上海医学可避免死亡率变化的归因分析

The attribution analysis of avoidable mortality in Shanghai

目的：通过分析上海市人1：7可避免死亡变化的原因，评价上海市卫生系统绩效，提出绩效改进方向。方法：根据国际上已经形成的标准确定可避免死亡的范围，从上海市疾病预防控制中心获得必要的人口和死亡数据，分析不同年龄组、性别以及疾病对可避免死亡率下降的贡献。结果：（1）1999—2010年上海市人口可避免死亡率呈下降趋势。（2）1999—2010年，65～74岁组人群可避免死亡的减少对全人群可避免死亡率下降的贡献最犬，为64．59％。（3）男性可避免死亡的减少对全人群可避免死亡率下降贡献为39．90％，女性为60．02％，明显高于男性。（4）对可避免死亡率下降贡献最大的疾病为脑血管疾病，贡献率为111．94％，其下降贡献最大的为65～74岁年龄组。负贡献最大的疾病为缺血性心脏病，贡献率为-18．20％，其上升贡献最大的是60～65岁年龄组。结论：上海市卫生系统绩效逐年提高；1999年至2010年期间，上海卫生系统总体在脑血管疾病、肾炎和肾病、肺炎，65～74岁组人群组以及女性的预防保健上取得一定成绩，尤其在65～74岁组脑血管疾病，50～55岁组女性乳腺癌疾病取得显著成效；但今后要加针对缺血性心脏病（重点60~65岁组）、女性乳腺癌（重点60—65岁组）的防治工作。

Objective： This study aims at evaluating Shanghai＇s health care system through analyzing the attribution of the decline of avoidable mortality, and proposing improving orientation. Methods： The list of avoidable causes of death was based on international criterion. Mortality and population data by age and gender were obtained from Shanghai Municipal Center for Disease Control and Prevention. And the contribution of different age groups, sex and diseases to the decline of avoidable mortality was examined. Results： The trend of Shanghai＇s avoidable mortality rate was declining during 1999-2010. During year 1999 to 2010, the biggest contribution of age groups to the decline of avoidable mortality rate was caused by 65~74 age groups and was achieving at 64.59%. The male contributed 39.90% to the decline of avoidable mortality rate, lower than female＇s 60.02%. Cerebrovascular disease contributed 111.94% to the decline of the avoidable mortality which was the biggest, whereas the biggest negative contribution was caused by ischemic heart disease with the proportion of -18.20%. Conclusion： During year 1999 to 2010, the performance of health care system in Shanghai was better in age group of 65 ~74 years old, in female and in prevention of cerebrovascular disease, nephritis, nephropathy and pneumonia, however, more emphasis should be put on the prevention of ischemic heart disease and breast cancer（ especially among population of 60~65 years old ）.