天津市1999至2014年糖尿病相关疾病死亡变化趋势分析

Trend of diabetes mellitus related mortality in Tianjin, China, 1999-2014

目的了解1999至2014年天津市居民糖尿病相关疾病死亡率及其变动趋势，探讨其在不同特征人群中的特点，为糖尿病的预防控制提供依据。方法采用天津市疾病预防控制中心收集的居民全死因监测数据，统计居民死亡证中提及糖尿病的死亡病例，分析糖尿病相关疾病构成、糖尿病并发症构成及糖尿病相关疾病死亡率16年的变化趋势以及在不同年龄、性别以及城乡之间分布差异。以2000年世界标准人口计算年龄别、性别标化死亡率。采用Joinpoint回归和Cochran-Armitage趋势检验对糖尿病相关疾病死亡进行趋势分析。结果天津市居民死于糖尿病本身的比例逐年下降，至2014年为74．86％，而死于心脏病、脑血管病、恶性肿瘤等疾病的比例却在逐年上升。根本死因为糖尿病的病例中不伴有并发症死亡的比例逐年降低，而伴有昏迷、酮症、肾脏并发症、眼并发症、神经并发症、周围循环并发症以及多个并发症的比例逐年上升，累计达46．82％。糖尿病相关疾病粗死亡率为13．53／10万-26．21／10万，呈上升趋势[Z=29．21，P〈0．001，年度变化百分比（APC）=3．72％1；标化死亡率为12．48／10万-15．08／10万，呈上升趋势（Z=3．74，P〈0．001，APC=0．56％）。男性粗死亡率总体低于女性（P〈0．001）。男性标化率呈上升趋势（P〈0．001），女性标化率为平稳趋势（P=0．615）。随着年龄升高，糖尿病相关疾病死亡率逐渐升高（．P〈0．001）。城市居民糖尿病相关疾病标化死亡率为16．38／10万～16．98／10万，呈平稳趋势（Z=-I．53，P=0．125，APC=-0．25％），各年份均高于农村地区（P〈0．001）。而农村居民标化死亡率为7．19／10万-12．05／10万，呈上升趋势（Z=9．35，P〈0．001，APC=2．17％）。结论1999-2014年期间天津市居民糖尿病相关疾病死亡率呈上升趋势。根本死因为糖尿病的，伴有并发症死亡的比例逐年上升。老年人、女性、城市人群为糖尿病相关疾病死亡高发人群，同时男性、农村人群为相对糖尿病相关疾病死亡风险上升更快的人群。应加强糖尿病的防治，减少糖尿病的死亡。

Objective To explore the trends of mortality from causes of death related to diabetes mellitus （DM） in Tianjin, and provide basis for prevention and control of DM. Methods All the death certificates data mentioning DM in 1999-2014 were from Tianjin population based mortality surveillance system maintained by the Tianjin Centers for Disease Control and Prevention, the mortality rates from causes of death related to DM and the proportion from DM specified complications were analyzed, permanent residents＇ population data was from Tianjin Municipal Public Security Bureau. Standardized mortality rates were calculated for DM related death, adjusted for age and gender using the year 2000 world standard population. Joinpoint regression and Cochran-Armitage trend were used to determine the statistical significance of differences in mortality trends. Results The proportions of specified complications including ketoacidosis, coma, renal complications, retinopathy, peripheral circulatory and muhiple complications increased dramatically which collectively accounted for over 46.82% in the underlying death cause of DM. Mortality rates from causes of death related to DM in Tianjin was observed from year 1999 to 2014 with the crude mortality rate of 13.53/100 000 to 26.21/100 000[Z=29.21, P〈0.001, annual percent change （APC）=3.72%], and with the standardized mortality rate of 12.48/100 000 to 15.08/100 000 （Z=3.74, P〈0.001, APC=0.56%）. The crude mortality rate of male was lower than that of female. The standardized mortality rate increased in male but flatted in female. With the increase of age, the mortality increased gradually. The distributions of DM mortality in urban and rural were different. The mortality rate was higher for people of living in the urban with the standardized mortality rate of 16.38/100 000 to 16.98/100 000 （Z=-1.53, P=0.125, APC=-0.25% ） than that in the rural with the standardized mortality rate of 7.19/ 100 000 to 12.05/100 000 （Z=9.35, P〈0.001, APC=2.17%） during this study period. Conclusions The general mortality of DM related death and the proportions of DM complications had increased since the period 1999-2014. The people of eider, female and in urban areas had higher mortality rates. The people of male and in rural areas had mortality in a rising state. Therefore further efforts is needed to prevention and control of DM and to reduce DM related death in Tianiin.