诊断切点的改变对中国高血压、高血脂、高血糖患病率的影响

The impact of broadened diagnostic criteria on the prevalence of hypertension, hyperlipidemia and diabetes mellitus in China

目的 高血压、高血脂和高血糖是可能引起心血管疾病并最终导致死亡的三种常见慢性病.20世纪80年代以来,中国高血压、高血脂和高血糖患者人数激增且尚无减缓的趋势,有关危险因素上升是重要原因,但由于在此过程中诊断切点下调过,危险因素上升可能不是患病率上升的唯一解释.本研究旨在估计诊断标准变化对这些疾病患病率影响的大小.方法 利用2002和2009年具有中国代表性的成年人健康调查数据（分别包括145254和8813名调查对象）,根据2000年前后新、旧两种诊断标准[＂新、旧＂切点：高血压：140/90和160/95 mmHg（1 mmHg=0.133 kPa）;高血脂：5.7和6.2 mmol/L;高血糖：7.0和7.8 mmol/L],分别估计高血压、高血脂和高血糖患病率及其他相关指标,以及诊断切点改变对它们的影响.并使用2000年全国普查人口的年龄、性别和城乡分布进行标化,估计诊断切点改变对全国患病率的影响,并对不同年份的患病率进行比较.结果 根据＂旧标准＂,2002年我国成年人高血压、高血脂和高血糖的标化患病率分别为8.21%、1.71%和1.43%,＂新标准＂下分别为19.18%、3.53%和2.66%;根据＂旧标准＂,2009年三种疾病的患病率分别为11.89%、9.34%和4.29%,＂新标准＂下分别为24.78%、18.36%和6.55%.由于采纳新的诊断标准,2002年三种疾病的总患病人次数增加了124%,2009年增加了95%.初步估计,从2002到2009年,因诊断标准改变导致全国增加的总患病人次数高达3.59亿.如果这三种疾病全部得到治疗,每年新增的药物费用总计2710亿,占2010年政府卫生总投入4800亿的56%.结论 中国约50%的高血压、高血脂和高血糖患病率可归因于诊断切点的降低.西方国家的诊断标准不一定直接适用于中国的实际,因诊断标准修订所引起的慢性病负担的＂增加＂应引起决策者和指南制定者的重视.在确定治疗切点时,除了治疗的效果、不良反应及费用之外,还应考虑现有资源的多寡以及患者的需要和价值观.

Objective The burden of chronic disease has been continuously increasing in China since the early 1980s. Besides the worsening of risk factors, the change in diagnostic criteria is very likely an important explanation for the increase in the prevalence of hypertension, hyperlipidemia and diabetes mellitus, three commonest, major chronic conditions that can lead to major vascular events and deaths. This study aims to estimate the contribution of changes in diagnostic criteria to the increase in the prevalence of the three conditions in China. Methods The data from two representative nation-wide surveys in China in 2002 and 2009, with 145254 and 8813 adults included respectively, were used to estimate the prevalence rate of the three conditions and the proportion attributable to the change in diagnostic criteria around year 2000. The new and old cutoff values for hypertension, hyperlipidemia, and hyperglycemia were 140/90 and 160/95 mmHg （1 mmHg=0.133 kPa）, 5.7 and 6.2 mmol/L, and 7.0 and 7.8 mmol/L, respectively. The＆amp;nbsp;prevalence was standardized according to the distribution of age, sex and rural-urban residence of the 2000 national census of the country so as to compare between the old and new diagnostic criteria and project the situation for the entire country. Results The standardized prevalence of hypertension, hyperlipidemia, and diabetes mellitus for the entire Chinese adult population in 2002 was 8.21%, 1.71%and 1.43%according to the immediate previous diagnostic criteria, and 19.18%, 3.53%and 2.66%according to the new criteria. In 2009, the prevalence was 11.89%, 9.34%and 4.29%according to the old criteria, and 24.78%, 18.36%and 6.55%according to the new criteria. The total cumulative prevalence of the three conditions was increased by 124%in 2002 and 95%in 2009 as a result of change in diagnostic criteria. Put it differently, the change in diagnostic criteria increased the number of the three conditions from 2002 to 2009 by approximately 359 million and could increase the annual drug costs by some 271 billion RMB if all the conditions are treated. The drug costs alone of treating all the three conditions could consume 56%of the total health budget of the Government in 2010. Conclusion About half of the number of the three conditions is a result of the change in diagnostic criteria. These criteria were adopted from western populations, which are designed to meet the population need and suit healthcare resources available in these countries. It is important for China to consider the resources available and needs and values of the population in addition to the benefits, harms and costs of treatment in determining the cutoff values for defining these conditions for drug interventions.