解读“健康中国行动”(2019—2030年)——合理膳食行动

<正>引言人民健康是民族昌盛和国家富强的重要标志。党的十八大以来,我国卫生健康事业取得新的显著成绩,医疗卫生服务水平大幅提高,居民主要健康指标总体优于中高收入国家平均水平。随着工业化、城镇化、人口老龄化发展及生态环境、生活行为方式变化,慢性非传染性疾病(以下简称慢性病)已成为居民的主要死亡原因和疾病负担。心脑血管疾病、癌症、慢性呼吸系统疾病、糖尿病等慢性病导致的负担占总疾病负担的     

慢性病防控要高度重视导致慢性病的社会决定因素

改革开放以来,我国卫生事业取得了显著成就,居民健康水平持续改善,主要健康指标接近发达国家水平。当前,我国正处于经济社会的加速转型期,伴随着工业化、城镇化、老龄化进程的加快,以心脑血管疾病、糖尿病、恶性肿瘤、慢性呼吸系统疾病为主的慢性病发病人数快速上升,现有确诊患者2.6亿人,慢性病导致的死亡已经占到我国总死亡的85%,导致的疾病负担已占总疾病     

慢病综合防控效果逐步显现

<正>当前,以心脑血管疾病、癌症和慢性呼吸系统疾病为代表的慢性病已成为我国居民的主要死亡原因。根据最新针对我国居民的监测结果显示,慢性病所导致的疾病负担已占到我国总疾病负担的70%以上,慢性病造成的死亡人数也占到总死亡人数的88%以上。带来这种发病趋势的主要原因有三方面:人口老龄化的加快。危险因素广泛存在。以及随着医疗服务水平提高,老龄人口增加,势必带来慢性病人口的增加。     

四大类主要慢性病流行现状与应对策略

目的 阐述4大类主要慢性病(心脑血管疾病、癌症、慢性呼吸系统疾病以及糖尿病)国内外流行现状,探索适合我国国情的应对策略.方法 检索中外数据库,对4大慢性病的国内外流行病学数据与相关应对策略进行综述探讨.结果 2012全球总死亡人数5600万,慢性病死亡人数占到了全球总死亡人数的68%,4大类慢性病占总死亡人数的55.7%,我国慢性病死亡人数占总死亡人数的86.6%,其中心脑血管疾病、癌症和慢性呼吸系统疾病是主要3大死因,占总死亡的79.4%,远高于全球水平.结论 慢性病已成为威胁人类健康的头号杀手.对慢性病危险因素的综合干预是防治重点.应重视对老年慢性病人群的照料,实现医养结合,老有所医、老有所养.     

农村社区的慢性病健康教育

慢性病已经对全世界人群的生活和健康带来了巨大的影响。根据对 1998年全球疾病负担的估计 ,4 3%归结为慢性病所致 ,而中国已经达到了 6 0 %。慢性病是中国人群的主要死因 ,慢性病的死亡占总死亡的 82 .4 % 〔1〕。因此 ,疾病的预防与控制工作应向慢性病防治做战略重点转移。1　农村慢性病防治必须以健康教育为重要手段1.1　慢性病是生活行为方式病　慢性病又称“富裕病”,主要包括心脑血管病、慢性呼吸道疾病和肿瘤等 ,其发病的主要危险因素是不健康的生活方式 ,主要包括吸烟、酗酒、静坐生活方式、高脂、高盐饮食、超重和肥胖等。预防慢性…     

我国慢性病与疾病负担的国际比较

目的 研究我国慢性非传染性疾病（NCD）导致的主要死亡原因和健康寿命损失年,与相关国家比较发现我国主要慢性病的危害程度与疾病负担特点.方法 根据世界卫生组织发布的各国因病（伤害）的死亡人数、死亡率、标准化死亡率、健康寿命损失年、每10万人健康寿命损失年、每10万人年龄标准化健康寿命损失年,按传染性疾病、慢性非传染性疾病、伤害进行大类分类,按疾病（伤害）类别进行中级分类,按病种进行小类分类后按照类别,选用R2.15分析软件绘图比较.结果 我国慢性病疾病死亡的绝对数每年约737.6万人,健康寿命损失1.41亿年,年龄标化死亡率627人/10万人,年龄标准化健康寿命损失10 829年/10万人.因慢性病导致的死亡占全死因死亡数的79.4％,健康寿命损失年占全死因健康寿命损失年的70.3％.结论 我国慢性病死亡率与健康寿命损失前三位分别为心血管疾病、恶性肿瘤、呼吸系统疾病与神经精神疾病、心血管疾病、感官疾病.在中国、英国、美国、加拿大、日本、韩国、印度7个国家中,我国疾病负担仅次于印度,其中食管癌、慢性阻塞性肺疾病的健康寿命损失为世界平均水平的6倍、2倍,糖尿病患病人数增长速度居世界前列.     

我国慢性病防治工作进展情况

影响我国人民群众身体健康的慢性病主要有心脑血管疾病、恶性肿瘤、糖尿病、慢性呼吸系统疾病等。近年来,随着工业化、城镇化、老龄化进程加快,慢性病患病、死亡呈现持续、快速增长趋势,目前确诊的慢性:病患者已超过2.6亿人,因慢性病死亡占我国居民总死亡的构成已上升至85%。当前我国已经进入慢性病的高负担期,具有"患病人数多、医疗成本高、患病时间长、服务需求大"的特点,慢性病在疾病负担中所占比重达到了70%。慢性病已     

加强早期健康损害研究预防环境相关疾病

慢性病主要包括心脑血管疾病、恶性肿瘤、糖尿病、慢性阻塞性肺部疾病、精神心理性疾病等,其中大多数是环境相关性疾病.随着社会经济的发展与转型,我国人群的疾病谱及死因构成已发生显著的变化,其疾病模式正在从以罹患营养不良和传染病为主向以罹患慢性病为主转变.慢性病已成为国民健康的头号杀手,严重制约了国民经济的可持续发展.有数据显示,慢性病占我国公民总死亡数的80.0％[1]和疾病负担(残疾调整生命年损失)的68.6％[2].     

宁波市慢性病防控综合管理模式的实践与探讨

1背景1.1慢性病防控形势日趋严峻近年来,宁波市伴随着快速工业化、城镇化,人口老龄化,以及随之而来的生产、生活方式的快速变化,慢性病发病人数快速上升。据宁波市疾病预防控制中心慢性病监测数据显示,2013年死亡的3.7万人中,肿瘤、循环系统病(主要为脑血管病和心脏病)、慢性呼吸系统疾病成为慢性病死亡的前三位死因。慢性病导致的死亡已占到总死亡的82%。宁波市慢性病在疾病负担中所占比重达     

慢性非传染性疾病预防控制能力评估研究进展

目前,我国居民死因构成中,恶性肿瘤、心脏病、脑血管疾病和慢性呼吸系统疾病位列前4位[1].慢性非传染性疾病(简称慢性病)占我国居民死因构成比由2005年的80%[2]上升到2008年的82.5%[3],由于慢性病的病程长且病情多迁延不愈,巨大的直接经济成本和劳动力丧失导致的间接经济成本必将给个人、家庭和整个社会带来沉重的负担,影响社会经济的健康发展[4].     

慢性病研究方法的发展与趋势

慢性病作为中国重大公共卫生问题之一,对国民健康和社会经济均造成了较大负担.在国民预防保健意识逐渐增强且健康生活方式不断变化的新时代背景下,探寻慢性病研究的新路径与新方向具有重要意义.本文通过梳理国内慢病研究现状,并结合当前形势,提出了新时代下对慢性病研究的新思考.     

The environmental burden of disease in Canada: respiratory disease, cardiovascular disease, cancer, and congenital affliction

BACKGROUND: Exposure to environmental hazards contributes to many chronic diseases, yet the magnitude of their contribution to the total disease burden in Canada is not well understood. OBJECTIVES: To estimate the environmental burden of disease (EBD) in Canada for respiratory disease, cardiovascular disease, cancer, and congenital affliction. Quantifying the contribution of environmental exposures to the overall burden of disease could play an important role in shaping public health and environmental policy priorities. METHODS: The World Health Organization (WHO) recently estimated the environmental burden of disease globally by using a combination of comparative risk assessment data and expert judgment to develop environmentally attributable fractions (EAFs) of mortality and morbidity for 85 categories of disease. We use the EAFs developed by the WHO, EAFs developed by other researchers, and data from Canadian public health institutions to provide an initial estimate of the environmental burden of disease in Canada for four major categories of disease. RESULTS: Our results indicate that: 10,000-25,000 deaths; 78,000-194,000 hospitalizations; 600,000-1.5 million days spent in hospital; 1.1 million-1.8 million restricted activity days for asthma sufferers; 8000-24,000 new cases of cancer; 500-2500 low birth weight babies; and between $3.6 billion and $9.1 billion in costs occur in Canada each year due to respiratory disease, cardiovascular illness, cancer, and congenital affliction associated with adverse environmental exposures. CONCLUSIONS: The burden of illness in Canada resulting from adverse environmental exposures is significant. Stronger efforts to prevent adverse environmental exposures are warranted, including research, education, and regulation.     

关于当前我国慢性病防治工作的思考

慢性病已经成为我国居民健康的头号威胁,慢性病死亡占到我国总死亡构成的85%以上。尽管政府的重视和多年的经验为我国慢性病防控提供了一定条件,但缺乏多部门合作机制和宏观政策突破,经费匮乏特别是预防性投入不足成为慢性病防控的重要挑战。因此,迫切需要建立多学科、多部门的慢性病应对体系;增加慢性病防治投入,调整卫生支出结构;提高卫生系统慢性病防治的能力;开发公共政策,形成慢性病防治的社会氛围。     

安徽省重大慢性非传染性疾病早死概率趋势预测及影响因素探索

目的 分析及预测未来安徽省重大慢性非传染性疾病（慢性病）早死概率变化趋势,评估2030年目标达成情况,探索其影响因素。方法 利用安徽省死因监测、统计年鉴等资料,采用时间序列累计和数据对数线性Joinpoint回归、主成分回归等方法进行趋势预测及影响因素分析。结果 安徽省总死亡中有28.10%为早死,其中84.40%归因于慢性病。恶性肿瘤和心血管疾病在慢性病早死中分别占45.88%和41.65%。预测显示,未来安徽省重大慢性病早死概率呈下降趋势,到2030年仅农村地区能达到“健康中国2030”规划目标。为降低早死,需重点关注恶性肿瘤和心血管疾病,城市男性为重点关注人群。人均园林绿地面积等反映城市基础设施情况的因素对重大慢性病早死概率影响较大。PM_2.5浓度等因素对早死概率有负面影响,人均园林绿地面积等因素则有积极影响。结论 安徽省面临恶性肿瘤等重大慢性病疾病负担,城市男性是需重点关注群体。     

Indoor air pollution in developing countries: a major environmental and public health challenge

Around 50% of people, almost all in developing countries, rely on coal and biomass in the form of wood, dung and crop residues for domestic energy. These materials are typically burnt in simple stoves with very incomplete combustion. Consequently, women and young children are exposed to high levels of indoor air pollution every day. There is consistent evidence that indoor air pollution increases the risk of chronic obstructive pulmonary disease and of acute respiratory infections in childhood, the most important cause of death among children under 5 years of age in developing countries. Evidence also exists of associations with low birth weight, increased infant and perinatal mortality, pulmonary tuberculosis, nasopharyngeal and laryngeal cancer, cataract, and, specifically in respect of the use of coal, with lung cancer. Conflicting evidence exists with regard to asthma. All studies are observational and very few have measured exposure directly, while a substantial proportion have not dealt with confounding. As a result, risk estimates are poorly quantified and may be biased. Exposure to indoor air pollution may be responsible for nearly 2 million excess deaths in developing countries and for some 4% of the global burden of disease. Indoor air pollution is a major global public health threat requiring greatly increased efforts in the areas of research and policy-making. Research on its health effects should be strengthened, particularly in relation to tuberculosis and acute lower respiratory infections. A more systematic approach to the development and evaluation of interventions is desirable, with clearer recognition of the interrelationships between poverty and dependence on polluting fuels.     

2010—2019年中国居民四类慢性非传染病的死亡趋势及差别分解分析

目的 分析2010—2019年我国居民4类主要慢性病（恶性肿瘤、糖尿病、心血管疾病和呼吸系统疾病）的死亡率变化趋势及影响其变化的因素。方法 数据来自全国疾病监测系统死亡数据资料,运用Joinpoint模型计算死亡率的年度平均变化百分比（AAPC）和年度变化百分比（APC）,并用死亡率差别分解法解释该趋势变化的影响因素。结果 2010—2019年我国居民四种慢性病的粗死亡率由456.22/10万上升至556.00/10万,标化死亡率由541.40/10万降至419.83/10万。死亡率变化是人口构成和其它危险因素共同作用的结果,其中人口构成因素促进了恶性肿瘤、糖尿病、心血管疾病和呼吸系统疾病死亡率的上升,贡献值分别48.52/10万、5.12/10万、135.28/10万、38.39/10万;其它危险因素促进糖尿病死亡率上升,而驱使另3种慢性病死亡率下降,贡献值分别- 23.11/10万、1.27/10万、- 55.87/10万、- 49.83/10万。结论 我国综合防控重大慢性病造成的死亡取得一定成效,但与此同时随着老龄化加剧,上述疾病依然是引发死亡的主要原因,卫生健康事业发展面临严峻挑战。     

The burden of disease from indoor air pollution in developing countries: comparison of estimates

Four different methods have been applied to estimate the burden of disease due to indoor air pollution from household solid fuel use in developing countries (LDCs). The largest number of estimates involves applying exposure-response information from urban ambient air pollution studies to estimate indoor exposure concentrations of particulate air pollution. Another approach is to construct child survival curves using the results of large-scale household surveys, as has been done for India. A third approach involves cross-national analyses of child survival and household fuel use. The fourth method, referred to as the 'fuel-based' approach, which is explored in more depth here, involves applying relative risk estimates from epidemiological studies that use exposure surrogates, such as fuel type, to estimates of household solid fuel use to determine population attributable fractions by disease and age group. With this method and conservative assumptions about relative risks, 4-5 percent of the global LDC totals for both deaths and DALYs (disability adjusted life years) from acute respiratory infections, chronic obstructive pulmonary disease, tuberculosis, asthma, lung cancer, ischaemic heart disease, and blindness can be attributed to solid fuel use in developing countries. Acute respiratory infections in children under five years of age are the largest single category of deaths (64%) and DALYs (81%) from indoor air pollution, apparently being responsible globally for about 1.2 million premature deaths annually in the early 1990s.     

The optics of noncommunicable diseases: from lifestyle to environmental toxicity

Until recently, the noncommunicable disease (NCD) category was composed of four chronic diseases (cancer, cardiovascular disease, diabetes and chronic respiratory disease) and four shared, ‘modifiable’ behavioural risk factors (smoking, diet, physical activity and alcohol). In late 2018, the NCD category was expanded to include mental health as an additional disease outcome and air pollution as an explicit environmental risk factor. The newly-expanded NCD category connects behavioural and environmental readings of risk and shifts attention from individual acts of consumption to unequal and inescapable conditions of environmental exposure. It thus renders the increasing ‘toxicity’ of everyday life amid ubiquitous environmental contamination a new conceptual and empirical concern for NCD research. It also, as this paper explores, signals a new ‘optics’ of a much-maligned disease category. This is particularly significant as chronic disease research has long been siloed between public and environmental health, with each discipline operationalising the notion of the ‘environment’ as a source of disease causation in contrasting ways. Given this, this paper is positioned as a significant contribution to both research on NCDs and environmental risk, bringing these interdisciplinary domains into a new critical conversation around the concept of toxicity.     

健康管理背景下慢性病社会问题

我国社会进程的急速变迁使得居民的疾病模式以及健康行为均发生了较大的转变,各种疾病的危险因素不断增加导致慢性病发病率不断上升,同时也使得慢性病危险度有所增加,目前我国慢性病发病出现了逐渐年轻化趋势,疾病对患者的危害也在不断加剧,不仅影响患者的生理、心理健康,还会导致其生活质量下降,同时还可能加重患者的家庭负担和社会负担,因此开展慢性病相关研究具有十分重要的现实意义和理论意义。该文以健康管理为背景,对慢性病健康管理构建中的社会问题和文化意义进行了梳理,以明确健康管理在社会经济发展以及人生进程中的作用和意义,以加强民众对慢性病防治的了解,提升慢性病管理质量,改善慢性病患者的病情和生活质量,同时也为慢性病防治提供新种学术依据。