安徽省2013—2014年全国疾病监测系统死因监测数据质量评价

目的分析2017—2019年上海市崇明区某社区户籍居民死亡水平、死因构成及变化趋势,为制订疾病预防控制策略提供科学依据。方法收集2017年1月1日至2019年12月31日期间该社区户籍人口死亡监测数据,按照《国际疾病分类第10版》（ICD-10）进行死因编码,再通过描述性流行病学方法,分析此3年期间的人口死亡情况。结果2017—2019年的粗死亡率分别为816.32/10万、825.01/10万、770.16/10万,年均死亡率为803.82/10万。年均前4位顺位死因分别为肿瘤、循环系统疾病、呼吸系统疾病、损伤和中毒外部原因。各年男性死亡率高于女性。结论影响该社区居民死亡的原因主要是慢性非传染性疾病,损伤和中毒外部原因也占很大比例。各部门需采取有针对性的健康教育措施,减少慢性病的发病和死亡,提高人群健康水平。     

Childhood housing conditions and later mortality in the Boyd Orr cohort

STUDY OBJECTIVES: To examine associations between five measures of housing conditions during childhood and subsequent mortality from all causes, coronary heart disease, stroke, and cancer. DESIGN: Historical cohort study. SETTING: Data on housing conditions were collected from survey centres in 16 areas of England and Scotland. PARTICIPANTS: Children of families participating in the Carnegie Survey of Family Diet and Health in pre-war Britain (1937-1939). Analyses are based on a subset of 4168 people who were traced and alive on 1 January 1948. MAIN RESULTS: Poorer housing conditions were generally associated with increased adult mortality. After adjustment for childhood and adult socioeconomic factors, statistically significant associations were only found between lack of private indoor tapped water supply and increased mortality from coronary heart disease (hazard ratio 1.73, (95% CI 1.13, 2.64); and between poor ventilation and overall mortality (hazard ratio for people from households with poorest ventilation relative to best ventilation 1.30, 95% CI 0.97, 1.74). CONCLUSIONS: This study provides evidence that associations between housing conditions in childhood and mortality from common diseases in adulthood are not strong, but are in some respects distinguishable from those of social deprivation.     

上海市男性饮酒与死亡关系的前瞻性研究

目的　探讨饮酒与上海市市区中老年男性死亡的关系。方法　自 1986年 1月～ 1989年 9月调查上海市区 4 5～ 6 4岁男性居民 182 4 4人 ,每年上门随访一次 ;用COX比例风险模型计算相对危险度。结果　至 2 0 0 2年度随访结束 ,全队列共随访 2 35 76 2人年 ,人均随访 12 .9年。在此期间共死亡 336 5人 ,其中恶性肿瘤死亡 1381人。在调整年龄、吸烟情况及教育程度后 ,相对于不饮酒者每天饮酒酒精量 <15 g和 15～ 2 9g者总死亡相对危险度 (RR)分别为 0 .80 (95 %CI:0 .72～ 0 .89)和 0 .87(95 %CI :0 .78～ 0 .97) ,每天饮酒酒精量 90 g及以上者RR为 1.2 5 (95 %CI:1.0 4～ 1.5 1)。少量饮酒者缺血性心脏病和慢性阻塞性肺部疾病死亡危险性显著降低。每天饮酒酒精量 70 g及以上者食管癌、结直肠癌、脑血管病死亡危险性显著升高 ,RR分别为 5 .0 8,2 .5 7和 1.5 7,肝硬化死亡危险性在每天饮酒酒精量 30 g及以上者中也显著上升 ,RR为 1.89。 结论　少量饮酒会降低中老年男性总死亡危险性 ,大量饮酒则会增加中老年男性食管癌、结直肠癌、脑血管病及肝硬化的死亡危险性。     

运动处方对社区老年人心理疾病干预效果分析

目的：观察运动处方对社区老年人心理疾病的干预作用效果。方法：选取2010年3月-2013年3月社区老年心理疾病患者85例,随机分为干预组43例及对照组42例。两组患者治疗8周后,采用SCL-90量表、汉密顿焦虑量表（HAMD）评分和SF-36量表对两组患者治疗前后各指标进行评价。结果：干预组干预前后各项得分比较,差异有统计学意义（P〈0.05）;而对照组各项得分差异无统计学意义（P〉0.05）。两组干预后各项得分比较,差异有统计学意义（P〈0.05）。干预组患者干预前后HAMD评分比较,差异有统计学意义（P〈0.05）;干预后两组比较,差异有统计学意义（P〈0.05）;对照组干预前后比较,差异无统计学意义（P〉0.05）。干预组患者干预前后SF-36量表评分比较,差异有统计学意义（P〈0.05）;干预后两组比较,差异有统计学意义（P〈0.05）;对照组治疗前后比较,差异无统计学意义（P〉0.05）。结论：对社区老年心理疾病患者进行运功处方干预,可以改善患者的焦虑、抑郁等不良情绪,并提高患者生活质量。     

Socioeconomic inequalities and infant mortality of 46,470 preterm infants born in Sweden between 1992 and 2006

Studies on possible sociodemographic inequities in the survival of preterm infants are scarce. Individual and neighbourhood sociodemographic factors are related to preterm birth and to infant mortality in full-term infants. The aim here was to examine whether infant mortality in Swedish preterm infants is related to individual and neighbourhood sociodemographic factors, and to study whether the hypothesised association between neighbourhood deprivation and infant mortality persists after accounting for individual sociodemographic factors. The study included 46,470 infants with a gestational length of <37 weeks, born in Sweden between 1992 and 2006. Neighbourhood deprivation was assessed by an index (education, income, unemployment, welfare assistance) in small geographical units, and categorised into low, moderate and high deprivation. Adjusted odds ratios for infant mortality were examined in relation to individual and neighbourhood sociodemographic factors. After adjusting for maternal age, infant mortality was associated with the following sociodemographic variables: maternal non-married/non-cohabiting status, low family income, low maternal education and rural status. After full adjustment, the odds ratio [95% confidence interval] was 2.98 [2.42, 3.67] for low family income compared with high family income. An increase in infant mortality was also associated with high neighbourhood deprivation; however, this increased risk no longer remained statistically significant after adjusting for individual sociodemographic factors. In conclusion, this study showed an increased infant mortality in preterm infants born to women with a less favourable sociodemographic profile.     

Airborne infectious diseases during infancy and mortality in later life in southern Sweden, 1766-1894

BACKGROUND: The importance of early life conditions and current conditions for mortality in later life was assessed using historical data from four rural parishes in southern Sweden. Both demographic and economic data are valid. METHODS: Longitudinal demographic and socioeconomic data for individuals and household socioeconomic data from parish registers were combined with local area data on food costs and disease load using a Cox regression framework to analyse the 55-80 year age group mortality (number of deaths = 1398). RESULTS: In a previous paper, the disease load experienced during the birth year, measured as the infant mortality rate, was strongly associated with old-age mortality, particularly the outcome of airborne infectious diseases. In the present paper, this impact persisted after controlling for variations in food prices during pregnancy and the birth year, and the disease load on mothers during pregnancy. The impact on mortality in later life stems from both the short-term cycles and the long-term decline in infant mortality. An asymmetrical effect and strong threshold effects were found for the cycles. Years with very high infant mortality, dominated by smallpox and whooping cough, had a strong impact, while modest changes had almost no impact at all. The effects of the disease load during the year of birth were particularly strong for children born during the winter and summer. Children severely exposed to airborne infectious diseases during their birth year had a much higher risk of dying of airborne infectious diseases in their old age. CONCLUSIONS: This study suggests that exposure to airborne infectious diseases during the first year of life increases mortality at ages 55-80.     

Exogenous determinants of early-life conditions,and mortality later in life

We analyze causal effects of conditions early in life on the individual mortality rate later in life. Conditions early in life are captured by transitory features of the macro-environment around birth, notably the state of the business cycle around birth, but also food price deviations, weather indicators, and demographic indicators. We argue that these features can only affect high-age mortality by way of the individual early-life conditions. Moreover, they are exogenous from the individual point of view, which is a methodological advantage compared to the use of unique characteristics of the newborn individual or his or her family or household as early-life indicators. We collected national annual time-series data on the above-mentioned indicators, and we combine these to the individual data records from the Danish Twin Registry covering births in 1873–1906. The empirical analyses (mostly based on the estimation of duration models) indicate a significant negative causal effect of economic conditions early in life on individual mortality rates at higher ages. If the national economic performance in the year of birth exceeds its trend value (i.e., if the business cycle is favorable) then the mortality rate later in life is lower. The implied effect on the median lifetime of those who survive until age 35 is about 10 months. A systematic empirical exploration of all macro-indicators reveals that economic conditions in the first years after birth also affect mortality rates later in life.     

无锡市气温对非意外死亡及寿命损失年影响的时间序列分析

目的 了解无锡市气温在不同滞后日对非意外死亡(A00-R99)人数及寿命损失年的影响。 方法 收集无锡市区(2012-2017年)非意外死亡与气象数据资料,利用分布滞后非线性模型研究气温与非意外死亡人数及寿命损失年的关系,分析低温、高温在不同滞后日期对非意外死亡的累积效应。 结果 无锡市日均气温对非意外死亡效应曲线为"V"形,冷效应具有延迟性,在滞后3 d开始出现并持续14 d,热效应表现为急性效应,当天就出现。低温对人群总效应大于高温;不同年龄、性别对冷、热效应敏感性存在差异。 结论 低温和高温均可增加非意外死亡风险,冷效应起效慢且持续时间长,热效应急促,低温对人群影响更大。     

Reexamination of a meta-analysis of the effect of antioxidant supplementation on mortality and health in randomized trials

A recent meta-analysis of selected randomized clinical trials (RCTs), in which population groups of differing ages and health status were supplemented with various doses of β-carotene, vitamin A, and/or vitamin E, found that these interventions increased all-cause mortality. However, this meta-analysis did not consider the rationale of the constituent RCTs for antioxidant supplementation, none of which included mortality as a primary outcome. As the rationale for these trials was to test the hypothesis of a potential benefit of antioxidant supplementation, an alternative approach to a systematic evaluation of these RCTs would be to evaluate this outcome relative to the putative risk of greater total mortality. Thus, we examined these data based on the primary outcome of the 66 RCTs included in the meta-analysis via a decision analysis to identify whether the results provided a positive (i.e., benefit), null or negative (i.e., harm) outcome. Our evaluation indicated that of these RCTs, 24 had a positive outcome, 39 had a null outcome, and 3 had a negative outcome. We further categorized these interventions as primary (risk reduction in healthy populations) or secondary (slowing pathogenesis or preventing recurrent events and/or cause-specific mortality) prevention or therapeutic (treatment to improve quality of life, limit complications, and/or provide rehabilitation) studies, and determined positive outcomes in 8 of 20 primary prevention studies, 10 of 34 secondary prevention studies, and 6 out of 16 therapeutic studies. Seven of the eight RCTs with a positive outcome in primary prevention included participants in a population where malnutrition is frequently described. These results suggest that analyses of potential risks from antioxidant supplementation should be placed in the context of a benefit/risk ratio.     

Does psychological distress contribute to racial and socioeconomic disparities in mortality?

Being black or poor are powerful predictors of mortality. Although psychological distress has been proposed as mediating the effects of race and socioeconomic status on mortality, this hypothesis has not been previously directly tested. We used data from the National Health and Nutrition Examination I (NHANES I), a nationally representative sample from the U.S, and the NHANES I Epidemiological Follow-up Survey (NHEFS) of subsequent mortality to test this hypothesis.Both black race and lower family income were associated with significantly higher psychological distress as measured at the time of the initial survey by reports of hopelessness, depression, and life dissatisfaction. Black race and low income in addition to each of the measures of psychological distress were associated with higher mortality at follow-up. In a series of Cox proportional hazards models that controlled for the effects of age and gender, additional adjustment for hopelessness, depression, or life dissatisfaction had little effect on the relationship between either African American race or family income and subsequent all-cause mortality. We conclude that the effects of both race and income on mortality are largely independent of psychological distress. These findings do not support the hypothesis that psychological distress is a significant mediator of the effects of race or class on health.     

山东省心脑血管疾病死亡状况和潜在减寿年数监测结果分析

目的 探索山东省心脑血管疾病死亡的特点,为开展有针对性的预防和干预措施提供科学依据。方法 采用粗死亡率、标化死亡率、潜在减寿年数(potential years of life lost,PYLL)、平均减寿年数(average years of life lost,AYLL)等指标对山东省全人群死因监测点2007－2013年居民心脑血管疾病的死亡资料进行分析。利用ArcGIS软件呈现山东省心脑血管疾病死亡率的地域分布。结果 2007－2013年山东省居民监测点心脑血管疾病死亡率由2007年的252.42/10万上升至2013年的323.48/10万,心脑血管疾病死亡率有上升趋势,各年份间、性别间差异均有统计学意义;心脑血管疾病死亡率随年龄增长呈上升趋势,从65～岁年龄组开始明显升高;心脑血管疾病的PYLL和AYLL均呈波动性上升趋势且男性的PYLL、AYLL和女性相比差异有统计学意义(Z_PYLL=5.79,P<0.05;Z_AYLL=5.68,P<0.05)。山东省西北和中部地区心脑血管疾病死亡率较高。结论 2007－2013年山东省心脑血管疾病死亡率呈波动性上升趋势,且具有年龄、地域等相关性,严重影响山东省居民健康。     

Effect of healthcare on mortality: trends in avoidable mortality in Australia and comparisons with Western Europe

OBJECTIVES: Using the concept of avoidable mortality, international studies suggest that healthcare has been effective in reducing mortality. This paper provides an analysis of avoidable mortality in Australia and compares trends with those of Western Europe. METHODS: Using unit-record mortality data, we calculated avoidable mortality rates in Australia for 1968-2001. We partitioned avoidable causes into three categories: those amenable to medical care; those mainly responsive to health policy; and ischaemic heart disease. We used Poisson regression to model the trends. We compared trends with those of nine European countries using published data. RESULTS: Total avoidable death rates fell by 68% in females and 72% in males. The corresponding non-avoidable death rates fell by 35 and 33%. The annual declines in avoidable mortality rates were: 3.47% [95% confidence intervals (CI) 3.44-3.50%] in males and 3.89% (95% CI 3.86-3.91%) in females. For non-avoidable mortality rates, the annual declines were 1.09% (95% CI 1.05-1.13%) and 0.95% (95% CI 0.92-0.98%), respectively. In females, declines in death rates from causes amenable to medical care contributed 54% to the decline in avoidable mortality rates, ischaemic heart disease contributed 45%, and causes responsive to health policy intervention contributed 1%. In males, the corresponding contributions were 32, 57 and 11%. These rates, and the declines between 1980 and 1998, were comparable with selected European countries, with Australia's ranking improving over the period. CONCLUSION: Trends in avoidable mortality in Australia suggest that the Australian healthcare system has been effective in improving population health. Australia's experience compares favourably with that of Europe.     

Tobacco- and alcohol-attributable mortality and years of potential life lost in Germany

AIM: To compare the ages of death caused by tobacco smoking and alcohol risk drinking. METHODS: Smoking rates from the largest population survey, alcohol drinking data from the National Health Survey and data from the vital statistics from Germany are used and attributable fractions computed. RESULTS: Alcohol-attributable deaths occurred at the youngest age, followed by tobacco- plus alcohol-attributable cases, whereas death cases attributable to tobacco smoking only occur latest. CONCLUSION: The overlap in the two substance-use behaviours has to be taken into account when considering attributable mortality data.     

中国婴儿死亡率和期望寿命的地区差异性研究

目的:以我国(大陆地区)各省市的婴儿死亡率和期望寿命为分析指标,以收敛性模型为分析工具,分析地区差异性的收敛特征。方法 :采用σ收敛(研究对象的标准差随时间逐步变小)和β收敛(发展初始水平较低的经济体比初始水平较高的经济体有更高的增长率)模型进行分析。结果 :婴儿死亡率显示了σ收敛趋势,而期望寿命的σ收敛变化则显示了不同时间分段内收敛趋势情况不同的现象,两个指标皆呈现β收敛,表明了我国婴儿死亡率和期望寿命地区差异性逐步缩小。结论 :建议长期观测各项卫生服务指标在全国各地的开展情况,考察变化趋势,促进人群健康的地区公平性。     

The mortality effects of changing public funding for home health care: An empirical analysis of Medicare home health care in the United States

In light of population aging, it is important to understand whether limiting public in‐kind transfers to the elderly affects elderly mortality. I focus on home health care—a popular in‐kind transfer—and I exploit variation in the Medicare home health care reimbursement that arose in 1997 in the United States to study whether cuts to government coverage of home health care affected elderly mortality. Under the identifying assumptions of the DID model, I find that the cuts affected total mortality for some men but not women, suggesting that changes in home health care can affect elderly mortality and differences in mortality between men and women. For men aged between 65 and 74, the Interim Payment System was associated with an increase in mortality equal to 0.6%, an effect in absolute value comparable to the mortality response to a one percentage point change in unemployment rates and within the range of other estimates of the impact of health insurance on elderly mortality.     

流动人口传染病社区综合防治效果观察

目的了解我区流动人口传染病社区综合防治效果,为提高流动人口健康水平寻找对策。方法采用自制的问卷调查表及传染病上报信息,对随机抽取的某小区1021位流动人员进行跟踪观察。结果流动人口传染病知识知晓率显著提高,卫生习惯明显改善,传染病发病率下降52．46％。结论依托社区综合防治开展流动人口传染病管理是降低传染病发病率,提高区域整体防病水平的有效措施。     

我国慢性非传染性疾病社区综合防治模式

慢性非传染性疾病已成为危害我国人民健康的重大公共卫生问题。预防和控制策略是以社区为基础，以健康教育和健康促进为主要手段，针对共同危险因素，在全人群和目标人群中开展慢性非传染性疾病综合防治。     

Smoking attributable mortality in the community of Madrid: 1992-1998

Background: The proportion of smokers and the number of cigarettesconsumed per person-year in Madrid is above the European average.To evaluate the impact of smoking in public health smoking attributablemortality was estimated for 1998 and for changes since 1992.Methods: The number of smoking attributable deaths and yearsof potential life lost attributable to cigarette smoking for1992 and 1998 by gender and age group were estimated, basedon the population attributable fraction. The relative risksof the Cancer Prevention Study II were used. To compare thetwo periods of study, a Poisson regression analysis adjustedby age was applied. Results: In 1998, 15.9% of total mortalityin the population older than 34 years was attributable to smoking.Lung cancer and chronic obstructive pulmonary disease are themain causes of death in both genders. In the period studied,1992–1998, the adjusted rates diminished in men in bothage groups, while in women they increased in the age group 35to 64 years. The mortality from lung cancer remained stablein men, increasing in women by 12%. The years of potential lifelost decreased by 14% in men and increased by 42% in women.Conclusions: One in four deaths in men and one in 36 deathsin women are attributed to cigarette smoking. The smoking attributablemortality in males has tended to stabilize, while in women prematuremortality is increasing. Key points

• Smoking attributable mortality was estimated for 1998 and forchanges since 1992 to evaluate the impact of smoking in thepopulation older than 34 years.

MAIN RESULTS

• In the period studied, 1992–1998, the adjusted mortalityrates attributable to smoking diminished in men, while in womenthey increased in the age group 35 to 64 years.
• The main causesof Smoking attributable mortality are Lung cancerand chronicobstructive pulmonary disease in both genders. Themortalityfrom lung cancer remained stable in men, increasingin womenby 12%.

IMPLICATIONS FOR PUBLIC HEALTH

• In the Community of Madrid, health promotion programmes to reducecigarette smoking need to be intensified, specially in women