慢性乙肝、乙肝后肝硬化和肝癌的疾病负担

目的：分析慢性乙型肝炎、乙肝后肝硬化和肝癌病人的疾病负担。方法：采用失能调整寿命年指标测量慢性乙肝、肝硬化和肝癌病人的疾病负担。结果：在所研究人群中，病人一生损失的健康寿命年，慢性乙肝为男10.94、女13.38，肝硬化为男20.53、女16.32，肝癌为男17.78、女15.19。结论：慢性乙肝、肝硬化和肝癌病人不仅因失能和早逝导致健康寿命年的损失，而且由于疾病对劳动力的严重影响也给社会带来沉重的负担。     

汉中市农村脑卒中患者失能调整生命年的研究

目的了解脑卒中造成农村人口的疾病负担,为促进我国脑卒中疾病负担的研究及今后卫生资源的合理配置提供参考;同时简化失能调整生命年(DALY)运算中失能的评估方式。方法整群抽样,采用自行设计的问卷,入户调查,调查脑卒中全部现患患者164人。问卷内容主要包括一般情况和失能的评估。结果汉中市农村脑卒中患者DALY为598.88 a,其中因死亡损失了471.05 a,失能损失了127.83 a,患者平均损失3.65个DALYs,汉中市农村人口每千人损失8.0个DALYs;以70~74岁年龄组损失最多;失能损失中,以65~69岁年龄组为最多,死亡的损失中,以55~59岁年龄组为最多,按性别分组后,男性损失343.26个DALYs,女性损失255.62个DALYs,分别占总损失的57.3%和42.7%。男性以55~59岁年龄组损失最多,女性以65~69岁年龄组损失最多。40~44岁年龄组的每个患者平均损失数最多,按残疾期限分组后,残疾1~4 a的损失DALY最多。将患者按照失能程度分组,存活的患者中,失能程度0.01~0.10的人数最多,失能程度0.51~0.60的DALY最多,失能程度0.51~0.60的人均DALY最多,达2.78个DALYs。结论脑卒中对我国造成的疾病负担高于发达国家,一方面可能由于我国脑卒中发病率和死亡率比较高,另一方面可能由于DALY本身的缺陷导致我国疾病负担的高估。     

恶性肿瘤病人住院陪护负担的分析

目的 恶性肿瘤是一类对家庭和社会产生严重影响的疾病，本文对恶性肿瘤病人住院而需陪护的负担进行了调查，并分析负担程度及影响因素。方法 采用流行病学现场调查方法调查了110名恶性肿瘤住院陪护情况。并对陪护程度进行量化，推算了癌症患者陪护所需的费用。结果 96．36％恶性肿瘤患者住院需要陪护。其中84．81％需要24h陪护，陪护主要由其配偶承担，子女的在职陪护较普遍，晚期患者的陪护时间要大于早期和中期患者。结论 晚期恶性肿瘤患者在治疗效果不明显情况下，从经济和情感上应提倡在社区开展对症治疗。     

1999年、2009年、2019年我国与全球脑卒中疾病负担研究

目的:研究脑卒中的疾病负担,为制定防治脑卒中卫生政策措施提供参考。方法:利用2019年全球疾病负担研究的数据,主要指标包括死亡率、伤残调整寿命年、寿命损失年、伤残损失寿命年等。结果:与1999年相比,2009年我国脑卒中死亡率增加了 12.5%,伤残调整寿命年增加了 10.8%。与2009年相比,2019年脑卒中的死亡率和伤残调整寿命年分别增加了 7.3%和5.9%。男性脑卒中的死亡率和伤残调整寿命年增长幅度高于女性。1999年、2009年、2019年我国脑卒中疾病负担均高于全球平均水平。结论:我国脑卒中疾病负担高于全球平均水平,并呈现增长趋势。出血性脑卒中疾病负担最为严重,疾病负担性别分布有明显差异,脑卒中疾病危险因素普遍流行,急需科学有效的方法,降低脑卒中疾病负担。     

应用伤残调整寿命年测量山东省恶性肿瘤疾病负担的研究

目的 评价山东省恶性肿瘤疾病负担,为卫生决策提供科学依据.方法 以2006年山东省第3次死因回顾抽样调查资料和2007年山东省恶性肿瘤现患状况抽样调查资料为基础,按照全球疾病负担(GBD)研究方法计算早死所致的寿命损失年(YLLs)、失能引起的寿命损失年(YLDs)、伤残调整寿命年(DALYs)和各种肿瘤的残疾权重,YLDs采用直接法进行测算,并对测算结果的不确定性进行分析.结果 山东省人群因各种恶性肿瘤共导致138.3万个DALYs.肺癌、肝癌、胃癌和食管癌为山东省人群健康负担最重的4种主要恶性肿瘤,占全部恶性肿瘤负担的71.45％以上.95％的恶性肿瘤健康负担为早死所致,伤残负担仅占5.26％.DALYs不确定性范围约为±11％,YLDs的不确定性高于YLLs.结论 恶性肿瘤对山东省人群造成的健康负担高于全国平均水平,肺癌、肝癌和胃癌应成为山东省恶性肿瘤预防控制工作的重点疾病.     

上海市静安区疾病负担研究

目的 在上海市静安区人群的健康研究中首次引入伤残调整寿命年(disability adjusted life year,DALY)指标,对静安区疾病负担进行综合性测量,确定区域主要卫生问题.方法 以DALY为疾病负担测量单位,采用直接法计算早逝寿命损失年( years of life lost,YLL),采用间接法计算失能寿命损失年(years lost due to disability,YLD).结果 在静安区疾病负担中非传染性疾病占比重最大.循环系统疾病、恶性肿瘤、神经精神类疾病位于静安区疾病负担的前3位.结论 静安区居民健康水平较高,传染性疾病、损伤和中毒控制在较低水平,但非传染性疾病疾病负担很高,居前3位的循环系统疾病、恶性肿瘤、神经精神类疾病应作为今后防控工作的重点.     

哈尔滨市居民冠心病和脑卒中的疾病负担研究

目的研究哈尔滨市居民1999—2001年冠心痛和脑卒中的疾病负担．分析冠心痛和脑卒中对哈尔滨市不同人群的健康影响。方法用伤残调整生命年（DALY）作为疾病负担测量单位。结果1999—2001年哈尔滨市居民每千人冠心痛和脑卒中的疾病负担分别为12．44DALY、14．31DALY和15．61DALY。在年龄方面。93．00％的疾病负担由45岁以上人群承担，其中，70～75岁年龄组疾病负担比重最大；在性别方面，男性大于女性。结论哈尔滨市居民冠心痛和脑卒中近年有增加的趋势，应进一步加强对冠心病和脑卒中的防治工作。     

脑卒中患者住院陪护负担分析

脑卒中具有高发病率、高死亡率、高致残率、高复发率的“四高”特点 ,是当前危害中老年人生命和健康的主要疾病 ,近年来已成为我国城市居民的首位、农村居民的第二位死因 ;初步估计每年用于治疗此疾病的直接费用超过 10 0亿元 ,这还不包括患者死亡或残疾导致的劳动力丧失的间接经济损失〔1,2〕。此外 ,由于此病病情严重、住院率高 ,而患者住院期间往往需要亲属陪护 ,必然影响患者亲属正常的工作、生活秩序 ,造成家庭和社会的巨大负担。本文拟就脑卒中患者住院期间其亲属陪护造成的误工损失方面的社会负担进行初步分析。资料与方法1998年 5～…     

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.     

Markov模型在DALY计算中的应用

伤残调整寿命年〔1〕(DALY)是指从发病到死亡所损失的全部健康寿命年,它定量地计算由于疾病造成的早死与残疾或失能而损失的健康寿命年。它克服了传统评价指标往往只计算早死引起的寿命损失的片面性和局限性,是现在用于测量疾病负担的重要指标之     

Socioeconomic differences in the burden of disease in Sweden

OBJECTIVE: We sought to analyse how much of the total burden of disease in Sweden, measured in disability-adjusted life years (DALYs), is a result of inequalities in health between socioeconomic groups. We also sought to determine how this unequal burden is distributed across different disease groups and socioeconomic groups. METHODS: Our analysis used data from the Swedish Burden of Disease Study. We studied all Swedish men and women in three age groups (15-44, 45-64, 65-84) and five major socioeconomic groups. The 18 disease and injury groups that contributed to 65% of the total burden of disease were analysed using attributable fractions and the slope index of inequality and the relative index of inequality. FINDINGS: About 30% of the burden of disease among women and 37% of the burden among men is a differential burden resulting from socioeconomic inequalities in health. A large part of this unequally distributed burden falls on unskilled manual workers. The largest contributors to inequalities in health for women are ischaemic heart disease, depression and neurosis, and stroke. For men, the largest contributors are ischaemic heart disease, alcohol addiction and self-inflicted injuries. CONCLUSION: This is the first study to use socioeconomic differences, measured by socioeconomic position, to assess the burden of disease using DALYs. We found that in Sweden one-third of the burden of the diseases we studied is unequally distributed. Studies of socioeconomic inequalities in the burden of disease that take both mortality and morbidity into account can help policy-makers understand the magnitude of inequalities in health for different disease groups.     

Body composition by the four-compartment model: validity of the BOD POD for assessing body fat in Mexican elderly

OBJECTIVE: The aims of this study were to validate BOD POD in a wide sample of healthy and independent Mexican elderly men and women subjects using the 4 compartment (4C) model as the reference method, and to evaluate the assumptions of the densitometric two-compartment (2C) model. DESIGN: Cross-sectional study designed to assess body composition and validation of a method based on 2C model (BOD POD). SETTING: Urban and rural regions of Sonora, Mexico. SUBJECTS: Two hundred and two free-living subjects >or=60 years old were completed in this study. METHODS: Body density and body fat were measured by the BOD POD, total body water by deuterium dilution and total body bone ash by dual energy X-ray absorptiometry. Body composition was determined using Baumgartner's equation. RESULTS: Percent body fat by the 4C model was 31.2 and 42.5% in men and women, respectively (P<0.001). Group mean accuracy of body fat by BOD POD against that of the 4C model showed an effect of sex (P<0.001), but not the method (P=0.27). Results of individual accuracy showed no significant difference with the identity line and the slope was significantly different from zero or a slope similar to one. Precision assessed by model R (2) was high for all subjects and for men and women by separate. The standard error of the estimate was low for all and for men and women by separate. Bland and Altman analysis showed no significant bias. CONCLUSION: The BOD POD technique is a valid and reliable method compared to the 4C model and it could be applied in subjects with similar physical and anthropometric characteristics to subjects of this study.     

脑卒中患者社会疏离及影响因素研究

目的 探讨脑卒中患者社会疏离现状及影响因素,为干预性研究提供依据。方法 应用一般情况调查表、Lubben社会网络量表、孤独感量表、脑卒中病耻感量表、自我感受负担量表,于2022年9月采用整群随机取样对河南省脑卒中患者进行调查。应用t检验、单因素方差分析、多元逐步线性回归进行分析。结果 共纳入患者1 028名,其中27.7%患者存在客观社会疏离,10.6%患者存在家庭隔离,8.9%患者存在朋友隔离,41.0%存在高风险社会隔离,27.8%患者存在主观社会疏离。客观社会疏离总分为（15.61±5.37）分,主观社会疏离总分为（41.65±9.08）分,处于中等水平。自我感受负担、病耻感与主观社会疏离呈正相关。多元逐步分析结果显示,自我感受负担、病耻感、文化程度、脑卒中发作次数、TOAST分型是其主要影响因素（P<0.05）。结论 脑卒中患者客观社会疏离较常见,主观社会疏离处于中等水平。在护理工作中应重点关注文化程度低、病情重、复发、自我感受负担和病耻感高的患者,采取针对性的干预措施。     

Serum sialic acid concentration predicts both coronary heart disease and stroke mortality: multivariate analysis including 54,385 men and women during 20.5 years follow-up.

To investigate the nature of the relationship between serum sialic acid concentration and cardiovascular mortality, the risks for coronary heart disease (CHD) and stroke were assessed separately in 26,693 men and 27,692 women followed during 20.5 years. Diastolic blood pressure, total cholesterol and body mass index were used as covariates in a person-year-based Poisson model. Relative risks for CHD mortality associated with the highest sialic acid quartile was 1.76 (95% confidence interval (CI): 1.58-1.96) in men and 1.94 (95% CI: 1.61-2.34) in women. Corresponding figures for stroke were 1.62 (95% CI: 1.26-2.09) and 1.68 (95% CI: 1.28-2.21) respectively. No significant patterns related to the age at entry was observed. For both genders, and both endpoints, diastolic blood pressure was associated with higher relative risk than sialic acid, and body mass index and serum total cholesterol were less predictive. Serum sialic acid concentration predicts both death from CHD and stroke in men and women independent of age. The biological foundation of this finding remains unclear.     

The contribution of risk factors to stroke differentials, by socioeconomic position in adulthood: the Renfrew/Paisley Study

OBJECTIVES: This study investigated stroke differentials by socioeconomic position in adulthood. METHODS: The relation of risk of stroke to deprivation category and social class was assessed among 6955 men and 7992 women who were aged 45 to 64 years and had been screened in 1972 to 1976. RESULTS: A total of 594 men and 677 women had a hospital admission for stroke or died from stroke. There were large differences in stroke by deprivation category or social class. Adjustment for risk factors (smoking, blood pressure, height, respiratory function, body mass index, cholesterol, diabetes, and preexisting heart disease) attenuated these differences. CONCLUSIONS: Risk factors for stroke can explain some of the socioeconomic differences in stroke risk. Women living in the most deprived areas seem particularly at risk of stroke.     

Baseline cardiovascular risk factors and stroke mortality by municipality population size in a 19-year follow-up study-NIPPON DATA80

The urban-rural difference in cardiovascular risk factors and stroke mortality throughout Japan was examined in a cohort by using hierarchical data structure. The subjects were 9,309 men and women aged > or = 30 years who were residents of 294 areas in 211 municipalities of Japan in 1980; they were followed up until 1999. The population sizes of the municipalities in which the aforementioned areas were located were used to distinguish between urban and rural areas. We applied multilevel modeling to take into account the hierarchical data structure of individuals (subjects) (level 1) nested within areas (level 2). Statistically significant differences were observed in the case of medium (30,000-300,000) and small (<30,000) municipality populations compared with large (> or =300,000) municipality populations with regard to the following parameters: body mass index in men, serum total cholesterol in both men and women, and daily alcohol drinking in women. The values or frequencies of these cardiovascular risk factors were significantly higher in large populations. Meanwhile, age-adjusted odds ratios for stroke mortality in the areas in the medium and small municipalities compared with those in the areas in the large municipalities were 1.31 (95% confidence interval (CI) 0.81-2.13) and 1.40 (95% CI 0.87-2.24) in men, and 1.32 (95% CI 0.79-2.20) and 1.62 (95% CI 0.99-2.65) in women, respectively. The results of multivariate analyses adjusted for age, body mass index, total cholesterol, diabetes, hypertension, current smoking, and daily alcohol consumption did not change materially. In conclusion, stroke mortality tended to be higher in rural areas than in urban areas in Japan, especially among women.     

Urban-rural difference in stroke mortality from a 19-year cohort study of the Japanese general population: NIPPON DATA80

In Japan, cohort studies on stroke have been mainly conducted in rural areas, with few studies comparing stroke mortality between urban and rural areas. We aimed to explore urban-rural difference in stroke mortality throughout Japan using a representative sample of the general Japanese population, the NIPPON DATA80. This study included 9309 subjects (4080 men and 5229 women) aged 30 years or older who were residents of 294 areas in 211 municipalities of Japan in 1980 and followed-up until 1999. Population size of the municipality in which the aforementioned areas were located was used to distinguish between urban and rural areas, because municipalities in Japan are classified as village, town or city principally by population size. We applied a multilevel logistic regression model to take into account the hierarchical data structure of individuals (subjects) (level 1) nested within areas (level 2), and then calculated odds ratios and 95% confidence intervals (CIs) of deaths from total stroke. Statistically significant variance between areas was not observed in men but was in women. Age-adjusted odds ratios of the areas in the medium (population > or = 30,000 and <300,000) and small municipalities (<30,000) compared with the areas in the large municipalities (> or = 300,000) were 1.31 and 1.40 in men, and 1.32 and 1.62 in women, respectively. Multivariate-adjusted odds ratios (adjusted for age, body mass index, total cholesterol, diabetes, hypertension, current smoking, and daily alcohol consumption) of the areas in the medium and small municipalities compared with the areas in the large municipalities were 1.29 and 1.36 in men, and 1.34 and 1.68 in women, respectively. In conclusion, stroke mortality tended to be higher in rural areas than in urban areas in Japan, especially among women.     

Social disadvantage and cardiovascular disease: development of an index and analysis of age, sex, and ethnicity effects

BACKGROUND: Social disadvantage is defined by adverse socio-economic characteristics and is distributed unequally by age, sex, and ethnicity. We studied the relationship between social disadvantage, cardiovascular risk factors, and cardiovascular disease (CVD) among men and women from diverse ethno-racial backgrounds. METHODS: A total of 1227 men and women of South Asian, Chinese, Aboriginal, and European ancestry were randomly selected from four communities in Canada to undergo a health assessment. Socio-economic factors, conventional and novel CV risk factors, atherosclerosis, and CVD were measured. A social disadvantage index was generated and included employment status, income, and marital status. Social disadvantage was examined in relation to risk factors for CVD, atherosclerosis, and prevalent CVD. RESULTS: Social disadvantage was higher among older people, women, and non-white ethnic groups. Cigarette smoking, glucose, overweight, abdominal obesity, and CRP were higher among individuals with higher social disadvantage, whereas systolic blood pressure, lipids, norepinephrine, and atherosclerosis were not. Social disadvantage is an independent predictor of CVD after adjustment for conventional and novel risk markers for CVD (OR for 1 point increase = 1.25; 95% CI 1.06-1.47). CONCLUSION: The social disadvantage index combines social and economic exposures into a single continuous measure. Significant variation in social disadvantage by age, sex, and ethnic group exists. Increased social disadvantage is associated with an increased burden of some CV risk factors, and is an independently associated with CVD.     

江苏省2013年60岁及以上人群被动吸烟与脑卒中疾病负担关系研究

目的 分析江苏省≥60岁人群脑卒中疾病负担及其归因于被动吸烟造成的健康损失。方法 利用2013年江苏省慢性病及其危险因素监测和死因监测登记资料,并结合2016年全球疾病负担研究（GBD2016）方法,计算因被动吸烟导致脑卒中的人群归因分值（PAF）及伤残调整寿命年（DALY）等指标。结果 2013年江苏省≥60岁人群脑卒中粗死亡率、标化死亡率、DALY和DALY率分别为718.15/10万、439.28/10万、1 179 602人年和9 234.99/10万,其中过早死亡损失寿命年（YLL）占总DALY的87.00%。脑卒中DALY和DALY率随年龄的增长而升高,而且女性DALY（612 084人年）和DALY率（9 319.71/10万）均高于男性（567 518人年、9 145.33/10万）。江苏省≥60岁人群被动吸烟率为34.04%,PAF、归因DALY、归因DALY率和标化归因DALY率分别为3.88%、45 769人年、358.12/10万和920.64/10万,其中男性分别为4.35%、24 687万人年、397.82/10万、515.30/10万,均高于女性（分别为3.44%、21 056人年、320.60/10万、405.34/10万）。结论 江苏省老年人群脑卒中疾病负担沉重,其中被动吸烟对脑卒中疾病负担产生较大影响,应积极采取措施,推进脑卒中防控和二手烟暴露控制工作,提高人们的健康水平。     

Prevalence of low ankle brachial index and its association with pulse pressure in an elderly chinese population: a cross-sectional study

Background: We investigated the prevalence of low ankle brachial index (ABI) and the association of low ABI with pulse pressure among elderly community residents in China.Methods: This population-based cross-sectional study was conducted in Beijing and recruited 2982 participants who were aged 60 years or older in 2007. Low ABI was defined as an ABI value less than 0.9 in either leg. Participants with or without stroke or coronary heart disease (CHD) were analyzed separately. The association between pulse pressure and low ABI was examined by using multiple logistic regression models.Results: The prevalence of low ABI was 5.65% (4.24% among men and 6.52% among women; P = 0.0221) among participants without stroke or CHD and 10.91% (13.07% among men and 9.49% among women; P = 0.1328) among those with stroke or CHD. After adjusting for confounders, the odds ratio (95% CI) for each 5-mm Hg increase in pulse pressure was 1.19 (1.07, 1.33) and 1.10 (1.02, 1.20) for men and women, respectively, among participants without stroke or CHD and 1.17 (1.03, 1.34) and 1.15 (1.02, 1.30) for men and women with stroke or CHD. When pulse pressure was classified into quartiles and the lowest quartile was used as reference, the association between pulse pressure and low ABI remained positive in men and women.Conclusions: Low ABI was prevalent among elderly Chinese, and pulse pressure was positively associated with low ABI.