社区心脑血管病危险因素长期干预效果评价

Evaluation of long-term community based intervention on cardiovascular diseases: 9 year follow up study of the mortality from the cohorts

目的 评价社区对心脑血管病危险因素进行长期干预对人群全死因死亡率和心脑血管病死亡率的影响。方法 1 987年在北京市崇文区和西城区分别选择 2个不相邻、人口与社会经济学构成相似、框架人口约为 1万的自然人群作为研究社区 ,崇文区为干预社区 ,西城区为对照社区。1 987年 5～ 7月从 2个社区 35岁人群中分别选取约 2 70 0名既往无脑卒中病史的居民作为队列人群 ,对其进行心脑血管病危险因素筛检后开始干预 ,随访队列人群并收集死亡资料。结果 到 1 995年 1 2月 31日为止 ,干预队列和对照队列 9年累计死亡率分别是 3.5 1 % (30 3/ 2 6 81 )和 4.71 % (390 / 2 76 0 ) ,心脑血管病死亡在死因构成占第 1位 (32 % ) ,肿瘤次之 (2 2 % ) ;干预队列全死因死亡率和心脑血管病死亡率明显低于对照 (P <0 .0 5 ) ;采用COX回归模型评价干预效果表明 ,与对照组相比 ,干预队列人群死亡的危险降低了 2 2 % (RR =0 .78,95 %CI:0 .6 7～ 0 .91 ) ,心脑血管病死亡的危险降低了 2 4% (RR=0 .76 ,95 %CI :0 .5 7～ 0 .96 )。结论 在社区对心脑血管病危险因素进行长期干预 ,不仅可以使人群心脑血管病死亡率持续下降 ,还可以有效降低全死因死亡率。

Objective To evaluate the effect of long term intervention on all causes mortality and the mortality of cardiovascular diseases. Methods In May 1987 in Beijing, 2 geographically separated community with a registered population of about 10 000 each were selected as either intervention or control community. In each community, a cohort containing 2 700 subjects (≥35 years) free of stroke was sampled. A baseline survey was administered to screen the eligible subjects for intervention. Death information from the cohorts was collected. Results By the end of Dec. 31, 1995, the 9 year cumulative all causes mortalities were 3.51%(303/2 861) in the intervention cohort and 4.71% (390/2 760)in the control cohort. Cardiovascular diseases and neoplasm were the first and second leading causes of death in the cohorts. Both the all causes mortality and the mortality of cardiovascular diseases were significantly lower in the intervention cohort than in the control group. The risk for dying of all causes death was reduced by 22% ( RR =0.78, 95% CI: 0.67～0.91) and the risk for dying of cardiovascular diseases was reduced by 24%( RR =0.76, 95%CI: 0.57～0.96) in the intervention cohort. Conclusion Long term community intervention for the risk factors of cardiovascular diseases can effectively reduce the mortality of cardiovascular diseases as well as all causes mortality.