卫生费用结构与户籍人口期望寿命的灰色关联度分析——以上海市为例

[目的]探析不同类型卫生费用支出对期望寿命的影响程度及其健康效用,为优化卫生服务资源配置提供参考.[方法]依据2001年以来上海市户籍人口期望寿命及卫生总费用数据,应用灰色关联度分析方法(GRA)探析卫生总费用结构和户籍人口期望寿命之间的关联性并加以排序,用以比较不同类型的卫生费用支出的健康效用.[结果]卫生费用支出对...     

期望寿命相关指标的发展和应用

期望寿命相关指标是目前应用最为广泛的衡量人群总体健康水平或疾病负担的指标之一。随着长期随访的人群队列的增加，越来越多的研究开始探索此类指标的影响因素。本文将就期望寿命相关研究中较常采用的指标及其定义、计算的基本原理和在慢性病流行病学研究中的应用实例进行综述。     

不同死亡评价指标在艾滋病防治中的应用

自艾滋病抗病毒治疗药物出现以来,艾滋病已从致命性疾病转变为可控的慢性传染病。我国自2003年开始实行针对HIV感染者和AIDS患者的免费抗病毒治疗,为进一步评价抗病毒治疗的公共卫生效果,需要采用死亡评价指标。常用的死亡评价指标包括死亡率、病死率、超额死亡率、标化死亡比、潜在减寿年数、伤残调整寿命年和期望寿命。本文总结了国内外在艾滋病防治效果评价时所使用的各种死亡指标,并分别阐述这些指标的应用范围和意义,提出我国今后应在艾滋病防治效果评价中增加期望寿命和疾病负担等方面的研究。     

Drinking water, mortality, and life expectancy: an assessment of the east-west mortality gap in Europe

The role of the drinking water in public health has been recognised for many years. Recent ecological studies of mortality rates in Slovakia when compared to indicators of environmental pollution have shown surprising results--areas with greater air pollution seem to have lower total mortality rates. This paradox may be explained by a number of other factors, including urban/rural occupational conditions, socio-economic status, access to health care, and perhaps drinking water. Overall population access to safe drinking water is about the same between East and West Europe, but more careful evaluation suggest at least one important difference. About 35.7% of the people in Central and Eastern European countries do not have 100% access to safe drinking water in their rural areas, compared to only 18.7% of the rural populations in Western Europe who do not have full access to safe drinking water. This study examines access to safe drinking water, assesses overall drinking water quality, and utilises an index of drinking water quality to perform correlation with total mortality, selected chronic diseases which have been associated with drinking water contamination, and life expectancy at birth. These methods are applied to data for East-West Europe, Slovakia, and detailed urban-rural comparisons for three areas of Slovakia (Trnava, Banská Bystrica, and Kosice).     

医疗机构公共卫生服务质量评估标准设计与实践

医疗机构作为公共卫生服务的重要组成部分,其公共卫生服务质量直接关系到整个地区(或城市)公共卫生服务质量。基于此对医疗机构公共卫生服务质量评估标准进行了探讨。该标准分为一、二、三级指标,内容包括基础质量、过程质量和终末质量。基础质量评价要素包括组织管理、制度建设、基础设施、人员及岗位培训、经费保障及管理等。过程质量评价要素包括突发公共卫生事件报告与处置,传染病报告、监测与管理,预防接种服务,死因监测与管理,慢性非传染性疾病报告与管理,职业病报告与管理,精神疾病报告与管理,医院感染控制与消毒管理,健康教育与促进,妇女儿童保健等。终末质量为上述评价要素的服务效果。根据标准深圳市于2010年对随机抽查的8家医疗机构进行了评估。     

人群健康综合测量——健康期望寿命的发展及应用

健康期望寿命是人群健康综合测量的代表性指标,本文介绍了其产生与发展的历程,总结了健康状态期望寿命与健康调整期望寿命两大类指标的特点：前者为两分或多分型指标,计算简便易于解释和理解;后者为权重调整型指标,在指标设计层面更为科学全面,但测算过程复杂。文章介绍了健康调整期望寿命、健康寿命年等指标在世界卫生组织、欧盟等国际组织及地区的应用现状,分析了各自的优劣及前景,并建议我国未来应重视健康期望寿命的研究和应用。     

Evaluation of the impact of various diseases on mortality

The scarcity of resources within the health sector creates serious allocation problems. If it were legitimate to allocate the available means to the various diseases according to their impact on the length of human life, how should this impact be evaluated? That is the purpose of this study, which compares and evaluates methods for measuring the importance of various diseases from the point of view of their lethal effects and significance for life expectancy.Three methods of evaluation have been used: the percentage of all deaths due to the disease (method A); the gain in life expectancy that would occur if the disease were eradicated as a cause of death (method B); and the change in the ratio between productive and nonproductive groups that would result from eliminating the disease as a cause of death (method C). The analyses are based on the total number of deaths in Denmark in 1969 and 1971. According to (A), one-third of all deaths was caused by heart diseases, one-fourth by cancer, and one-tenth by stroke. The results of method (B) were in agreement with those of method (A); the greatest gain in life expectancy was obtained by eliminating cardiac diseases; cancer ranked second, and accidents third for men and fourth for women. Method (C) yielded contrasting results. The result of eliminating most diseases would be a decrease in the proportion of persons of productive age. This was most distinct for cardiac diseases. The most important exception to this rule was accidents: if these were eliminated, the distribution of the population in the productive and nonproductive age groups would remain stable.     

深圳市公共卫生服务质量整体评估与疾病预防控制绩效评估的比较分析

公共卫生服务质量评估和疾病预防控制绩效评估都是根据公共卫生的职能和目标,从结构、过程、结果等方面对公共卫生系统和机构进行测评,但在研究定位、评估指标、满意度评估等方面存在差异。质量评估侧重于公共卫生服务的过程考核,较为适合当地实际;绩效评估是经过严密设计和科学论证的指标体系,具有很强的理论性和指导性。     

哈尔滨市香坊区1997—2006年居民伤害死亡减寿分析

目的研究伤害对居民寿命的影响。方法用2000年中国人口作标准人口,对1997—2006年哈尔滨市香坊区居民伤害死亡资料进行分析,计算期望寿命、期望寿命损失年数、潜在减寿年数（YPLL）、标准化潜在减寿率（SYPLL%）和平均减寿年数（AYLL）等指标。结果伤害是香坊区居民第5位死亡原因;10年间居民期望寿命存在线性上升趋势（P〈0．05）;伤害所致平均期望寿命损失为0．82年,男性的寿命损失明显高于女性;YPLL最高的伤害死因男女均为交通事故,而AYLL第1位均为淹死。结论伤害与其他疾病相比,导致“早死”的风险更大,已成为严重危害香坊区居民生命健康的重要公共卫生问题,亟需采取有针对性的干预措施加以控制。     

Healthy life expectancy in Hong Kong Special Administrative Region of China

Sullivan's method and a regression model were used to calculate healthy life expectancy (HALE) for men and women in Hong Kong Special Administrative Region (Hong Kong SAR) of China. These methods need estimates of the prevalence and information on disability distributions of 109 diseases and HALE for 191 countries by age, sex and region of the world from the WHO's health assessment of 2000. The population of Hong Kong SAR has one of the highest healthy life expectancies in the world. Sullivan's method gives higher estimates than the classic linear regression method. Although Sullivan's method accurately calculates the influence of disease prevalence within small areas and regions, the regression method can approximate HALE for all economies for which information on life expectancy is available. This paper identifies some problems of the two methods and discusses the accuracy of estimates of HALE that rely on data from the WHO assessment.     

健康期望寿命的指标定义和测算方法研究进展

目的 健康期望寿命（HLE）将预期寿命与健康水平相结合,是各国衡量国民寿命长度和质量的重要综合性指标。本研究采用概括性综述梳理全球HLE的指标定义和测算方法以及实证研究,以期为决策者遴选和发展适合中国国情的HLE指标和算法提供借鉴和参考。方法 检索7个中英文文献数据库,检索时限为建库至2022年5月7日;同时,手动检索综述性文献及其参考文献。纳入HLE指标及测算方法相关的系统评价和实证研究,提取并汇总研究地区、研究类型、研究人群、HLE指标、测算方法、测算数据源和近5年实证研究等内容,梳理HLE的指标定义演变、不同指标适用范围、定义健康的量表,以及HLE的测算方法,总结不同指标测算方法的实证研究结果。研究遵循概括性综述规范实施步骤,文章撰写参考PRSIMA-ScR声明。结果 共纳入文献84篇,其中13篇综述评价,17篇为HLE指标定义的原始研究,10篇为指标测算方法的原始研究,44篇为近5年开展的实证研究。HLE的相关指标多达20种,定义健康的量表各有侧重;不同学者提出10种指标测算方法,根据指标的健康定义、是否设置权重和数据类型而不同。近5年最常用的指标是无残疾期望寿命和不区分具体类型的HLE。对于HLE的测算,横断面数据多使用沙利文法、纵向数据多采用多状态寿命表法。结论 HLE的定义和测算方法多样,尚无公认的最优方法。总结全球范围内的HLE概念、健康评价技术和测算方法以及实证研究,可为我国HLE指标测算的本土化提供借鉴和参考。     

Changing health status and health expectancies among older adults in China: Gender differences from 1992 to 2002

Numerous studies document improvements in health status and health expectancies among older adults over time. However, most evidence is from developed nations and gender differences in health trends are often inconsistent. It remains unknown whether changes in health in developing countries resemble Western trends or whether patterns of health improvement are unique to the country's epidemiologic transition and gender norms. Using two nationally representative samples of non-institutionalized adults in China aged 65 years and older, this study investigates gender differences in the improvements in disability, chronic disease prevalence, and self-rated health from 1992 to 2002. Results from multivariate logistic regression models show that all three indicators of health improved over the 10-year period, with the largest improvement in self-rated health. With the exception of disability, the health of women improved more than men. Using Sullivan's decomposition methods, we also show that active life expectancy, disease-free life expectancy, and healthy life expectancy increased over this decade and were patterned differently according to gender. Overall, the findings demonstrate that China experienced broad health improvements during its early stages of the epidemiologic transition and that these changes were not uniform by gender. We discuss the public health implications of the findings in the context of China's rapidly aging population.     

健康预期寿命指标中的健康概念及其测量研究

健康预期寿命作为健康测量的综合性指标,是在平均预期寿命的基础上进一步识别健康部分和病态(非健康)部分。因此,健康的概念和测量是测量健康预期寿命的核心和关键。现有健康预期寿命领域的研究大致从六个方面对健康进行定义和操作化,包括沙利文的活动限制定义、世界卫生组织的疾病、残疾、损失定义、华盛顿残疾统计团队的残疾定义、Euro-Reves的全球活动限制指数(GALI)定义、日常生活自理能力指数(ADLs和IADLs)定义和自评健康定义。这些健康的概念和操作化各有优势,也都有弊端。在众多指标中,尽管自评健康受自评者对其健康信息了解程度的影响,但是自评健康简单易行,目前在全球范围内使用最为广泛的健康测量指标,能有效反映人群健康,进行健康预测和比较。     

1990—2010 年疾病谱变化对上海市居民期望寿命增长的影响

目的］ 比较上海市1990—2010 年不同时期人群期望寿命变化趋势,探讨疾病谱变化对期望寿命的影响,确定疾病干预的优先领域。 ［方法］ 利用1990—2010 年上海市居民死亡登记系统的死亡数据和上海市公安系统的人口数据,应用简略寿命表法、期望寿命分解法、死因分解法,比较年龄和不同死因对期望寿命的影响。 ［结果］1990—2010 年上海市男性和女性期望寿命分别增加了6.91 岁和6.94 岁,年均增寿均达0.35 岁。65 岁以上老年人口对期望寿命增长的贡献最大,男女分别占增寿总量的52.97%和51.44%。呼吸系统疾病、循环系统疾病和肿瘤死亡率的降低是期望寿命增加的主要原因,他们对男女性期望寿命的贡献分别为2.13 岁和1.98 岁、1.42 岁和1.89 岁、1.35 岁和0.67岁。 ［结论］ 上海市现阶段,居民的死亡大部分是疾病造成,提高人群期望寿命,重点是关注中老年人健康状况。近20年慢性病死亡率虽大幅下降,但仍是上海市主要死因,建立健全慢病防治体系,提高慢性病防治效果,是进一步提高上海市人口健康水平,增加上海市居民期望寿命的有效途径。     

Principles for planning the teaching of dental public health in an MPH course

Dental public health should be presented to MPH students as an integral component in the general promotion of health. Students should be presented with the "dental" component in public health and the "public health" component in dentistry. Dental examples should be utilized to illustrate most of the other disciplines taught in the MPH course. The underlying principals that determine the teaching of dental public health within an MPH course include: the associations between oral and general health; oral health as an integral component in quality of life; basic concepts in the understanding of oral health and disease; the prevalence of oral diseases; oral diseases as a specific characteristic of industrialized-urbanized-developed societies; the methods of measuring dental health in epidemiological surveys; the patterns of changing dental epidemiology around the world; the social component of dental disease; the promotion of oral health as an important, typical, example of successful public health efforts; socio-economic-political aspects of oral health promotion; dental health care delivery systems in different regions; members of the expanded oral health team and the potential of including the general health team; oral health promotion for the geriatric population; specific examples of planning, implementation, monitoring and evaluation of community oral health programs.     

我国疾病预防控制机构绩效考核指标体系简介

疾病预防控制机构绩效考核指标体系反映了各级疾病预防控制机构履行公共职能的条件、能力、过程、结果等,包括疾病预防与控制、突发公共卫生事件处置、信息管理、健康危害因素监测与控制、实验室检验、健康教育与健康促进、技术指导与应用研究、综合指标等8个类别,其中省级机构包括34个项目77个指标,市级机构包括35个项目104个指标,县级机构包括35个项目101个指标。     

去病因健康调整期望寿命——一个新的疾病负担评价指标

利用去死因期望寿命、健康调整期望寿命、失能调整寿命年的原理和计算方法构建了一个全新的疾病负担评价指标--去病因健康调整期望寿命.去病因健康调整期望寿命通过虚拟死亡人数的概念将疾病导致的伤残和死亡结合到一起,从而解决了健康调整期望寿命难于应用于单个疾病的问题.去病因健康调整期望寿命概念上容易理解,在理论上有依据,计算方法上简单可行,不受评价人口的年龄构成影响,更有利于不同疾病、不同人群间疾病负担的比较.     

Mortality of the population in Slovakia: past and present

This contribution presents an analysis of the health status of the Slovakian population using trends in overall mortality, death rates from major diseases, and of other health indicators. The health status of the Slovak population at the beginning of this century as well as at the time of the establishment of Czechoslovakia in 1918 was very bad. This situation is demonstrated by the extremely high infant mortality rate, short life expectancy and enormous mortality from infectious diseases, particularly from tuberculosis. Despite progress before the Second World War, only in the postwar period was the health status comparable with other developed countries of western Europe as there was a rapid improvement of health lasting until the middle of 1960s. This positive evolution resulted mainly from the extensive use of preventive measures against infectious diseases, contributing to the decline of infant mortality and the gradual prolongation of life expectancy. A simultaneous rapid increase of noninfectious, mainly chronic diseases, particularly of cardiovascular diseases and cancer was observed. Attempts to deal with this increase lead only to enlargement of treatment facilities. The whole health policy in prevention, including the pre- and postgradual education of physicians and paramedical personnel, remained in its traditional orientation against infectious diseases. This situation, together with low social and moral standard of the population, increasing consumption of cigarettes, alcohol and inadequate composition and superfluous food led to the rapid deterioration of the health status of the Slovakian population in the past three decades. The orientation of the health policy to the prevention of noninfectious, mainly chronic, degenerative diseases and, above all a change of the attitude of the inhabitants of this country to their own health, present the only way to the substantial and rapid improvement of the health status of the population of Slovakia.     

生命质量评价应用及存在问题分析

传统的健康评价指标如患病率、死亡率及期望寿命等越来越不适应现代人对健康评价和需求。以重视健康主观感受的生命质量评价得到了广泛应用,不仅应用于一般人群和特殊人群,而且还有助于卫生政策的制定和卫生效益的评价。但生命质量评价在我国应用中还存在重视程度不够、应用范围不广、测量手段单一等问题。