解开平市居民死亡水平、死因模式,为制定卫生服务政策和资源配置提供依据。方法采用描述性流行病学方法对开平市2010_2011年居民死因监测资料进行分析,采用SAS9．0和Excel统计软件进行数据统计。结果死亡总例数为9886例,男性5182例,女性4704例,粗死亡率为718．69／10万,标化死亡率为423．69／10万;男性标化死亡率为483．43／10万,女性标化死亡率为362．20／10万,男性高于女性（P〈0．01）;心血管疾病是开平市居民的首位死因,死亡率达302．79／10万,占居民总死因的42．13％（4165／9886）,第2～4位死因分别为脑血管疾病（1905例）、恶性肿瘤（1433例）、慢性呼吸系统疾病（421例）,前4位死因合占居民总死因的80．15％（7924／9886）。0～19岁青少年的主要死因为恶性肿瘤（15例）、先天性疾病（14例）、围生期疾病（12例）和心血管疾病（9例）;20～59岁中青年的主要死因为恶性肿瘤（637例,占38．47％）和心血管疾病（312例,占18．84％）;≥60岁老年人主要死因是心血管疾病（3844例,占47．36％）、脑血管疾病（1701例,占20．96％）、恶性肿瘤（781例,占9．62％）和慢性呼吸系统疾病（398例,占4．90％）。结论心、脑血管疾病和恶性肿瘤等慢性非传染性疾病是开平市居民的主要死因,提示政府部门应适时调整卫生服务规划,倡导健康生活方式,积极开展慢性非传染性疾病的预防控制工作。     

禹州市1 3年糖尿病死亡流行病学分析

目的：描述禹州市人群糖尿病死亡变化趋势及分布特点。方法：对1987年－1999年禹州市糖尿病死亡纵向分析，死亡构成特点分析，结果：糖尿病所在的内分泌疾病在全死因顺位中排位由1987年的第十一位到1999年的第七位，糖尿病在内分泌疾病中所占比例由1997年的87．34％到1999年的97．90％，1987－1999年禹州市糖尿病死亡率6．69％／10万，从1987年的3．52／10万到1998年的10．71／10万，糖尿病在全死因疾病中所占比例由1987年的0．59％到1998年的1．62％，呈上升趋势，60岁以上组为糖尿病死亡的高发年龄段，女性高于男性死亡率，分别是7．84／10万和5．65／10万。结论：糖尿病死亡已成为危害我市人群的主要死因之一，应重视糖尿病的防治工作。     

成都市2012年居民家庭内死亡分析

目的了解成都市居民家庭内死亡情况变化趋势,为制定防控政策提提供科学依据。方法对成都市2012年居民家庭内死亡数据进行分析。结果2012年成都市报告死亡数为72632例,其中发生在家庭内的死亡为44182例,占总死亡数的60．83％。男性家庭内死亡率显著高于女性（X^2=80459,P〈0．01）。男女性前3位的死因分别是慢性下呼吸道疾病、脑血管病和肺癌。各午龄组均有家庭内死亡发生,0～14岁组以淹死为主,15～39岁组以其它恶性肿痛为主,40-64岁组以脑血管病为主,65岁以上组以慢性下呼吸道疾病为主。结论老午人群是家庭内死亡的主要人群,慢性病和肿瘤是成都市居民家庭内死亡的主要死因,应采取有效的防控措施。     

上海市2008年居民家庭内死亡分析

[目的]了解上海市2008年在家死亡者的年龄、疾病分布,为社区卫生服务提供信息。[方法]2008年上海市在家死亡个案卡,采用ICD-10疾病分类标准,进行综合统计分析。[结果]在家死亡女性死亡率略高于男性,男性首位死因为支气管和肺的恶性肿瘤,女性首位死因为脑血管病后遗症。各年龄组都有在家死亡的发生,0～14岁组以先天性疾病为主,15～39岁组以损伤中毒为主,40～64岁组以肿瘤为主,65岁及以上年龄以脑血管病后遗症为主。[结论]65岁以上人群、损伤中毒的危害已成为在家死亡不容忽视的公共卫生问题。     

2004-2005年广东省居民心脑血管疾病死亡特征分析

目的了解广东省居民心脑血管疾病的死亡特征,为预防及干预提供参考依据。方法利用2006年广东省第3次全国死因回顾调查资料,包括2004年1月1日至2005年12月31日广东省12个县（区、市）居民死亡个案资料,采用“死亡原因调查表”及“死因推断量表”2种调查表进行调查。结果广东省调查点2004-2005年心脑血管疾病死亡38170例,死亡率为251．6／10万（38170／15170945）,占全死因的38．2％（38170／99919）。脑血管疾病标化死亡率为102．1／10万,男性标化死亡率（132．2／10万）高于女性（77．7／10万）（P〈0．01）,农村标化死亡率（110．7／10万）高于城市（83．1／10万）（P〈0．01）;心血管疾病标化死亡率为88．5／10万,男性标化死亡率（106．8／10万）高于女性（73．4／10万）（P〈0．01）,农村标化死亡率（89．5／10万）高于城市（87．0／10万）（P〈0．01）。心脑血管疾病死亡率随着年龄增加呈升高趋势（P〈0．01）,60岁及以上人群死亡率为1926．2／10万。心脑血管疾病死亡人群主要以农林牧渔职业为主,占69．75％（26625／38170）;文化程度以文盲、半文盲和小学为主,占83．24％（31774／38170）。结论心脑血管疾病是广东省居民的首位死因,应重点加强60岁及以上老年人群,尤其农村老年人心脑血管疾病防治健康教育和健康促进,同时加大基层医疗机构的投入和建设,提高基层心脑血管疾病诊疗水平,降低心脑血管疾病死亡率。     

Vital Signs: Avoidable Deaths from Heart Disease,Stroke, and Hypertensive Disease — United States, 2001–2010

Background

Deaths attributed to lack of preventive health care or timely and effective medical care can be considered avoidable. In this report, avoidable causes of death are either preventable, as in preventing cardiovascular events by addressing risk factors, or treatable, as in treating conditions once they have occurred. Although various definitions for avoidable deaths exist, studies have consistently demonstrated high rates in the United States. Cardiovascular disease is the leading cause of U.S. deaths (approximately 800,000 per year) and many of them (e.g., heart disease, stroke, and hypertensive deaths among persons aged <75 years) are potentially avoidable.

Methods

National Vital Statistics System mortality data for the period 2001–2010 were analyzed. Avoidable deaths were defined as those resulting from an underlying cause of heart disease (ischemic or chronic rheumatic), stroke, or hypertensive disease in decedents aged <75 years. Rates and trends by age, sex, race/ethnicity, and place were calculated.

Results

In 2010, an estimated 200,070 avoidable deaths from heart disease, stroke, and hypertensive disease occurred in the United States, 56% of which occurred among persons aged <65 years. The overall age-standardized death rate was 60.7 per 100,000. Rates were highest in the 65–74 years age group, among males, among non-Hispanic blacks, and in the South. During 2001–2010, the overall rate declined 29%, and rates of decline varied by age.

Conclusions

Nearly one fourth of all cardiovascular disease deaths are avoidable. These deaths disproportionately occurred among non-Hispanic blacks and residents of the South. Persons aged <65 years had lower rates than those aged 65–74 years but still accounted for a considerable share of avoidable deaths and demonstrated less improvement.

Implications for Public Health Practice

National, state, and local initiatives aimed at improving health-care systems and supporting healthy behaviors are essential to reducing avoidable heart disease, stroke, and hypertensive disease deaths. Strategies include promoting the ABCS (aspirin when appropriate, blood pressure control, cholesterol management, and smoking cessation), reducing sodium consumption, and creating healthy environments.     

1990—2010 年疾病谱变化对上海市居民期望寿命增长的影响

目的］ 比较上海市1990—2010 年不同时期人群期望寿命变化趋势,探讨疾病谱变化对期望寿命的影响,确定疾病干预的优先领域。 ［方法］ 利用1990—2010 年上海市居民死亡登记系统的死亡数据和上海市公安系统的人口数据,应用简略寿命表法、期望寿命分解法、死因分解法,比较年龄和不同死因对期望寿命的影响。 ［结果］1990—2010 年上海市男性和女性期望寿命分别增加了6.91 岁和6.94 岁,年均增寿均达0.35 岁。65 岁以上老年人口对期望寿命增长的贡献最大,男女分别占增寿总量的52.97%和51.44%。呼吸系统疾病、循环系统疾病和肿瘤死亡率的降低是期望寿命增加的主要原因,他们对男女性期望寿命的贡献分别为2.13 岁和1.98 岁、1.42 岁和1.89 岁、1.35 岁和0.67岁。 ［结论］ 上海市现阶段,居民的死亡大部分是疾病造成,提高人群期望寿命,重点是关注中老年人健康状况。近20年慢性病死亡率虽大幅下降,但仍是上海市主要死因,建立健全慢病防治体系,提高慢性病防治效果,是进一步提高上海市人口健康水平,增加上海市居民期望寿命的有效途径。     

Avoidable mortality in New Zealand, 1981-97

Objective : To describe avoidable mortality in New Zealand, including trends and variations between groups by age, gender, ethnicity and degree of deprivation. Method : New Zealand Health Information Service mortality unit records, 1981 to 1997, were classified as ‘avoidable’ or ‘unavoidable’ based on a reassessment of ICD9 codes and an upper age limit of 75 years. ‘Avoidable’ causes of death were further subcategorised according to the level of intervention involved (primary, secondary or tertiary). Deaths were assigned a deprivation score using a Census‐based small area deprivation index, the NZDep96. Mortality rates were age standardised by the direct method, with Segi's world population as the reference. Results : Avoidable mortality declined 38% from 1981 to 1997; unavoidable mortality declined only 9%. In 1996–97 almost 70% of deaths in the 0–74 age range were still considered to be potentially avoidable. Almost 80% of avoidable deaths occur in the 45–74 age group. These deaths are dominated by the emergence of chronic diseases such as ischaemic heart disease, diabetes and smoking‐related cancers. In younger age groups, injury (including suicide) dominates avoidable mortality. Males experience a greater burden of avoidable mortality than females‐a relative excess of 54% (approximately 2,000) in 1996–97. The gender difference is largely attributable to diseases and injuries amenable to primary prevention, with the largest single contribution coming from ischaemic heart disease. The ethnic gap in avoidable mortality remains wide: rates for Maori and Pacific people were 2–2¹/₂ times higher than European rates in 1996–97. Similar gradients are seen with deprivation. Conclusion and implications : Avoidable mortality analysis provides a useful tool for evidence‐based health needs assessment and health policy development.     

Did early detection and treatment contribute to the decline in ischemic heart disease mortality? Prospective evidence from the Alameda County Study

In a previous study, the authors reported a 45 per cent decline in ischemic heart disease mortality between cohorts selected to be representative of Alameda County, California, in 1965 and 1974. The decline could not be explained by baseline differences in the distribution of many of the known ischemic heart disease risk factors available for analysis in this cohort. This study reports the results of further analyses which evaluated the hypothesis that early detection and improved treatment contributed to the decline. In multiple logistic analyses adjusted for age, sex, and race, those who reported heart trouble at baseline had an ischemic heart disease mortality decline 2.5 times greater than those who did not (p = 0.01). Those who used preventive health services had an ischemic heart disease mortality decline 2.2 times greater than those who did not (p = 0.03). These interactions were independent of each other and were not explained by adjustment for physical activity, smoking, social connections, or body mass index. There was an increase in the prevalence of self-reported heart trouble between 1965 and 1974, especially among younger age groups. These results are consistent with the hypothesis that early detection and treatment contributed to the decline in ischemic heart disease mortality observed in the Alameda County Study.     

Gender differences in premature mortality and avoidable deaths

OBJECTIVE: This paper aims to describe and to analyse disparities between men and women for "premature" mortality rates (deaths before 65 year-old). The study is particularly focused on "avoidable" causes of death. These types of deaths are greatly related to risk behaviours such as alcohol abuse, tobacco abuse or dangerous driving. Taking account of these indicators ("premature" and "avoidable" mortality) enables to study health status discrepancies by gender and to characterize specific public health issues in France including high rates of "premature" mortality and risk behaviours. METHODS: The analysis is based on exhaustive mortality data from 1980 to 1999 supplied by the Centre for epidemiology of medical causes of death (CepiDc-INSERM). Specific causes of death closely related to risk behaviours are classified as "avoidable": lung and upper airways cancers, cirrhosis, alcoholic psychosis, traffic accidents, aids and suicide. The contribution of these categories in the global male overmortality was assessed according to different demographic and geographic characteristics. RESULTS: Within "premature" mortality, males experience greater burden of "avoidable" mortality (sex-ratio: 4 versus 2). The gender differences are mainly due to injuries and suicides in the younger age groups and to tobacco and alcohol-related cancers (lung and upper airways) in the 45-64 years age group. The recent decline in "premature" mortality sex-ratio is explained by an increase of these two cancers for females. Among european countries, the French male overmortality is especially marked and mainly attributable to "avoidable" causes of death. CONCLUSION: "Avoidable" and "premature" mortality provide useful tools for the follow-up of health status in France particularly because of high risk behaviours and prevention inadequacy. Reducing gender discrepancies will depend mainly on public health policies in terms of primary prevention.     

The relationship between deaths that are avoidable with adequate health care and the implementation of the Unified Health System in Brazil]

OBJECTIVE: To analyze the relationship between the occurrence of deaths that are avoidable with adequate health care and the reorganization of the Brazilian health care system between 1983 and 2002. METHOD: This ecological study analyzed avoidable mortality in 117 municipalities of Brazil. The causes of death avoidable with adequate health care were grouped into three: (1) ones avoidable through early diagnosis and treatment, (2) ones avoidable with improvements in the quality of treatment and medical care, and (3) ischemic heart disease. To evaluate the association between avoidable mortality and reorganization of the health care system, the period under study was divided into two subperiods: from 1983 through 1992 and from 1993 through 2002 (respectively, before and after approval of the operational guideline that served as the reference for the organization of the Unified Health System (Sistema Unico de Saúde)). A negative binomial regression model that controlled for sex, age, geographic region, and socioeconomic conditions was used for the analysis. RESULTS: During the period analyzed, 1 854 165 individuals between 0 and 74 years old died from avoidable causes in the municipalities studied. The multivariate analysis showed that, for all three groups of avoidable causes, the risk of avoidable mortality was higher in the 1983-1992 subperiod than in the 1993-2002 subperiod. For the entire 1983-2002 period, the risk was higher for males than for females, especially with respect to ischemic heart disease. Younger populations had lower risk. Higher socioeconomic level reduced the risk of death from avoidable causes, except for ischemic heart disease. CONCLUSIONS: Our results suggest that in Brazil the decrease in avoidable mortality from the 1983-1992 subperiod to the 1993-2002 subperiod was partially due to the changes in the availability of and access to health services brought about by the reorganization of the Brazilian health care system.     

中国2010-2015年呼吸系统疾病死亡的预期寿命差异分析

  目的   分析我国2010年-2015年呼吸系统疾病死亡率变化对预期寿命影响的年龄、地区差异。   方法   本文数据来源于国家统计局2010年-2015年人口普查结果, 以及国家卫生健康委统计信息中心和中国疾病预防控制中心公布的《中国死因监测数据集》, 应用简略寿命表、Arriaga分解法计算不同年龄组和不同地区的呼吸系统疾病死亡率变化对预期寿命增量的贡献值和百分比。   结果   2010年-2015年, 我国呼吸系统疾病死亡率有所下降。2010和2015年因呼吸系统疾病减少的寿命分别为2.0岁和1.6岁, 呼吸系统疾病死亡率降低对预期寿命增量的贡献分别为, 东部地区15.4%, 中部12.5%, 西部55.6%。从年龄维度分析, 0~5岁、70岁以上年龄组死亡率的下降对提升预期寿命贡献最大。   结论   2010年-2015年全国因呼吸系统疾病减少的寿命降幅为20.0%, 具有明显的区域差异; 从疾病别维度分析, 慢性下呼吸道疾病对预期寿命的影响最大, 但对预期寿命的增加贡献较小; 肺炎对预期寿命的增加有贡献, 其中0~10岁人群肺炎的改善促进预期寿命增长。     

清新地区短暂性脑缺血发作患者年龄对后继脑梗死的影响

目的探讨清新地区TIA患者发生后继脑梗死与患者年龄的相关性。方法调取2012年1月至2013年12月间确诊的脑梗死病例资料118例,根据患者脑梗死前1周内是否发生TIA分为TIA组和对照组,两组根据年龄再分为<65岁和≥65岁组,比较患者神经功能缺损MESSS评分和日常生活能力Barthel评分。结果年龄<65岁的TIA组患者MESSS评分极显著低于对照组,Barthel评分极显著高于对照组(P<0.01);年龄≥65岁患者两组MESSS和Barthel评分比较无统计学差异(P>0.05)。结论 TIA的缺血耐受作用与患者年龄具有一定相关性,低于65岁患者TIA发生后1周内出现后继脑梗死,TIA可产生较强的神经保护作用,缓解生活能力的下降程度,而年龄超过65岁患者的TIA神经功能保护作用则明显减弱。