2009—2019年中国老年人心血管疾病死亡趋势及预测分析

目的 了解2009—2019年我国老年人心血管疾病总体死亡趋势并进行趋势预测的分析,为制定适合我国老年人心血管疾病整体防治策略提供相关理论基础。方法 利用2009—2019年《中国死因监测数据集》,采用joinpoint回归模型分析老年人心血管疾病死亡率的平均年度变化百分比(AAPC),应用GM(1,1)对我国2020—2030年老年人心血管疾病死亡粗率进行预测。结果 与2009年相比,2019年我国老年人心血管疾病平均死亡粗率降至2 039.99/10万,年龄标化死亡率则降至2 172.24/10万;我国总老年人群、老年男性和女性、城市和乡村老年人心血管疾病标化死亡率AAPC分别为-2.400%、-2.843%、-2.049%、-1.368%、-3.298%,均呈长期下降趋势,P<0.05;老年男性的死亡率下降速度快于老年女性,但2009—2019年老年男性心血管病标化死亡率始终较女性高;农村的下降速度快于城市,但2009—2019年农村老年人心血管病标化死亡率始终较城市高;随着年龄的增长,中国65岁以上老年人心血管疾病的死亡率逐渐上升,在≥85岁组死亡率达到最高,各年龄组AA...     

Incidence and case fatality rates for acute appendicitis in California. A population-based study of the effects of age

In 1984, 24,794 appendectomies and abscess drainage procedures were performed for acute appendicitis in California hospitals. Analysis of hospital discharge abstracts revealed age- and sex-specific incidence rates and in-hospital case fatality rates for acute appendicitis lower than previously reported. In persons aged 60 years and older, the case fatality rate for nonperforating appendicitis with appendectomy was 0.7% and for perforating appendicitis and abscess 2.4%. Surgery was delayed beyond the day of admission in 21% of persons aged 40-59 years, 29% of persons aged 60-79 years, and 47% of persons aged 80 years and over. The proportion of cases with perforation increased from 22% to 75% between ages 20 and 80 years. The population incidence of perforating appendicitis changed little after age 20 years, while the incidence of nonperforating cases declined sharply. The high proportion of appendicitis cases with perforation among the elderly may be due to the decreased incidence of nonperforating appendicitis in the elderly and not to a greater propensity for perforation, as previously proposed. Most elderly in California receive timely surgery for appendicitis and tolerate it better than previously reported. Diminished tolerance for intra-abdominal infection may be the primary determinant of the increase in case fatality with age.     

Exclusion of elderly persons from health-risk behavior clinical trials

BACKGROUND: It has been found that the elderly population is underrepresented in clinical trials aimed at disease treatment. It is unknown to what extent this group is also excluded from clinical trials aimed at reducing health-risk behaviors. METHOD: We systematically reviewed clinical trials targeting the leading health-risk behaviors, as identified by Healthy People 2010: tobacco use, overweight/obesity, physical inactivity, substance abuse, and irresponsible sexual behavior. Using MEDLINE, we identified clinical trials published in the five most cited medical journals between January 1990 and May 2004. RESULTS: The majority (53%) of the 198 health-risk behavior clinical trials excluded persons over the age of 65; the exclusion percentage increased to 72% for those over the age of 75. The exclusion of elderly persons in these five medical journals did not decline over the 14 years studied. This age exclusion pattern was not explained by the intervention's intrusiveness or whether illness was an exclusion criterion. The trials that included those over the age of 65 were more likely to report a significant finding in the predicted direction. CONCLUSIONS: Although elderly persons are most at risk for diseases linked to lifestyle behavior, such as heart disease, they were excluded from the majority of health-risk behavior clinical trials in five major medical journals.     

Disorders requiring nursing care and the period before recognized as needing nursing care (active life expectancy) in relation to nursing care insurance

PURPOSE: To measure the state of health of the elderly population, active and dependent life expectancies were calculated based on the number of people needing nursing care. For this purpose, active life expectancy was defined as the period before nursing care was recognized by insurers as being required. Moreover, to cast light on disorders requiring nursing care, age-adjusted nursing time needed for different ailments per ten thousand elderly population was calculated. SUBJECTS AND METHODS: Subjects were those 65 years or over living in Taihaku-ku, Sendai City, recognized as needing nursing care by nursing care insurers. The period before being recognized as needing nursing care was calculated using the Sullivan method, and termed the active life expectancy. Dependent life expectancy = life expectancy - active life expectancy. The number of those needing nursing care caused by each disorder diagnosed by attending physicians, was also age-adjusted by the reference population and multiplied by the nursing time needed for each level of nursing, resulting in the age-adjusted nursing time needed per ten thousand elderly population. RESULTS: Those recognized as needing nursing care were 7.5% (7.7% after age adjustment) of the male elderly population, and 12.5% of the female population (10.7% after age adjustment). For men, the active life expectancy was 16.1 years for the age of 65, 9.2 years for 75 and 4.4 years for 85, while the dependent one was 2.0-2.1 years for all ages. For women, the active life expectancy was 19.3 years for the age of 65, 11.1 years for 75 and 4.8 years for 85, while the dependent one was 4.6-5.3 years. The age-adjusted nursing time needed per ten thousand elderly population was 874 hours for men and 1,125 hours for women: of the time 51% was for men with cerebrovascular disease (40% for cerebral infarction), 11% for men with dementia; 37% for women with cerebrovascular disease (26% for cerebral infarction), 20% for women with skeletal diseases, 18% for women with dementia. CONCLUSIONS: The active life expectancy for women is longer than for men, by 3.7 years for the age of 65, by 2.3 years for 75 and by 0.5 years for 85. The dependent life expectancy for women is also longer than for men, by 3.2 years for the ages of 65 and 75 and by 2.6 years for 85. Thus, nursing prevention is an urgent issue, especially for women. The disorders requiring particularly long age-adjusted nursing time are carebrovascular disease (particularly cerebral infarction), dementia and skeletal disorders (particularly among women).     

河南省老年人常见慢性病共病现状分析

目的了解河南省60岁及以上老年人慢性患共病的现状。方法采用多阶段随机抽样方法,抽取河南省18个省辖市、10个直管县的60岁及以上老年人,调查老年人慢性病共病情况。结果本研究调查6 094名老年人,慢性病患病率为38.96%,共病患病率为12.64%,排在前3位的慢性病分别是糖尿病(14.1%)、高血压(13.9%)、脑卒中(13.0%)。其中患有2种、≥3种共病的患病率分别为7.54%、5.09%。高血压+糖尿病组合模式的患病人数最多,为23.48%。男性、高龄、城市、独居、无医保的老年人对慢性病共病的患病率均产生影响,差异均有统计学意义(P<0.05)。结论河南省中老年人群慢性病共病患病率较高,女性应注重高血压、糖尿病、脑卒中、抑郁症的慢性病管理,男性应加强对冠心病、慢性阻塞性肺疾病、恶性肿瘤、老年性痴呆的预防。共病组合模式中常见的疾病是高血压、糖尿病、脑血管病组合,应加强管理,提高对慢性病共病的防治成效。     

2005-2014年上海市浦东新区户籍老年人口死因分析

摘要:目的　分析2005-2014年浦东新区户籍老年人死亡情况,为老年人疾病预防保健工作提供依据。方法　应用死亡率、构成比和老年保健效益系数（GEI）等指标,对60岁及以上老年人口死因资料进行分析。结果　2005-2014年浦东新区60岁以上老年人口死亡167800人,占总死亡数的85.56%。标化死亡率为24.62‰,疾病别死亡率随年龄增加而上升。主要死因为慢性病,占88.51%。除内分泌营养代谢病和损伤中毒外,男性疾病别死亡率高于女性。女性GEI高于男性。损伤中毒和恶性肿瘤GEI最低,呼吸和循环系统疾病GEI较高。男性恶性肿瘤GEI呈下降趋势。结论　浦东新区老龄化严重,应针对不同性别特点,优先关注老年人恶性肿瘤等慢性病,加强意外跌倒自我防护和交通安全意识,提高人群健康意识和疾病防控的能力。     

循环系疾病已经成为上海地区60岁以上老人首位死因

[目的 ]　分析上海地区 6 0岁以上老年人循环系病死亡情况。 [方法 ]　利用上海市 2 0 0 0年死亡个案记录 ,按国际疾病分类 (ICD— 9)进行分类。用DIS居民死亡分析软件处理。 [结果 ]　 6 0岁以上老年人循环系病死亡占 6 0岁以上死亡总数的 36 .2 9% ,男性死亡率大于女性 ,各年龄组死亡率上升幅度呈几何级数增加 ,高血压、糖尿病、脑血管病的晚期(残留 )效应是主要的危险因素。 [结论 ]　循环系病是 6 0岁以上老人的首位死因 ,同时也构成了当前上海地区人群的主要死亡原因     

清远市凤城社区老年人糖尿病防治情况分析

目的了解清远市清城区凤城社区60岁及以上老年人群糖尿病患病率、知晓率、治疗率、控制率情况,为该社区老年人群糖尿病防治提供科学依据。方法以2010年1月-2012年12月清远市清城区凤城社区26个行政村60岁及以上7314例老年人健康检查横断面调查结果为样本。对老年人糖尿病患病及有关特点进行分析。结果该社区60岁及以上人群糖尿病患病率（标化）为5．89％。标化后男女性糖尿病患病率随年龄增长而增加的变化趋势差异均有统计学意义（P〈0．01）。知晓率、治疗率和控制率（简称三率）分别为44．94％、24．27％和9．44％。女性三率高于男性。男女分别有41．52％和41．34％实测糖尿病患者不知自身已患有糖尿病。结论该社区有必要开展实施“防、治、保、康、教一体化”为主的糖尿病综合防治措施,积极对不良生活方式进行干预,预防和早期治疗糖尿病,提高糖尿病的知晓率和治疗率。     

2017—2018年南昌市城区流感病例经济负担和影响因素分析

目的 调查南昌市城区流感病例的经济负担,分析其影响因素,为制定传染病防控策略提供依据。 方法 将分层整群抽样抽取的南昌市城区6个街道2017—2018年报告的141例流感确诊病例作为调查对象,通过回顾性调查,收集其直接经济负担和间接经济负担数据,采用Spearman秩相关和logistic回归模型,对流感病例经济负担的影响因素进行分析。 结果 南昌城区流感门诊病例和住院病例平均经济负担分别为946元和8561元。直接医疗费用、直接非医疗费用和间接经济负担分别占门诊病例的经济负担的48.11%、18.20%和33.68%,直接医疗费用、直接非医疗费用分别和间接经济负担分别占住院病例的经济负担的76.74%、15.78%和7.48%。病例年龄在5岁以下（OR=4.662, 95%CI=1.295~16.785）和60岁及以上（OR=9.171, 95%CI=1.353~62.173）、延误抗病毒治疗（OR=3.957, 95%CI=1.989~7.871）为流感病例直接经济负担增高的危险因素,病例年龄在5岁以下（OR=17.453, 95%CI=4.485~67.918）和60岁及以上（OR=16.844, 95%CI=2.884~98.395）为流感病例间接经济负担增高的危险因素,流感疫苗接种既是流感病例直接经济负担增高的保护性因素（OR=0.119, 95%CI=0.026~0.539）,也是间接经济负担增高的保护性因素（OR=0.224, 95%CI=0.067~0.746）,P均<0.05。 结论 应将5岁以下儿童、60岁以上老年人作为流感防控的重点人群,促进公众接种流感疫苗,引导流感病例及早就医接受抗病毒治疗,以降低流感给病例造成的经济损失。     

宜川社区60岁以上老年人卫生服务需求调查

目的探索老年人医疗服务需求现状和对策。方法2008年3至4月，采用随机整群抽样法，以问卷形式对宜川社区557名≥60岁户籍老年人进行健康状况和医疗服务需求调查。结果97．2％的调查对象患有慢性疾病，以高血压、冠心病最为多见；大部分老人日常生活基本能自理，希望得到就近社区卫生服务中心（站）的基本医疗服务和健康指导。结论老年人是社区卫生服务的重点人群，社区卫生服务应针对目前老年人的需求和经济状况，开展一些老年人需要并乐于接受的社区医疗卫生服务。     

Cost effectiveness of influenza vaccination for healthy persons between ages 65 and 74 years

Healthy persons between 65 and 74 years of age represent a large proportion of the population in this age group. Internationally, there is a substantial variation in whether these people are included among the recommendations for routine influenza vaccination. We therefore conducted this study, updating an earlier analysis, to assess the health and economic benefits of routine influenza vaccination of healthy persons between 65 and 74 years of age. The health benefits associated with vaccination were estimated using the administrative data bases of a large HMO in the Minneapolis, St. Paul, Minnesota area. Multivariate models were used to estimate reductions in hospitalization and death associated with vaccination. The economic analysis took the societal perspective and presented the results as net cost or saving per 10,000 persons vaccinated and per death prevented. Direct and indirect monetary costs were included in the models and were estimated from the published literature. Monte Carlo simulation was used to conduct probabilistic sensitivity analysis in order to derive probability intervals for each estimate of net costs or savings. Over the six consecutive study seasons, 1990-1991 to 1995-1996, vaccination of healthy elderly person was associated with a 36% reduction in hospitalization for pneumonia or influenza (95% CI, 2-39%), an 18% reduction in hospitalization for all respiratory conditions (95% CI, -6 to 37%) and a 40% reduction in death (95% CI, 14-38%). Vaccination was also associated with cost savings in all scenarios evaluated. The findings of this study again affirm the value of an age-based strategy for routine influenza vaccination of all elderly persons including healthy elderly persons between 65 and 74 years.     

Low-income senior citizens in the Municipality of São Carlos, São Paulo State, Brazil: an epidemiological survey

This study focuses on the health profile of the elderly population in Sao Carlos, Sao Paulo State, Brazil, in 2003. The study population consisted of a sample over 60 years of age (n = 523) registered with the Family Health Program and the Unified National Health System. Point and interval prevalence of disabilities and chronic non-communicable diseases and cognitive status were estimated (95%CI). The study population was predominantly female with low education; 24.8% lacked any kind of retirement pension; 43.6% presented a low level of social integration; 46.7% required some form of help for 1 to 3 routine activities; 74.9% presented 1 to 5 chronic non-communicable diseases; and 56.2% scored under 24 on a cognitive test. Some 87.0% had sought health care and 22.4% required some kind of inpatient care. The results confirmed the need for improved professional training, adequacy of health services, and effective public policy to provide qualified health care for the elderly population.     

Economic evaluation of disability prevention programs for community-dwelling elderly secular trend analyses of medical and care expenses comparing participants and non-participants in the programs

OBJECTIVE: This study was conducted to evaluate disability prevention programs for community-dwelling elderly in terms of the cost/benefit balance. METHODS: Out of all residents aged 65 years and over who lived in Yoita Town, Niigata Prefecture, Japan (n = 1,673), 1,544 persons participated in the baseline survey conducted in November, 2000 (response rate, 92.2%). Based on the results, Yoita town then launched several kinds of disability prevention programs for community-dwelling elderly, e.g., preventive programs for falls, dementia and homeboundness. The subjects for the present study included only those aged 70 years and over who responded to the baseline survey and were alive as of March 2004. During 2001 to 2003, 146 persons had participated at lease once in one of disability prevention programs (denoted as the participant group), whereas 846 persons had not participated in any of the programs (denoted as the non-participant group). We compared medical and care expenses (sum of national and employment health insurance benefits, and long-term care insurance) between the two groups during 2000-2003, and determined whether participating in program affected subsequent medical and care expenses independent of key confounders [sex, age, and baseline medical and care expenses or health indicator (TMIG-Index of Competence or Generic Mobility Index)], using general linear models. RESULTS: The mean medical expenses per capita and per month slightly decreased over the period of the study in the participant group (51,606 yen for 2000 to 47,539 yen for 2003), while those in non-participant group steadily increased (41,888 yen, to 51,558 yen, respectively). During the same period, the mean care cost per capita and per month increased in both groups, but the increase was much more moderate in the participating group (507 yen to 5,186 yen vs. 8,127 yen to 27,072 yen for non-participant group). Summed cost reduction through the program participation accounted for 49 million yen during the three years (2001-2003). After adjustment for sex, age and baseline medical and care expenses or health indicator, it was estimated as 12 million yen per year. Given that the expenses for the disability prevention programs summed 2.3 million yen per year, the net benefit of disability prevention programs was estimated to be approx. 10 million yen per year. CONCLUSION: Disability preventive programs for the community-dwelling elderly are economically efficient in terms of the cost/benefit balance. Future research is needed to examine how such programs lead to cost reduction.     

南通市人口老龄化与老年人死因分析和预测

目的分析南通市人口老龄化和老年人死因现状,预测未来变化趋势,为合理制定老年人卫生保健计划提供科学依据。方法用描述流行病学方法对2006-2009年的人口资料和居民死亡资料进行分析,建立灰色预测GM（1,1）模型,对南通市人口老龄化和老年人死因变化趋势进行预测。结果 2006-2009年,南通市平均老年系数为17.63%;预测2013年老年系数将超过20%,2030年将超过30%;≥60岁老年人死亡率为37.17‰;前5位死因依次是循环系统疾病（13.19‰）、恶性肿瘤（8.85‰）、呼吸系统疾病（5.56‰）、损伤和中毒（0.96‰）及消化系统疾病（0.78‰）。结论预测随着人口老龄化的发展,老年人循环系统疾病、恶性肿瘤的死亡率将持续上升。循环系统疾病、恶性肿瘤等疾病是老年人疾病预防与控制工作的重点,社会和政府有关部门应给予高度重视。     

2009-2018年上海市金山区新登记户籍老年肺结核疫情特征分析

目的分析2009-2018年上海市金山区户籍老年人群肺结核流行特征,为针对性防控提供理论依据。方法采用描述性流行病学方法对2009-2018年国家结核病信息管理系统中登记的现住址为金山区的60岁及以上户籍老年肺结核患者特征进行分析,采用SPSS 22.0软件对数据进行统计分析。结果 2009-2018年金山区共登记户籍老年肺结核患者793例,占同期户籍全人群登记病例数的53.33%,且占比整体呈上升趋势(从2009年的46.63%上升到2018年的65.69%);老年肺结核年均登记率为58.48/10万;男性和女性肺结核年均登记率分别为97.21/10万和24.08/10万,男性明显高于女性(X²=309.10,P<0.01),其中男性高峰年龄段在80～84岁,登记率为190.02/10万,女性在75～79岁,登记率为33.29/10万;职业以离退人员(40.23%)和农民(39.34%)为主,街镇分布位居前三位的依次是朱泾镇(19.92%)、枫泾镇(11.10%)和亭林镇(11.10%),患者主要来源于因症就诊(68.98%);老年肺结核患者菌阳病例539...     

老年人健康体检结果分析与健康指导

目的 通过对2011年1～12月60岁以上老年居民的健康体检结果分析,为进一步预防、治疗等提供科学依据.方法 收集1 114例老年人的健康体检资料并进行分析.结果 检出主要疾病从高到低分别是高血压(67.1％)、脂肪肝(51.2％)、高脂血症(46.8％)、高血糖(38.4％).结论 应大力开展健康教育,提高老年人生活质量.     

基于“SHA 2011”的海南省医疗服务费用多维度分析

目的:了解海南省医疗服务费用的总量及不同维度分布情况。方法:以监测点数据为基础,采用"SHA2011"对海南2016年卫生费用进行核算和分析。结果:2016年海南省治疗费用为270.42亿元,治疗费用排前五位疾病是:呼吸系统疾病、循环系统疾病、传染病和寄生虫病、消化系统疾病、精神和行为障碍;60岁及以上老年人治疗费用占比最高;4岁及以下人群人均治疗费用次高;19岁及以下患者在医院就诊治疗费用占比在60%以下,20岁及以上患者随着年龄的加大,医院就诊费用占比在60%~88%之间呈增长态势。结论:提高老年人和婴幼儿的医疗保障水平,提高卫生筹资的公平性;提倡健康的生活方式,提供免费体检,预防疾病的发生;提高传染病的防治能力,保障精神病人的治疗费用;提高基层医疗卫生服务能力。     

邵阳市94例新型冠状病毒肺炎疫情分析及对策

目的 分析邵阳市新型冠状病毒肺炎(简称新冠肺炎)疫情特征,为预防控制新冠肺炎疫情提供相关科学依据。 方法 收集截止2020年2月11日邵阳市新冠肺炎病例相关的人口学、流行病学和临床资料,建立数据库,应用SPSS 18.0进行描述性统计分析。 结果 共报告确诊病例94例,其中家庭聚集性疫情21起,先后出现武汉(或湖北)输入病例和本地续发病例两个高峰。地区分布以邵东市、新邵县和洞口县为主(69.15%)。全人群粗发病率1.28/10万,邵东市最高为4.06/10万。发病年龄最小为8岁,最大为84岁,主要以20~59岁年龄段为主(占79.8%),以武汉(或湖北)旅居史和务工返乡人员为主(占69.15%)。60岁及以上老年人确诊病例的重症(危重症)比例达66.7%(10/15),高于60岁以下年龄组确诊病例的重症(危重症)比(χ²=31.150,P<0.001)。 结论 邵阳市新冠肺炎疫情形势严峻,易发生家庭聚集性疫情,老年人易出现重症。应加强新冠肺炎相关预防控制工作,特别是对60岁以上老年人进行针对性的防护。     

The relation of serum cholesterol to risk of coronary heart disease: implications for the elderly

Elevated cholesterol is a known risk factor for coronary heart disease (CHD) in young and middle-aged persons. Because of the high prevalence of CHD in a growing elderly population, physicians must decide whether to devote clinical attention to this condition in older patients. Longitudinal cohort studies show that while the association between serum cholesterol and CHD decreases after age 55 years, it still persists. Primary prevention trials performed mostly on middle-aged men have reduced the incidence rate of CHD through cholesterol lowering but they have yet to show a reduction in overall mortality. Secondary prevention studies of lipid alteration have reported decreased mortality and slowed progression of coronary stenoses, again in predominantly male subjects aged less than 60 years. Implications of these findings for care of older patients are discussed along with recommendations for clinical management and future research.