云南省农村居民四种常见慢性病经济负担及其与肥胖的关系研究

Economic Burden and Correlation of 4 Common Chronic Diseases with Obesity in Rural Residents of Yunnan Province

目的了解云南省农村居民4种常见慢性病(高血压、糖尿病、冠心病、脑卒中)的经济负担,并测算其归因于肥胖的疾病经济负担。方法于2015年1—9月采用多阶段分层抽样法,在云南省抽取12个行政村的5 040例居民,以完成问卷调查的4 979例为研究对象。采用自行设计的调查问卷收集纳入居民的一般资料,由经过严格培训的体检人员对纳入居民进行体格检查。采用二步模型法测算居民的直接经济负担,采用人力资本法结合伤残调整生命年(DALY)测算居民的间接经济负担,并与归因危险度(PAR)相结合测算归因于全身性肥胖、中心性肥胖的疾病经济负担。结果居民的全身性肥胖患病率为6.8%(337/4 979),中心性肥胖患病率为38.4%(1 912/4 979);高血压、糖尿病、冠心病、脑卒中患病率分别为35.3%(1 757/4 979)、9.9%(491/4 979)、3.8%(191/4 979)、1.7%(83/4 979)。多因素Logistic回归分析结果显示,控制了其他混杂因素后,全身性肥胖者患高血压、糖尿病、冠心病、脑卒中的风险分别为非全身性肥胖者的1.71、3.81、3.53、4.70倍,中心性肥胖者患高血压、糖尿病、冠心病、脑卒中的风险分别为非中心性肥胖者的2.21、1.92、1.61、2.10倍;消除全身性肥胖可使高血压、糖尿病、冠心病、脑卒中的患病率分别下降4.61%、17.51%、14.68%、20.10%,消除中心性肥胖可使高血压、糖尿病、冠心病、脑卒中的患病率分别下降32.50%、26.80%、19.53%、29.70%。居民高血压、糖尿病、冠心病、脑卒中的人均疾病经济负担分别为6 667.4、9 126.1、9 270.0、16 187.2元,总疾病经济负担分别为108 185.2百万元、41 529.5百万元、16 192.0百万元、12 649.0百万元。4种常见慢性病归因于全身性肥胖的经济负担分别为8 167.6百万元、6 876.6百万元、3 491.7百万元、2 740.2百万元,归因于中心性肥胖的经济负担分别为34 370.2百万元、10 696.1百万元、3 232.4百万元、3 177.0百万元。4种常见慢性病的总疾病经济负担为178 555.7百万元,其中11.9%(21 276.1百万元/178 555.7百万元)归因于全身性肥胖,28.8%(51 475.7百万元/178 555.7百万元)归因于中心性肥胖。结论肥胖及4种相关慢性病给当地造成的经济负担较重,降低全身性肥胖和中心性肥胖的患病率,有助于减轻该4种常见慢性病的经济负担。

Objective The aim of this study was to analyze the relationship between obesity and 4 common chronic diseases,hypertension,diabetes,coronary heart disease（ CHD） and stroke,in rural residents of Yunnan Province,and to calculate the economic burden caused by the 4 diseases and to estimate the economic burden attributable to obesity. Methods Using multistage stratified random sampling procedure,we selected 5 040 residents from 12 administrative villages of Yunnan Province between January to September 2015. We collected the general data of the residents by a survey with self- developed questionnaire. The final participants of this study consisted of 4 979 residents who completed the questionnaire. A physical examination was performed in the participants by strictly trained medical examiners. Two- step modeling method was used to measure direct economic burden caused by the diseases,whereas human capital approach combined with disability adjusted life years（ DALY） was applied to measure indirect economic burden. And population attributable risk（ PAR） combined with the above was adopted to estimate the cost attributable to the combination of systemic obesity and central obesity. Results In the study region,the prevalence of general obesity and central obesity was 6. 8%（ 337 /4 979） and 38. 4%（ 1 912 /4 979）,respectively. The prevalence of hypertension,diabetes,CHD and stroke was 35. 3%（ 1 757 /4 979）,9. 9%（ 491 /4 979）,3. 8%（ 191 /4 979） and 1. 7%（ 83 /4 979）,respectively. Results of multivariate Logistic regression analysis showed that,after adjusting for other confounding factors,the prevalence risk of hypertension,diabetes,CHD and stroke in subjects with general obesity was 1. 71,3. 81,3. 53,4. 70 times than that in non- general obese subjects,separately. And the prevalence risk of hypertension,diabetes,CHD and stroke in subjects with central obesity was 2. 21,1. 92,1. 61 and 2. 10 times than that in non- central obese subjects,separately. Based on PAR,our study estimated that the prevalence of hypertension,diabetes,CHD and stroke accounted for 4. 61%, 17. 51%, 14. 68%, 20. 10% attributable to general obesity, respectively, as well as32. 50%,26. 80%, 19. 53%, 29. 70% attributable to central obesity, respectively. The average cost of hypertension,diabetes,CHD and stroke per person was 6 667. 4 yuan,9 126. 1 yuan,9 270. 0 yuan and 16 187. 2 yuan,respectively,and the total costs were 108 185. 2 million yuan for hypertension,41 529. 5 million yuan for diabetes,16 192. 0 million yuan for CHD,and 12 649. 0 million yuan for stroke. Of this,the cost of hypertension,diabetes,CHD and stroke attributable to general obesity was 8 167. 6 million yuan,6 876. 6 million yuan,3 491. 7 million yuan,and 2 740. 2 million yuan,respectively,and that of the four chronic diseases attributable to central obesity was 34 370. 2 million yuan,10 696. 1 million yuan,3 232. 4million yuan,and 3 177. 0 million yuan,respectively. The total costs of the 4 chronic diseases were 178 555. 7 million yuan,in which 11. 9%（ 21 276. 1 million yuan /178 555. 7 million yuan） was attributable to general obesity and 28. 8%（ 51 475. 7million yuan /178 555. 7million yuan） attributable to central obesity. Conclusion The costs of obesity and 4 obesity- related diseases are substantial in rural residents of Yunnan Province. Reducing the prevalence of general obesity and central obesity is helpful to decrease economic burden of the 4 obesity- related chronic diseases.