以阻塞性肺疾病为根本死因患者的特征分析

目的分析上海市杨浦区2003-2016年以阻塞性肺疾病(OLD)为根本死亡原因患者的相关因素特征,为进一步研究和制定有针对性的防治措施提供依据。方法根据上海市杨浦区疾病预防控制中心提供的数据,选择居民死亡医学证明书死亡原因栏填写为OLD的患者为研究对象,进行OLD根本死因死亡患者的多因素分析。结果当OLD作为根本死因时,2003-2016年间杨浦区OLD死亡患者的直接死因依次为其他阻塞性肺疾病(32.6%)、慢性支气管炎(20.7%)和肺源性心脏病(17.2%)等;其主要相关死因为心血管疾病(50.0%)、脑血管疾病(9.8%)和糖尿病(6.2%)。OLD为根本死因,死亡发生在医疗场所(包括医院和急诊室)为最多,约占70.4%;比较在医院内外死亡的OLD根本死亡患者,性别、婚姻状况及受教育程度在两组之间均存在差异。OLD根本死因死亡数亦具有显著的季节差异性,其中冬季死亡人数最多。结论 2003-2016年间上海市杨浦区以阻塞性肺疾病(OLD)为根本死亡原因患者的多因素死亡特征明显,可针对性采取综合预防控制措施。     

慢性阻塞性肺疾病的新药研究进展

慢性阻塞性肺疾病(chronic obstructive pul-monary diseases,COPD)是常见的呼吸系统疾病之一,我国的调查表明40岁以上人群COPD的患病率为8.2%[1],且呈逐年上升趋势。COPD分列农村和城市死亡原因的第3和第4位,每年因COPD死亡的人数超过128万。COPD反复急性加重,影响患     

其它

20020697上海市慢性非传染性疾病流行病学趋势研究:1951~1,98年死亡资料分析/林松柏…刀中华流行病学杂志一2001,22(4)一265~268 上海市居民平均期望寿命,在1951年为44.39岁,1999年增长到78.44岁。死亡率从1953年989.31/10万下降至1963年474.00/10万,以后呈上升趋势,至1997年达     

联合吸入沙美特罗替卡松及噻托溴铵对COPD患者肺功能的改善作用

据统计,我国慢性阻塞性肺病(COPD)发病率为4.3%,40岁以上更是高达8.2%〔1〕。呼吸衰竭是COPD患者死亡的主要原因,居于所有疾病死亡原因的第4位〔2〕。因此,改善COPD患者肺功能对延缓疾病进展,提高生活质量,降低死亡率具有重要意义。本文回顾分析COPD患者联合吸入沙美特罗替卡     

慢性阻塞性肺疾病合并贫血相关研究进展

<正>慢性阻塞性肺疾病(COPD)是一组以气流受限为特征的可以预防和治疗的疾病,气流受限不完全可逆,呈进行性发展。在全球范围内COPD是一种发病率和死亡率较高的疾病。目前,COPD在欧洲死亡原因中排第三位〔1〕,在美国死亡原因中排第四位〔2〕。COPD具有多种并发症,对COPD患者的预后及死亡率有显著的负面影响。文献报道〔3〕,COPD的常见并发症有心脏疾病、肺癌、骨质疏松和抑郁症等。目前有研究认为贫     

慢性阻塞性肺疾病的发病机制

慢性阻塞性肺疾病(COPD)是一种严重危害人民健康的常见病,有不少患者反复急性加重并最终发展为呼吸衰竭和(或)肺心病,致患者丧失劳动能力甚至死亡。据报道[1-3],COPD的发病率和死亡率有逐年增加的趋势,1990年COPD为全球第六位死亡原因,1996年居第5位,目前,COPD已成为全球第四位死亡原因,预计2020年将成为全球第三位致死原因和经济负担的第五位。患病人数之多,死亡率之高,社会经济负担之重,已成为世界各国广泛重视的公共卫生问题,本文着重对近年来有关COPD的发病机制作一综述。1COPD的定义2001年发表的“慢性阻塞性肺疾病全球防治…     

河北省正定农村居民肺心病死亡及动态分析

目的 研究农村居民慢性肺心病死亡率的动态变化趋势。方法 分析河北省正定农村居民24年死亡监测资料。结果 24年死亡率呈下降趋势,总死亡率下降了22.5％(标化死亡率下降了44.5％);男性下降了20.2％(43.1％),女性下降了25.2％(49.1％)。每年冬季为死亡最高期,特别1月下旬。肺心病死亡年龄曲线高峰后移5岁。结论 健康保健,医疗与卫生工作的改善及戒烟、环境污染控制,均可能是慢性肺心病死亡率下降的原因。     

AECOPD病人的营养支持治疗

慢性阻塞性肺疾病(COPD)在全世界范围内是一种发病率和死亡率较高的重要疾病,造成严重的经济和社会负担,而且这种负担在不断增加。COPD病人营养不良发生率较高,国外调查为24%～71%[1-2],特别是住院病人可高达50%。COPD患者常因营养不良导致呼吸肌无力,免疫力下降,病情迁延不愈,甚至危及生命。2007年更新的《中国COPD指南》、2011年慢性阻塞性肺疾病全球倡议(GOLD)都相继提出     

湖南省某县居民呼吸系统疾病死亡的疾病负担

目的 探讨安仁县居民呼吸系统疾病死亡的疾病负担.方法 收集并分析2004～2005年呼吸系统疾病死亡监测资料,分别计算潜在期望寿命损失年(the expected years of potential life lost,EYPLL)、早死生命损失年(years of life lost,YLLs)、死亡率等疾病负担指标.结果 2004呼吸系统疾病死亡率、EYPLLP、YLLs/1 000分别为82.79/10万、885.83年、10.42,2005年上述指标分别为85.74/10万、706.22年、10.38.2005年死亡率较2004年升高,而EYPLLP、YLLs/1000下降;疾病负担为女性高于男性,呈现0岁和60岁以上两个高峰,肺炎和慢性阻塞性肺病(COPD)分别以0岁组和>35岁组为疾病负担之首.结论 COPD和肺炎是安仁县居民呼吸系统疾病死亡的主要疾病负担,<1岁和>60岁居民是重点人群.     

慢性阻塞性肺疾病合并贫血研究进展

<正>慢性阻塞性肺疾病(COPD)是一组气流受限为特征的疾病,呈进行性发展,其病因与肺部对香烟烟雾等有害颗粒或有害气体的异常炎症反应有关。据WHO统计,在全球死亡病因中COPD居第四位[1],且呈逐年上升趋势。近年来,人们越来越多的认识到COPD所致的全身效应在临床方面的重要性及其它慢性疾病与COPD的相关性。COPD相关肺外疾病研究最多的为心血管疾病、骨质疏松、骨骼肌萎     

Mortality in COPD: Role of comorbidities.

Chronic obstructive pulmonary disease (COPD) represents an increasing burden throughout the world. COPD-related mortality is probably underestimated because of the difficulties associated with identifying the precise cause of death. Respiratory failure is considered the major cause of death in advanced COPD. Comorbidities such as cardiovascular disease and lung cancer are also major causes and, in mild-to-moderate COPD, are the leading causes of mortality. The links between COPD and these conditions are not fully understood. However, a link through the inflammation pathway has been suggested, as persistent low-grade pulmonary and systemic inflammation, both known risk factors for cardiovascular disease and cancer, are present in COPD independent of cigarette smoking. Lung-specific measurements, such as forced expiratory volume in one second (FEV(1)), predict mortality in COPD and in the general population. However, composite tools, such as health-status measurements (e.g. St George's Respiratory Questionnaire) and the BODE index, which incorporates Body mass index, lung function (airflow Obstruction), Dyspnoea and Exercise capacity, predict mortality better than FEV(1) alone. These multidimensional tools may be more valuable because, unlike predictive approaches based on single parameters, they can reflect the range of comorbidities and the complexity of underlying mechanisms associated with COPD. The current paper reviews the role of comorbidities in chronic obstructive pulmonary disease mortality, the putative underlying pathogenic link between chronic obstructive pulmonary disease and comorbid conditions (i.e. inflammation), and the tools used to predict chronic obstructive pulmonary disease mortality.     

The concurrent COPD mortality doubles the mortality estimate from COPD as underlying cause in Lazio, Italy

BACKGROUND: In Lazio region (Italy), mortality data are currently available from the death cause registry (DCR), which reports only underlying causes. Mortality due to other causes, defined concurrent mortality, are need to appropriately estimate the health impact from chronic diseases. The aims of the study were to estimate concurrent mortality from chronic obstructive pulmonary disease (COPD), using hospital discharge registry (HDR), to discuss the validity and limits of this method, and to compare underlying and concurrent mortality from COPD in the Lazio region. METHODS: A mortality study was carried out for residents who died in 1996-2000 with COPD listed as the underlying cause of death and those who died in the hospital with a different underlying cause of death listed but with a discharge diagnosis of COPD. Age-standardized mortality rates were obtained for males and females separately, using the direct method. A random sample of death certificates was used to validate concurrent causes of death as defined from discharge diagnoses. RESULTS: Age-standardised mortality for COPD as underlying cause of death was 3.68/10,000 in male and 2.29/10,000 in female residents. Mortality increased slightly in the study period for women, but no trend was evident. Age-standardised mortality for COPD as concurrent cause of death was 2.39/10,000 in male and 1.31/10,000 in female residents. The positive predictive value for concurrent COPD mortality was 54.3%. CONCLUSIONS: Concurrent COPD mortality contributed 62.3% to the whole mortality. The estimates of concurrent COPD mortality were comparable to those reported in other countries, though using hospital data may overestimate the real concurrent mortality as estimated from death certificates.     

Epidemiologie von Lungenkrankheiten

Diseases of the respiratory system increase with advancing age and contribute substantially to worldwide morbidity and mortality. With respect to the number of deaths pulmonary diseases constitute the third most frequent cause of death following cardiovascular diseases and neoplasms. Lower respiratory tract infections, chronic obstructive pulmonary disease, lung cancer and tuberculosis are among the top ten causes of death worldwide and asthma is globally one of the most common chronic diseases. Despite improved medical diagnostics and therapy the prevalence and morbidity have increased in recent years. Due to increased life expectation and declining morbidity the age structure of the German population will change in the coming years with the growing group of people aged 60 years or older. While diseases, such as chronic obstructive pulmonary disease, lung cancer and pneumonia predominantly affect older people, asthma and tuberculosis occur in all age groups. Worldwide, an increase in the prevalence of lung diseases is expected for the future. The healthcare costs increase disproportionally with advancing age, therefore, the demographic transition will have a decisive impact on the healthcare system.     

Potential misclassification of causes of death from COPD.

Little is known about causes of death in chronic obstructive pulmonary disease (COPD) and the validity of mortality statistics in COPD. The present authors examined causes of death using data from the Copenhagen City Heart Study. Of the 12,979 subjects with sufficient data from the baseline examination during 1976-1978, 6,709 died before 2001. Of these, 242 died with COPD as cause of death. Among subjects with at least severe COPD at baseline, only 24.9% had COPD as cause of death and, in almost half of the cases where COPD was listed as cause of death, the subject had a normal forced expiratory volume in one second /forced vital capacity ratio at baseline. In COPD patients, having COPD on the death certificate was associated with chronic mucus hypersecretion (CMH) at baseline, an odds ratio (OR) of 3.6 (95% confidence interval 1.7-7.7), and being female (OR 2.7 (1.3-5.6)). In subjects without COPD, CMH and smoking were predictors of COPD as underlying cause of death, ORs 2.3 (1.5-3.7) and 2.2 (1.4-3.6), respectively. It was concluded that chronic obstructive pulmonary disease is underreported on death certificates, that biases in the use of chronic obstructive pulmonary disease as cause of death can be assessed, and that possible "over-diagnosis" of chronic obstructive pulmonary disease on death certificates in subjects unlikely to have significant disease should initiate caution when using causes of mortality in chronic obstructive pulmonary disease epidemiology.     

军队172例离休干部寿限与相关影响因素

目的调查离休干部去世前一般身体状况、死因、以及寿限和相关影响因素,为军队离休干部的健康指导和疾病防治提供参考依据。方法以1985年3月至2013年1月所有在第二军医大学附属长海医院住院去世的上海地区军队干休所离休干部为研究对象,对其家属进行问卷调查,并查阅住院病历、死亡病历及死亡登记表。结果去世年龄为59～98（79.39±7.30）岁。去世前最后一次住院指标与去世前一年比较,血白细胞、空腹血糖、血肌酐、血尿素、血清总胆红素水平上升,血红细胞、血红蛋白、总蛋白、白蛋白、白球比水平下降（P＜0.05）。前五位死因分别为肿瘤（41.9%）、神经系统（16.9%）,循环系统（15.7%）,呼吸系统（10.5%）,内分泌、营养与代谢疾病（7.6%）;前五位死亡病种分类分别为肿瘤（42.4%）、冠心病（12.8%）、慢性阻塞性肺疾病（8.7%）、脑梗死（8.1%）和2型糖尿病（7.6%）;肿瘤前两位分别为肺癌（35.6%）和胰腺癌（9.6%）。结论该人群以高龄老人为主。肺癌是该人群最主要的致死肿瘤。心脑血管疾病是该人群住院死亡的主要原因之一。高血压病史、脑梗死病史与寿限呈负相关,经常体育锻炼、常饮牛奶与寿限呈正相关。     

老年心力衰竭急性加重住院病人临床特点分析

目的探讨老年心力衰竭急性加重病人住院的临床特点,为老年心力衰竭急性加重的防治提供理论依据。方法回顾性分析2017年1月-2017年12月住院急性心力衰竭病人的临床资料,收集65岁及以上病人且以80岁为界,分为高龄组和老年组进行分析。共纳入3914例老年急性心力衰竭住院病人,其中老年组1602例,高龄组2312例。结果两组年龄、男性、住院天数、死亡率、住院费用比较差异均有统计学意义(P<0.05)。老年组前5位住院原因分别是高血压病(18.3%)、慢性阻塞性肺疾病急性发作(13.4%)、冠状动脉粥样硬化性心脏病(12.4%)、脑卒中(7.8%)、其他类型心脏病(6.2%)。高龄组前5位住院原因分别为慢性阻塞性肺疾病急性发作(15.9%)、冠状动脉粥样硬化性心脏病(13.6%)、高血压病(12.2%)、肺炎(7.7%)、脑卒中(6.7%)。结论慢性阻塞性肺疾病急性发作是导致老年特别是高龄病人心力衰竭急性加重入院的重要原因。     

Agreement Between Nosologist and Cardiovascular Health Study Review of Deaths: Implications of Coding Differences

OBJECTIVES: To compare nosologist coding of underlying cause of death according to the death certificate with adjudicated cause of death for subjects aged 65 and older in the Cardiovascular Health Study (CHS). DESIGN: Observational. SETTING: Four communities: Forsyth County, North Carolina (Wake Forest University); Sacramento County, California (University of California at Davis); Washington County, Maryland (Johns Hopkins University); and Pittsburgh, Pennsylvania (University of Pittsburgh). PARTICIPANTS: Men and women aged 65 and older participating in CHS, a longitudinal study of coronary heart disease and stroke, who died through June 2004. MEASUREMENTS: The CHS centrally adjudicated underlying cause of death for 3,194 fatal events from June 1989 to June 2004 using medical records, death certificates, proxy interviews, and autopsies, and results were compared with underlying cause of death assigned by a trained nosologist based on death certificate only. RESULTS: Comparison of 3,194 CHS versus nosologist underlying cause of death revealed moderate agreement except for cancer (kappa=0.91, 95% confidence interval (CI)=0.89–0.93). kappas varied according to category (coronary heart disease, kappa=0.61, 95% CI=0.58–0.64; stroke, kappa=0.59, 95% CI=0.54–0.64; chronic obstructive pulmonary disease, kappa=0.58, 95% CI=0.51–0.65; dementia, kappa=0.40, 95% CI=0.34–0.45; and pneumonia, kappa=0.35, 95% CI=0.29–0.42). Differences between CHS and nosologist coding of dementia were found especially in older ages in the sex and race categories. CHS attributed 340 (10.6%) deaths due to dementia, whereas nosologist coding attributed only 113 (3.5%) to dementia as the underlying cause. CONCLUSION: Studies that use only death certificates to determine cause of death may result in misclassification and potential bias. Changing trends in cause‐specific mortality in older individuals may be a function of classification process rather than incidence and case fatality.     

COPD-Related Mortality and Co-morbidities in Northeastern Italy, 2008-2012: A Multiple Causes of Death Analysis

Introduction: Analysis of COPD mortality based only on the underlying cause of death (UCOD) derived from death certificates underestimates disease burden. We analyzed the burden of COPD, as well as the pattern of reporting COPD and its co-morbidities in death certificates, using multiple-cause of death (MCOD) records.

Methods: All 220,281 death certificates of decedents aged ≥40 years in the Veneto region (northeastern Italy) were analyzed through 2008–2012. The UCOD was selected by the Automated Classification of Medical Entities software. COPD was defined by ICD-10 codes J40-J44 and J47 based either on the UCOD or on any mention of COPD in death certificates (MCOD). Annual age-standardized COPD death rates were computed for 40–85 year-old subjects.

Results: COPD was mentioned in 7.9% (and selected as the UCOD in 2.7%) of death certificates. In about half of these, COPD was mentioned in Part II only. After circulatory and neoplastic diseases, the most frequent chronic diseases reported in certificates with any mention of COPD were diabetes (15.2%) and dementia/Alzheimer (8.9%). Between 2008 and 2012, age-standardized death rates (/100,000/year) decreased from 39.8 to 34.0 in males and from 12.7 to 11.3 in females in the UCOD analyses. These trends were confirmed, although figures were three times greater, in the MCOD analyses.

Conclusions: MCOD analysis should be adopted to fully evaluate the burden of COPD-related mortality. Our findings support a decreasing trend in COPD-related mortality in northeastern Italy between 2008 and 2012, in line with other recent studies in Europe and beyond.     

阜阳地区呼吸系统疾病住院患者疾病构成及发病情况分析

目的分析阜阳地区呼吸系统疾病住院患者疾病构成及发病情况。方法收集2007—2012年安徽省阜阳市人民医院呼吸科住院病历资料9 012份,进行疾病分类统计和构成比分析,分析各年度各类疾病住院人数的变化。结果我院6年间呼吸系统疾病中以慢性阻塞性肺疾病、肺癌及肺炎为主,平均构成比分别为34.31%、23.44%及12.30%。慢性阻塞性肺疾病随年份有下降趋势,肺癌、肺结核、间质性肺疾病和肺栓塞随年份有上升趋势。慢性阻塞性肺疾病以老年患者为主,60~79岁为高发年龄段,发生率为40.25%;而支气管哮喘多发于年轻患者;肺癌高发于60~69岁年龄段,发生率为35.55%,但有年轻化趋势;呼吸系统疾病整体发病率以60~69岁为最高峰。结论慢性阻塞性肺疾病、肺癌、肺炎仍为阜阳地区主要呼吸系统疾病,肺癌发病率上升,有年轻化趋势,肺结核、间质性肺病及肺栓塞构成比提高。