中国成年人主要死亡原因及其危险因素

目的调查我国成人的主要死亡原因及其可改变的主要危险因素。方法前瞻性队列研究。该队列包括169871名≥40岁男女性有代表性样本,基线调查于1991年,于1999和2000年进行随访,随访率为93.4%。结果我国40～64岁人群中,恶性肿瘤、脑血管疾病和心脏病死亡率分别为265.9/10万人.年、171.5/10万人.年和159.1/10万人.年,高于美国同年龄人群。高血压的全死因相对危险性和人群归因危险度(PAR)分别为1.48%(95%CI1.44～1.53),11.7%;与未患高血压的人群相比,高血压患者总死亡率高48%,若高血压得到有效控制,预计全人群的全死因死亡将下降11.7%。吸烟、缺乏体力活动分别为第2、3位主要死亡原因,吸烟、缺乏体力活动PAR分别是7.9%和6.8%。男性的前5位死因为恶性肿瘤、心脏病、脑血管疾病、意外伤害和传染病;女性前5位死因为心脏病、脑血管疾病、恶性肿瘤、肺炎、流感和传染性疾病。结论血管疾病和癌症是中国成年人死亡的主要原因。控制血压、戒烟、增加体力活动和改善营养等方法是降低中国成年人早死负担的重要策略。

Main Causes and Its Modifiable Risks of Death among Men and Women in China

Objective To study the major causes of death and its modifiable risk factors in a nationwide representative cohort in China.Methods A cohort of 169 871 men and women aged 40 years older was studied with prospective method.Baseline data of the subjects were obtained in 1991.The follow-up evaluation was conducted in 1999 and 2000,with a follow-up rate of 93.4 percent.Results 20 033 death cases were documented in 1 239 191 person-years of follow-up.It was found that a large proportion of people were affected by chronic diseases during their prime working years in China,as compared with developed countries such as United States.The mortality was 265.9 per 100 000 person-years for malignant neoplasm,171.5 per 100 000 person-years for cerebrovascular disease,and 159.1 per 100 000 person-years for diseases of the heart in the Chinese population aged 40 to 64 years old in our study.The multivariate-adjusted relative risk of death and the population attributable risk for preventable risk factors were as follows: hypertension,1.48 and 11.7%,respectively;cigarette smoking,1.23 and 7.9%;physical inactivity,1.20 and 6.8%;and underweight 1.47 and 5.2%.The five leading causes of death were malignant neoplasm,diseases of the heart,cerebrovascular disease,accidents,and infectious diseases among men and diseases of the heart,cerebrovascular disease,malignant neoplasm,pneumonia and influenza,and infectious diseases among women.Conclusions Vascular disease and cancer had become the leading causes of death among Chinese adults.Control of hypertension,smoking cessation,increased physical activity,and improved nutrition should be important strategies for reducing the burden of premature death among adults in China.