云南省罗平县高血压的经济负担与烟草暴露的关系研究

Analysis of association of economic burden of hypertension with tobacco exposure in Luoping county of Yunnan province

目的 分析云南省罗平县高血压与烟草暴露的相关关系,测算归因于高血压的直接经济负担.方法 采用按比例概率抽样法（PPS）,于2011年4月在云南省罗平县12个乡镇中分别抽取当地18岁以上常住农村居民5000名,完成调查4611名.采用自行设计的调查问卷收集调查对象的一般情况、吸烟情况、因患高血压的门诊费、住院费、治疗费、药费、交通费、住宿费和营养费及健康相关行为等信息,测量其身高、体重、腰围、臀围和血压.同时计算高血压患者的直接经济负担.采用Х^2检验比较性别间高血压患病率、吸炯及被动吸烟率的差异；采用t检验比较性别、是否吸烟及是否被动吸烟之间高血压直接经济负担的差异；采用多因素logistic同归模型分析高血压患病的影响因素.结果 罗平县4611名调查对象的年龄为（46.90±16.74）岁,男性占49.8％（2294/4611）,女性占50.2％ （2317/4611）；男性吸烟率[75.7％（1736/2294）]高于女性[1.6％ （38/2317）]（Х^2=2669.21,P＜0.01）；男性被动吸烟率[10.0％ （230/2294）]低于女性[46.2％（1070/2317）]（Х^2=744.27,P＜0.05）；男性非烟草暴露率[14.3％ （328/1537）]低于女性[52.2％ （1209/1537）]（Х^2=744.37,P＜0.05）.吸炯和被动吸烟者患高血压的风险均高于非烟草暴露者[OR（95％ CI）值分别为1.41 （1.15～1.71）、1.31（1.07 ～ 1.63）（P值均＜0.05）].高血压患者人均直接经济负担为（3444.09±3067.83）元,其中,烟草暴露者的人均直接经济负担为（4552.46±3189.05）元,高于非烟草暴露[（1907.71±1383.94）元]（t=-3.81,P＜0.05）,吸烟者为（6951.71±3422.87）元,高于被动吸烟者[（3128.09±2083.17）元]（t=3.19,P＜0.05）,男性为（5827.39±3240.50）元,高于女性[（2633.03±2569.01）元]（=3.22,P＜0.05）其中归因于吸烟和被动吸烟的经济负担分别为0.41亿元和0.38亿元.结论 吸烟和被动吸烟对云南省罗平县高血压患病率及经济负担造成了影响.

Objective To analyze the association between hypertension and tobacco exposure Luoping county of Yunnan province and estimate the direct cost attributable to hypertension.Methods Using Probability proportional to size （PPS） sampling method,5000 rural residents aged over 18 years were selected from 12 townships in Luoping county,Yunnan province in April 2011,from which 4611 subjects completed the survey.Self-designed questionnaires were used to collect general information,smoking status,costs for outpatient consultation,inpatient,treatment,medication,travel,accommodation and extra-nutrition caused by hypertension as well as the information of health-related behavior.Their height,weight,waist circumference,hip circumference and blood pressure were measured.The direct economic burden of hypertension was calculated.Chi-square （Х^2） test was used to compare gender differences of hypertension prevalence,smoking and passive smoking.And t test was used to compare the differences of direct economic burden of hypertension among different gender,smoking and passive smoking status.Multivariable logistic regression model was used to analyze the influence factors of hypertension.Results Amongthe 4611subjects,the age was （46.90 ± 16.74） years old.Male accounted for 49.8% （2294/4611） and female 50.2% （2317/4611）.The smoking rate was higher in males （75.7% （1736/2294）） than in females （1.6% （38/2317）） （Х^2 =2669.21,P 〈 0.01）.The passive smoking rate was lower in males （10.0%（230/2294）） than in females （46.2% （1070/2317）） （Х^2 =744.27,P 〈 0.05）.Non-tobacco exposure rate in males （14.3% （328/1537）） was lower than in females （52.2% （1209/1537）） （Х^2 =744.37,P 〈0.05）.The risk of hypertension in smokers and passive smokers were higher than those without tobacco exposure,OR（95% CI）was 1.41 （1.15-1.71） （P 〈0.05） and 1.31（1.07-1.63） （P 〈0.05）respectively.The per capita direct cost of hypertension was （3444.09 ± 3067.83） Yuan.Of this,tobacco exposure （4552.46 ± 3189.05） Yuan was higher than non-tobacco exposure （1907.71 ± 1383.94） Yuan （t =-3.81,P 〈 0.05）.Moreover,smokers were （6951.71 ± 3422.87） Yuan higher than passive smokers （3128.09 ± 2083.17） Yuan（t =3.19,P 〈 0.05） and males （5827.39 ± 3240.50） Yuan were higher than females （2633.03 ± 2569.01） Yuan （t =3.22,P 〈 0.05）.The total direct costs of hypertension attributable to smoking and SHS was 41 million and 38 million,respectively.Conclusion Both smoking and SHS had significant impact on prevalence and economic burden of hypertension in Luoping county.Implementing effective strategies to control tobacco exposure is useful to reduce the economic burden of hypertension in the study region.