上海市居民跌倒伤害的流行特征

目的]观察不同收入、受教育程度及老龄化人群跌倒伤害的分布情况,以分析上海市城市居民跌倒伤害的流行特征。方法]于2006年,调查采用分层多阶段概率比例整群抽样的方法,抽取上海市常住居民45 857人进行入户调查;同时采集164家医院跌倒伤害信息及2001—2011年全市居民病伤死亡原因及其相关人口统计学资料。采用logistic多因素回归分析,控制年龄、性别、教育程度及收入的混杂效应。结果]1在2001—2011年的11年里,上海市人均年工资性收入增加了206.63%,但居民跌倒伤害死亡率从2001年的10.63/10万上升到2011年的14.76/10万。总受伤率为14.70‰。家庭月人均收入低于500元人民币的受伤率约为收入高于5 000元人民币的6.5倍。2小学及以下文化程度人群的跌倒伤害死亡率及受伤率最高,分别是57.85/10万（73.23%）和33.96‰（49.24%）,分别约为大学及以上文化程度者的22倍和5.5倍;3老龄化程度最大的卢湾区和静安区,其相应的死亡率也最高,分别为24.10/10万和19.59/10万。5岁以下年龄组死亡率在所有儿童中居于首位,15~64岁劳动力人口的死伤率随年龄增长而加大,其中50~54岁年龄组所占比重最高,受伤率增加幅度显著加快。女性死伤率高于男性。在所有跌倒伤亡者中,因头部受伤致死者近半。生活水准越低、受教育程度越低及老龄化程度越严重,发生跌倒伤害的风险越大,其相对危险性OR值分别为1.39、1.27和1.21。结论]上海市居民跌倒伤害预防和控制面临着巨大的挑战,收入、受教育程度,年龄是跌倒伤害相关的主要危险因素。干预重点应放在低于小学文化程度、低收入、年龄5岁以下或50岁以上人群,建议在新医改中推出的家庭医生责任制系统中增加跌倒伤害防治服务包。

Epidemiological Pattern of Fall.Related Injuries among Residents in Shanghai,China

Objective] To investigate the epidemiologic features of fall-related injuries, and its relationships with income, education level, and senior residents in Shanghai, China.Methods] A multi-stage stratified cluster sampling approach with probability proportional to size was used to select 45 857 residents in Shanghai for home visits.Mortality and demographic data were collected from Shanghai Vital Registration System from 2001 to 2011.Records on fall-related hospitalized cases and fatalities from 164 hospitals in Shanghai were also analyzed.Logistic regression was used to control confounding from age, gender, education levels and income.Results] During 2001 to 2011, the average annual income increased by 206.63% in Shanghai; while the fall specific mortality rate increased from 10.63 per 100 000 in 2001 to 14.76 per 100 000 in 2011.The morbidity of fall was 14.70 per 1 000 in the survey.Those with family average monthly incomes lower than 500 Yuan RMB were 6.5 times as likely as to suffer from fall-related injuries than those with higher than 5 000 Yuan RMB.The residents with an education level of primary school and under showed the highest fall specific mortality and morbidity rates, 57.85 per 100 000（73.23%） and 33.96 per 1 000（49.24%）, 22 times and 5.5 times compared with those with college degree or above, respectively.The Luwan and Jing＇an districts showed the highest mortality rates（24.10 per 100 000 and 19.59 per 100 000 respectively） with leading proportions of senior residents.The mortality rate of fall in the children 5 years was the highest among children aged 0-14 years.The mortality and morbidity of fall increased dramatically with age among those aged 50 years or above, among which the 50-54 age group accounted for the largest proportion and the morbidity accelerated.The female showed higher mortality and morbidity rates of fall than the male.Combined head injuries accounted for about half of the total fatalities of fall.The relative risk of fall-related injuries was higher in lower i