中国35岁以上高血压患者社区管理的现状研究

The study of management of hypertensive people aged 35 and over in communities in China

目的 通过对中国高血压社区管理人群的调查,掌握我国35岁以上居民高血压社区管理开展的现况,为高血压社区管理评价提供基础数据.方法 研究对象选自于2011年开展的横断面研究所追访到的2010年中国慢性病及其危险因素所监测的人群.在2011追访到的人群中,再采用整群抽样的方法从中选取35岁以上常住居民（在该地区居住6个月以上）,并已被乡镇（社区）级或以上医院的医生确诊为高血压的患者作为研究对象,共11977例.通过面对面问卷调查收集调查对象的一般人口学特征、参加社区高血压管理、血压治疗及控制情况.采用复杂加权计算调查对象不同特征各情况的率及其95％ CI值,以便可以代表全国35岁以上的高血压人群,率的比较采用Raoscott x2检验.结果 11977例高血压患者中,有5120例参加了高血压病管理,经复杂加权后,管理率为43.99％ （95％ CI：38.17％ ～49.81％）,在不同年龄间差异有统计学意义（x2=21.98,P＜0.01）,其中≥65岁组最高,为46.97％ （95％ CI：40.44％ ～53.50％）,35 ～44岁组最低,为37.72％（31.78％～43.65％）；女性为45.37％（95％ CI：39.24％～51.50％）,高于男性[42.50％ （95％ CI：36.71％～48.30％）]（x2=4.18,P＜0.05）.纳入社区高血压管理的患者的规范管理率为35.30％（95％ CI：31.78％ ～38.81％）,在不同年龄间的差异有统计学意义（x2=28.66,P＜0.01）,其中≥65岁组最高,为40.52％ （95％ CI：36.21％ ～ 44.82％）,35 ～ 44岁组最低,为26.18％ （95％ CI：20.07％ ～32.29％）；男性为16.78％ （95％ CI：14.13％ ～ 19.42％）,低于女性[51.29％ （95％ CI：46.41％～56.16％）] （x2=235.85,P＜0.01）；城市患者为38.53％（95％ CI：34.34％ ～ 42.72％）,高于农村[33.36％（95％ CI：28.17％ ～ 38.55％）]（x2=9.29,P＜0.01）.纳入社区高血压管理的患者的高血压治疗率为92.73％（95％CI：91.52％ ～93.93％）,不同年龄组间的治疗率的差异有统计学意义（x2=26.39,P＜0.05）,≥65岁组最高,为94.67％（95％CI：93.41％ ～ 95.93％）,35～44岁组最低,为86.47％ （95％ CI：81.05％ ～ 91.89％）；女性为94.35％（95％CI：93.15％ ～95.55％）,高于男性[90.84％ （95％ CI：88.99％ ～ 92.70％）]（x2=13.91,P＜0.01）,城市患者为94.17％（95％ CI：92.62％ ～95.71％）,高于农村[91.86％ （95％ CI：90.20％ ～93.52％）]（x2 =4.27,P＜0.05）.纳入社区高血压管理的患者的血压控制率为33.13％ （95％ CI：29.50％ ～ 36.76％）,城市患者为45.09％（95％ CI：38.73％～51.45％）,高于农村[25.96％（95％ CI：21.63％ ～ 30.30％）]（x2=22.40,P＜0.01）.结论 中国高血压患者社区管理项目已得到普及,项目的实施提高了社区高血压患者的血压治疗和控制水平.

Objective To investigate the community-based management status of hypertensive patients aged 35 or over in China and provide basic data for evaluation by investigating the hypertensive patients managed in communities.Methods The subjects in this study were recruited from the individuals of the 2010 China Non-communicable and Chronic Diseases.In September 2011,flow-up survey and a crosssection analysis has been done during the same people interviewed in 2010.Clustering sampling method was used to select 11 977 samples aged 35 or over and diagnosed by doctors from community level or above hospitals to be interviewed.A face to face questionnaire survey was carried out to collect information on general demographic characteristics,the treatment and control of blood pressure and risk factors of the hypertensive patients of community management.Sample was weighted according to complex sampling scheme and post-stratification to represent the population of Chinese hypertensive patients aged 35 or over and the rates with 95％ confidence intervals （CI） were calculated for the subgroups according to different characteristics.The Rao-scott X2 test was performed to test for the differences of the rates of the subgroups.Results In the survey,there were 11 977 patients aged 35 or over diagnosed as hypertension by doctors,and among them,a total of 5120 hypertensive patients had been under management in communities.After being weighted the rate of management of hypertensive patients in communities was 43.99％ （95％ CI：38.17％-49.81％）.There was a significant difference in the proportion of patients receiving management services when comparing different age groups （x2 =21.98,P ＜0.01） and sex （x2 =4.18,P ＜ 0.05）,the rate of management among the patients aged 65 or over was 46.97％ （95％ CI：40.44％-53.50％）,while among the patients aged 35 to 44 was only 37.72％ （31.78％-43.65％）.The rate of management was higher among females （45.37％,95％ CI：39.24％-51.50％） than males （42.50％,95％ CI：36.71％-48.30％）.The overall rate of standardized management of hypertensive patients managed in communities was 35.30％ （95％ CI：31.78％-38.81％）.The research also found differences in the proportions of patients receiving standardized management services when comparing different age groups （x2 =28.66,P ＜0.05）,gender （x2 =235.85,P ＜0.01）,and regions （x2 =9.29,P ＜0.05）.The rate of receiving standardized management services among the patients aged 65 or over was 40.52％ （95％ CI：36.21％-44.82％）,while among the patients aged 35 to 44 was only 26.18％（95％ CI：20.07％-32.29％）,the rate was lower among males （16.78％,95％ CI：14.13％-19.42％）than females （51.29％,95 ％ CI：46.41％-56.16 ％）,the rate of patients living in urban areas （38.53 ％,95％ CI：34.34％-42.72％） was higher than patients living in rural areas （33.36％,95％ CI：28.17％-38.55％）.The differences of the treatment rates of hypertensive patients managed in communities were found among different age groups （x2 =26.39,P ＜ 0.01）,gender （x2 =13.91,P ＜ 0.01）,and regions （x2 =4.27,P ＜0.05）,the rate of treatment was 94.67％ （93.41％-95.93％） among the patients aged 65or over,while 86.47％ （95％ CI：81.05％-91.89％） among patients aged 35 to 44,the rate of treatment was higher among females（94.35％,95％ CI：93.15％-95.55％） than among males （90.84％,95％ CI：88.99％-92.70％）,and it was also higher among patients living in urban regions （94.17％,95％ CI：92.62％-95.71％） than among patients living in rural regions （91.86％,95％ CI：90.20％-93.52％）.The rate of control of hypertensive patients managed in communities was 33.13％ （95％ CI：29.50％-36.76％） and the rate was higher among the subjects living in the urban areas （45.09％,95％ CI：38.73％-51.45％） than in rural areas （25.96％,95％ CI：21.63％-30.30％） （x2 =22.40,P ＜0.01）.Conclusion Results from our study showed that community management of hypertension had been popularized across the country.And it could significantly improve the program on the treatment and control of hypertension at the community level in China.