中国超重和肥胖造成相关慢性疾病的经济负担研究

目的评价由超重和肥胖造成的4种慢性疾病（高血压、糖尿病、冠心病、脑卒中）的直接经济负担,预测不同超重和肥胖率比值下的医疗负担变化.方法利用2002年中国居民营养与健康状况调查、2003年国家第三次卫生服务需求调查等相关资料,分别计算与超重和肥胖相关的4种慢性疾病的患病相对风险和人群归因危险度百分比,计算4种慢性疾病的直接疾病负担;根据人群归因危险度百分比计算超重和肥胖造成4种慢性病的直接经济负担.结果2003年中国超重和肥胖所造成的高血压、糖尿病、冠心病、脑卒中的直接经济负担分别为89.7、25.5、22.6和73.3亿元,4种病合计归因于超重和肥胖的直接经济负担高达211.1亿元人民币,占4种病合计直接疾病负担的25.5%.如果不采取相应措施,当超重与肥胖率比值达到1.1：1时,归因于超重和肥胖导致4种病的直接经济负担将达到369.9亿元,将比2003年上升75.2%.结论目前超重和肥胖所造成的高血压、糖尿病、冠心病、脑卒中的直接经济负担,分别占2003年中国卫生总费用和医疗总费用的3.2%和3.7%.     

基于网络的个性化高血压健康教育模式

当前高血压已经成为威胁群众生命健康的重要的公共卫生问题。2002年中国居民营养与健康调查和2003年第3次国家卫生服务调查结果显示：我国至少有1．74亿高血压患者,高血压是冠心病和卒中最重要的危险因素,与正常人群相比,高血压患者卒中发生率增加2．6—2．8倍,心绞痛发生率增加2～2．2倍,充血性心力衰竭发生率增加3～4倍;高血压的经济负担巨大,其所造成冠心病和卒中的直接经济负担,已占该两种疾病直接疾病负担近50％。     

阜新市农村居民慢性疾病患病及经济负担调查

目的 调查辽宁省阜新市(高血压、冠心病、脑卒中、糖尿病)的患病率及经济负担.方法 2004～2006年,对辽宁省阜新市农村地区8个乡镇、85个自然村的35岁及以上的45 925名常住居民进行调查.应用患病比值比和人群归因危险度,计算超重和肥胖造成这4种慢性疾病的直接经济负担.结果 阜新市农村居民高血压、冠心病、脑卒中和糖尿病的患病率分别为37.8%,4.2%,2.5%和1.9%,而这4种慢性疾病造成的直接经济负担分别为5.2亿元,1.3亿元,1.7亿元和1.4亿元.其中归因于超重和肥胖的直接经济负担为2.3亿元,占4种病合计直接疾病负担的24.4%.结论 超重和肥胖对农村居民所造成的高血压、冠心病、脑卒中和糖尿病的直接经济负担较重,应加强农村居民健康教育,提高对肥胖危害的认识及预防措施.     

中北大学社区高血压用药依存性调查及分析

根据2002年全国居民和健康状况调查，我国成人高血压患病率为18．8％，比1991年增加31％，估计全国有高血压患者1．6亿。但人群高血压的知晓率、治疗率和控制率却很低，仅分别为30％、25％和6％。众所周知，高血压是脑卒中、冠心病、心力衰竭及肾脏病的主要危险因素。大量的临床研究表明，积极控制高血压，     

走出治疗高血压的误区

原发性高血压是一种严重危害人类健康的疾病，是冠心病、脑卒中和肾功能衰竭的主要发病因素。我国高血压呈现出“三高三低”的特点，即患病率、致残率和病死率高；知晓率、治疗率和控制达标率低。据2002年国家卫生部组织的全国居民营养与健康状况调查显示，18岁及以上居民高血压患病率为18．8％，估计全国患病人数1．6亿多，每年新增300万人以上；     

建立医院与社区高血压防治一体化体系

心脑血管疾病已成为全球最重要和最常见的危害人们健康的公共卫生问题之一。业已证实，高血压是心脑血管疾病相关的危险因素。20世纪80年代，我国开展了以社区为基础的高血压人群防治研究，并努力实施高血压防治的4个转变：由医院为中心向社区为中心转变；由专家行为向政府行为转变；由医疗、科研为主向社区综合防治、预防为主转变；由专业部门参与向全社会参与转变。据有关资料报道，1991年我国高血压患者约为1亿，人群高血压知晓率、治疗率和控制率分别为26．6％，24．8％，5．8%；2002年中国居民营养与健康状况调查报告显示．我国高血压患病率有较大幅度升高，全国现患人数约为1．6亿，人群高血压知晓率、治疗率和控制率分别为30．2％，24．7％和6．1％，仍处于较差水平。     

社区干预对高血压和脑卒中预防效果评价

目的：评价社区干预对中年和老年人群高血压和脑卒中的预防效果。方法：对“中国七城市脑卒中干预试验研究”的资料做进一步分析和评估。在北京等六城市城区选择2个不相邻、框架人口约为1万的自然人群，分别作为干预和对照社区，从两社区35岁以上人群中分别选取2700名既往无脑卒中病史的居民作为队列人群，进行脑卒中危险因素调查(基线调查)和体格检查，筛查高危对象。3年后对参加过基线调查者随访。在干预队列，对基线调查筛查出的高危人群进行干预，重点是高血压预防与控制，同时对社区居民进行大众健康教育。对照社区则顺其原有医疗条件，不予干预。结果：3年后，无论是干预队列还是对照队列，高血压患病率均有所增加，但以对照队列中年人增加最突出。无论是中年人还是老年人，干预组知晓率、治疗率和控制率都有不同程度的改善。3年中干预队列脑卒中发病的危险减少了29％(HR=0.71，95％CI：0．58～0．87)，死亡减少了40％(HR=0．60，95％CI：0．42～0．86)。干预可以减少各类型高血压患者的脑卒中，在单纯性收缩期高血压患者组最为显著，其次是复合高血压。与此同时，干预队列全死因死亡率与对照队列相比降低了11％(HR=0．89，95％CI：0.78～0．99)。结论：社区干预可以有效地控制高血压，提高人群的高血压知晓率、治疗率和控制率，减少各类型高血压患者的脑卒中发病率和死亡率，同时明显减少人群全死因死亡率。     

对社区高血压病人实施健康管理效果评价

高血压病是最常见的心血管疾病之一,与人类的主要疾病如冠心病、脑血管疾病密切相关,据2002年卫生部组织的全国居民营养与健康状况调查资料统计,中国成人高血压患病率为18.9%,全国有高血压病人约1.6亿[1];而受检对象对高血压知晓率、治疗率、控制率在城市分别为36.3%,17.4%和4.2%,在农村则更低[2].     

南宁市城区居民连续13年高血压、脑卒中、冠心病发病趋势分析

目的：了解南宁市城区居民1991-2003年高血压、脑卒中、冠心病发病率变化趋势，为心脑血管疾病的有效干预决策提供科学依据。方法：分析1991-2003年高血压、脑卒中、冠心病监测数据。结果：我市城区居民高血压、脑卒中、冠心病发病数以高血压发病人数居多（占总发病总数的45．74％）；3种病的发病率均处在较高发病水平，且发病率呈逐年上升趋势（P〈0．001）；男性发病率均高于女性（P〈0．001）；3种疾病的发病率均随年龄增大而增加。结论：南宁市高血压、脑卒中、冠心病发病率呈上升趋势，已成为严重威胁我市城区居民健康的主要疾病，采取控制高血压为主的社区人群综合性干预活动是防治心脑血管疾病的关键。     

某社区高血压防治模式变化与其效果分析

目的评估本社区在10年间不断完善高血压防治模式的过程中，各阶段高血压综合防治效果。方法1995年在对本社区35～74岁居民高血压普查基础上探索高血压防治管理模式，采用3个时间横断面调查社区居民高血压病知晓率及高血压患者治疗率和血压控制率，并比较分析。结果通过优化人员组合和综合干预内容，增加服务形式，本社区居民高血压病知晓率以及高血压患者治疗率和血压控制率随时间变化不断提高，高血压患者的血压值随时间变化不断下降（P〈0.01）。结论社区全科团队高血压综合防治对提高社区居民和高血压患者的高血压防治意识和血压控制率有较好的效果。     

Differences in disability among black and white stroke survivors--United States, 2000-2001

Stroke is a leading cause of serious, long-term disability in the United States and was responsible for an estimated 53.6 billion dollars in direct and indirect costs during 2004. Stroke survivors can experience residual physical, psychological, and social impairment; nearly 45% of all stroke survivors aged > or =65 years have moderate or severe disability. Furthermore, persons in certain racial/ethnic populations experience disparities in stroke-related disability. To assess the prevalence of functional limitations among U.S. adult stroke survivors and to examine potential racial/ethnic disparities in stroke-related disability, CDC analyzed National Health Interview Survey (NHIS) data from 2000-2001. The results of this analysis indicated that black stroke survivors had greater activity limitations than white stroke survivors. To increase the quality and length of life among stroke survivors and to eliminate disparities in stroke incidence, greater efforts are needed to implement stroke prevention and intervention activities among black populations, particularly young to middle-aged adults. Increasing public awareness of stroke-related warning signs and encouraging patients to seek immediate treatment might reduce stroke-related disabilities and costs.     

Economic burden of cardiovascular disease associated with excess body weight in U.S. adults

BACKGROUND: Excess body weight (EBW), which continues to become more prevalent, is a clear contributor to cardiovascular disease (CVD), the leading cause of death and disability among U.S. adults. Information on the economic impact of CVD associated with EBW is lacking, however. OBJECTIVE: To estimate the direct medical costs of CVD associated with EBW. METHODS: We conducted a population-based analysis of direct medical costs by linking the 1995 National Health Interview Survey and the 1996 Medical Expenditure Panel Survey. The study subjects are adults (aged > or =25 years, excluding pregnant women) in the non-institutionalized, civilian population in 1996. RESULTS: The prevalence of CVD among people in the normal weight (body mass index [BMI] > or =18.5 to <25), overweight (BMI > or =25 to <30), and obese (BMI > or =30) groups was 20%, 28%, and 39%, respectively. There were 12.95 million CVD cases among overweight people, more than 25% of which was associated with overweight. There were 9.3 million CVD cases among obese people, of which more than 45% was associated with obesity. This extra disease burden led to $22.17 billion in direct medical costs in 1996 ($31 billion in 2001 dollars, 17% of the total direct medical cost of treating CVD). CONCLUSIONS: The strong positive association between EBW and CVD, and the significant economic impact of EBW-associated CVD demonstrate the need to prevent EBW among U.S. adults.     

Trends in the prevalence, awareness, treatment, and control of cardiovascular disease risk factors among noninstitutionalized patients with a history of myocardial infarction and stroke

Rates of hypertension, high low density lipoprotein (LDL) cholesterol, and diabetes mellitus awareness, treatment, and control for persons with a history of myocardial infarction and stroke were compared by using two nationally representative samples of the US population: the Third National Health and Nutrition Examination Survey in 1988-1994 (n = 1,004) and the National Health and Nutrition Examination Survey in 1999-2002 (n = 512). Estimated numbers of adult myocardial infarction and stroke survivors increased from 6.32 to 6.78 million and from 3.85 to 4.96 million, respectively. Among such survivors, awareness of a previous diagnosis of hypertension and prevalence of self-reported diabetes mellitus remained stable while awareness of high LDL cholesterol increased from 43.3% to 60.2% (p < 0.01). Among those aware of their diagnosis, pharmacologic treatment for high LDL cholesterol increased from 33.1% to 78.4% and pharmacologic treatment for diabetes mellitus increased from 80.0% to 93.6% during this time (each p < 0.01), while pharmacologic treatment for hypertension increased nonsignificantly. Among those receiving pharmacologic treatment, hypertension and high LDL cholesterol control increased from 48.9% to 59.3% (p = 0.05) and from 5.1% to 33.1% (p < 0.01), respectively. In contrast, glycemic control among diabetics decreased from 45.0% to 33.2% (p = 0.20). The number of US myocardial infarction and stroke survivors increased between 1988-1994 and 1999-2002, and substantial improvements occurred in the awareness, treatment, and control of high LDL cholesterol in this population.     

Forecasting the Future Economic Burden of Current Adolescent Overweight: An Estimate of the Coronary Heart Disease Policy Model

Objectives. We predicted the future economic burden attributable to high rates of current adolescent overweight.Methods. We constructed models to simulate the costs of excess obesity and associated diabetes and coronary heart disease (CHD) among adults aged 35–64 years in the US population in 2020 to 2050.Results. Current adolescent overweight is projected to result in 161 million life-years complicated by obesity, diabetes, or CHD and 1.5 million life-years lost. The cumulative excess attributable total costs are estimated at $254 billion: $208 billion because of lost productivity from earlier death or morbidity and $46 billion from direct medical costs. Currently available therapies for hypertension, hyperlipidemia, and diabetes, used according to guidelines, if applied in the future, would result in modest reductions in excess mortality (decreased to 1.1 million life-years lost) but increase total excess costs by another $7 billion (increased to $261 billion total).Conclusions. Current adolescent overweight will likely lead to large future economic and health burdens, especially lost productivity from premature death and disability. Application of currently available medical treatments will not greatly reduce these future burdens of increased adult obesity.Excessive weight gain in childhood and adolescence has risen over the past several decades. The prevalence of overweight adolescents tripled between the 1970s and 2000 and reached 17% as of 2000 to 2004.¹ Overweight adolescents are likely to become obese adults,^2–4 thereby producing a substantial, long-lasting future health burden. The prevalence of adult obesity was reported to be 34% in 2007.⁵ A recent study forecast that current adolescent overweight will increase future adult obesity by 5% to 15% by 2035, resulting in more than 100 000 excess prevalent cases of coronary heart disease (CHD) by 2035.¹The economic burden attributable to this future excess obesity has not been estimated. In addition to the costs of medical treatment of the higher rates of obesity, CHD, and other obesity-related illness such as diabetes, the costs of lost productivity resulting from premature morbidity and mortality in the working-age population may also be high.We used the CHD Policy Model^6–8 to estimate the increase from 2020 to 2050 in adult obesity, obesity-associated CHD, and obesity-related diabetes attributable to increases in prevalence of adolescent overweight between the late 1970s and 2000. We then estimated the attributable increases in direct medical costs and indirect productivity costs. We also estimated the economic costs associated with medical treatment protocols (or standards of care or policies) that might mitigate the projected rise of modifiable, obesity-related cardiovascular risk factors.     

The Socioeconomic Burden of Coronary Heart Disease in Korea

Objectives

We aimed to estimate the annual socioeconomic burden of coronary heart disease (CHD) in Korea in 2005, using the National Health Insurance (NHI) claims data.

Methods

A prevalence-based, top-down, cost-of-treatment method was used to assess the direct and indirect costs of CHD (International Classification of Diseases, 10th revision codes of I20-I25), angina pectoris (I20), and myocardial infarction (MI, I21-I23) from a societal perspective.

Results

Estimated national spending on CHD in 2005 was $2.52 billion. The majority of the spending was attributable to medical costs (53.3%), followed by productivity loss due to morbidity and premature death (33.6%), transportation (8.1%), and informal caregiver costs (4.9%). While medical cost was the predominant cost attribute in treating angina (74.3% of the total cost), premature death was the largest cost attribute for patients with MI (66.9%). Annual per-capita cost of treating MI, excluding premature death cost, was $3183, which is about 2 times higher than the cost for angina ($1556).

Conclusions

The total insurance-covered medical cost ($1.13 billion) of CHD accounted for approximately 6.02% of the total annual NHI expenditure. These findings suggest that the current burden of CHD on society is tremendous and that more effective prevention strategies are required in Korea.     

Estimated economic costs of obesity to U.S. business.

OBJECTIVE: To estimate the economic costs of obesity to U.S. business. METHODS: Standard epidemiologic methods for risk attribution and techniques for ascertaining cost of illness were used to estimate obesity-attributable expenditures on selected employee benefits, including health, life, and disability insurance and paid sick leave by private-sector firms in the U.S. in 1994. Data were obtained from a variety of secondary sources, including the National Health Interview Survey, reports from the Bureau of Labor Statistics and other federal agencies, and the published literature. Attention was focused on employees between the ages of 25 and 64 years who were classified according to body mass index (BMI) as "nonobese" (BMI < 25 kg/m2), "mildly obese" (BMI = 25-28.9 kg/m2), or "moderately to severely obese" (BMI > or = 29 kg/m2). RESULTS: The cost of obesity to U.S. business in 1994 was estimated to total $12.7 billion, including $2.6 billion as a result of mild obesity and $10.1 billion due to moderate to severe obesity. Health insurance expenditures constituted $7.7 billion of the total amount, representing 43% of all spending by U.S. business on coronary heart disease, hypertension, type 2 diabetes, hypercholesterolemia, stroke, gallbladder disease, osteoarthritis of the knee, and endometrial cancer. Obesity-attributable business expenditures on paid sick leave, life insurance, and disability insurance amounted to $2.4 billion, $1.8 billion, and $800 million, respectively. CONCLUSIONS: The health-related economic cost of obesity to U.S. business is substantial, representing approximately 5% of total medical care costs. Further research is needed to determine the cost-effectiveness of worksite weight management programs and of other efforts to reduce the prevalence of obesity in the U.S. workforce.     

云南省大姚县归因于肥胖的高血压疾病经济负担研究

摘要:目的　分析云南省大姚县归因于肥胖的高血压疾病经济负担。方法　采用多阶段分层随机抽样方法,抽取该地区≥35岁农村居民2479名进行问卷调查和体格检查。采用二步模型法估算高血压的直接经济负担,采用人力资本法估算其间接经济负担。结果　大姚县高血压、肥胖和中心性肥胖的患病率分别为40.4%、4.6%和39.9%;其中男性分别为40.6%、4.4%、29.9%;女性分别为40.2%、4.9%、49.3%;女性中心性肥胖率明显高于男性（P＜0.01）。高血压的患病率和中心性肥胖率随年龄的增加而上升,随文化程度和人均年收入的增加而下降（P＜0.01）;肥胖者和中心性肥胖者患高血压的风险均明显高于非肥胖者和非中心肥胖者（P＜0.01）。大姚县高血压的人均直接和间接经济负担分别为6802.2元和64.1元;总疾病经济负担为784百万元,其中归因于肥胖和中心性肥胖的高血压疾病经济负担分别为37.6百万元和286.1百万元。结论　归因于肥胖和中心性肥胖的高血压疾病经济负担对当地经济影响显著。应采取措施减少当地肥胖和中心性肥胖的发生,从而降低其导致的经济负担。     

State-specific prevalence of obesity among adults--United States, 2005

Obesity, one of the 10 leading U.S. health indicators, is associated with increased risk for hypertension, dyslipidemia, type 2 diabetes, coronary heart disease, stroke, and certain cancers. A Healthy People 2010 objective is to reduce to 15% the prevalence of obesity among adults in the United States (objective 19-2). Both national-level data from the National Health and Nutrition Examination Survey (NHANES) and state-level data from the Behavioral Risk Factor Surveillance System (BRFSS) indicate that the prevalence of obesity among adults continued to increase during the past decade. In 2003, one study estimated that state-specific, obesity-attributable medical expenditures ranged from $87 million in Wyoming to $7.7 billion in California. To assess the prevalence of obesity among adults by state and demographic characteristics since 1995, data were analyzed from the 1995, 2000, and 2005 BRFSS surveys. The results of these analyses indicated that 23.9% of U.S. adults were obese in 2005, and the prevalence of obesity increased during 1995-2005 in all states. To reverse this trend, a sustained and effective public health response is needed, including surveillance, research, policies, and programs directed at improving environmental factors, increasing awareness, and changing behaviors to increase physical activity and decrease calorie intake.     

Million hearts: strategies to reduce the prevalence of leading cardiovascular disease risk factors--United States, 2011

Cardiovascular disease (CVD) causes one in three (approximately 800,000) deaths reported each year in the United States. Annual direct and overall costs resulting from CVD are estimated at $273 billion and $444 billion, respectively. Strategies that address leading CVD risk factors, such as hypertension, high cholesterol levels, and smoking, can greatly reduce the burden of CVD. To estimate the U.S. prevalence of these three risk factors, CDC analyzed data from the National Health and Nutrition Examination Survey (NHANES) on uncontrolled hypertension, uncontrolled high levels of low-density lipoprotein cholesterol (LDL-C), and current smoking. This report summarizes the results of that analysis, which found that 49.7% of U.S. adults aged ≥20 years (an estimated 107.3 million persons) have at least one of the three risk factors. To reduce the prevalence of CVD risk factors among persons in the United States, the U.S. Department of Health and Human Services, in collaboration with nonprofit and private organizations, is launching Million Hearts, a multifaceted combination of evidence-based interventions and strategies aimed at preventing 1 million heart attacks and strokes over the next 5 years.     

Medical costs of fourteen occupational illnesses in the United States in 1999

OBJECTIVES: This study estimated the annual medical costs associated with 14 occupational illnesses in the United States in 1999. METHODS: National data sets collected by the National Center for Health Statistics, the Health Care Financing Administration, and the Agency for Healthcare Research and Quality were aggregated and analyzed. The cost assessment began with estimates of national health expenditures. These included categories for hospital care, professional services, nursing homes, and medical products, including drugs, administration, public health activities, research and construction. The total disease burden was assessed from estimates of hospital days and number of outpatient visits. The occupational disease burden was assessed by multiplying the total disease burden by a given percentage of the proportionate attributable risk for the disease in question. The occupational burden was then combined with costs for each disease. Adjustments were made for unique inpatient and outpatient costs. RESULTS: In the preferred model, the 14 diseases generated USD 14.5 billion in medical costs in 1999. Roughly USD 10.7 billion was attributed to men and USD 3.8 billion to women. The diseases generating the most costs were as follows: circulatory diseases in the age group 24-64 years (USD 4.7 billion), cancer (USD 4.3 billion), chronic obstructive pulmonary disease (USD 2.2 billion), and asthma (USD 1.5 billion). A sensitivity analysis generated alternative estimates. An upper age limit of 74 years increased the circulatory disease estimate by USD 3.7 billion. The range of the sensitivity analysis was USD 9.6-19.7 billion. CONCLUSION: This study significantly improves over the methodology of previous literature. Our methods were transparent. Occupational illnesses were a major contributor to the total cost of medical care.