2013—2018年恩施市常住居民死因监测及减寿分析

目的分析2013—2018年恩施市常住居民的死亡情况和主要死因的变化趋势,评估不同疾病所导致的疾病负担,为制定疾病防治对策提供依据。方法收集2013—2018年恩施市常住居民死亡监测数据,分别计算粗死亡率、标化死亡率、期望寿命、潜在减寿年数(PYLL)、标化减寿年数(SPYLL)、潜在减寿率(AYLL)、年度变化百分比(APC)等指标描述死因的分布和变化趋势。结果2013—2018年恩施市居民年均粗死亡率679.43/10万,年均标化死亡率615.02/10万;前5位死因分别为循环系统疾病、呼吸系统疾病、恶性肿瘤、伤害、消化系统疾病,合计占总死亡人数的91.2%。分析期望寿命发现,当地居民2013—2018年的平均期望寿命为78.02岁,且男性(75.57岁)低于女性(80.78岁)。减寿分析发现恩施市2013—2018年各类疾病导致的PYLL为171620人年,SPYLL为171284.62人年,AYLL为15.03年/人。其中,减寿顺位前5位分别是伤害、恶性肿瘤、循环系统疾病、呼吸系统疾病和消化系统疾病。结论2013—2018年恩施市居民死亡率水平较高,年均粗死亡率呈上升趋势,年均标化死亡率呈下降趋势,说明该地区老龄化程度较高。循环系统疾病、恶性肿瘤、呼吸系统疾病等慢性疾病和伤害是导致死亡的主要原因,并导致了沉重的疾病负担,应作为日后防控工作的重点。同时,男性居民的死亡水平和减寿指标均高于女性,采取针对性的防控措施,缩小男女之间的差距,提高人群整体的生活质量。     

Economic Evaluation of In-Hospital Clinical Practices in Acute Injury Care: A Systematic Review

ObjectivesUnderuse of high-value clinical practices and overuse of low-value practices are major sources of inefficiencies in modern healthcare systems. To achieve value-based care, guidelines and recommendations should target both underuse and overuse and be supported by evidence from economic evaluations. We aimed to conduct a systematic review of the economic value of in-hospital clinical practices in acute injury care to advance knowledge on value-based care in this patient population.MethodsPairs of independent reviewers systematically searched MEDLINE, Embase, Web of Science, and Cochrane Central Register for full economic evaluations of in-hospital clinical practices in acute trauma care published from 2009 to 2019 (last updated on June 17, 2020). Results were converted into incremental net monetary benefit and were summarized with forest plots. The protocol was registered with PROSPERO (CRD42020164494).ResultsOf 33 910 unique citations, 75 studies met our inclusion criteria. We identified 62 cost-utility, 8 cost-effectiveness, and 5 cost-minimization studies. Values of incremental net monetary benefit ranged from international dollars ?467 000 to international dollars 194 000. Of 114 clinical interventions evaluated (vs comparators), 56 were cost-effective. We identified 15 cost-effective interventions in emergency medicine, 6 in critical care medicine, and 35 in orthopedic medicine. A total of 58 studies were classified as high quality and 17 as moderate quality. From studies with a high level of evidence (randomized controlled trials), 4 interventions were clearly dominant and 8 were dominated.ConclusionsThis research advances knowledge on value-based care for injury admissions. Results suggest that almost half of clinical interventions in acute injury care that have been studied may not be cost-effective.