1999-2015年天津市不同特征居民脑内出血死亡率及变化趋势分析

The trend of intracerebral hemorrhage mortality of the residents with different characteristics in Tianjin, China, 1999-2015

目的 了解1999—2015年天津市居民脑内出血死亡率及其变化趋势，探讨其在不同特征人群中的特点。方法 利用天津市全死因监测管理系统收集1999—2015年天津市居民脑内出血死亡情况，统计天津市居民脑内出血死亡率，比较不同年龄、性别以及地区之间死亡率的差异，并分析其变化趋势。采用2000年世界标准人口计算标化死亡率。采用Joinpoint回归和Cochran-Armitage趋势检验进行趋势分析。结果 1999—2015年脑内出血死亡率为76.35/10万~51.46/10万，呈下降趋势[年度变化百分比（APC）=-1.96%，Z=-31.08，P〈0.001]；标化死亡率为72.41/10万~29.00/10万，呈下降趋势（APC=-5.20%，Z=-70.91，P〈0.001）。男性脑内出血死亡率为87.26/10万~59.89/10万，呈下降趋势（APC=-1.79%，Z=-21.71，P〈0.001）；标化死亡率为85.65/10万~35.75/10万，呈下降趋势（APC=-4.93%，Z=-52.32，P〈0.001）。女性脑内出血死亡率为65.21/10万~42.98/10万，呈下降趋势（APC=-2.18%，Z=-22.28，P〈0.001）；标化死亡率为59.17/10万~22.26/10万，呈下降趋势（APC=-5.63%，Z=-48.15，P〈0.001）。35岁以下年龄组脑内出血死亡率为0.78/10万~0.92/10万，呈上升趋势（APC=4.41%，Z=5.07，P〈0.001），特别是35岁以下男性脑内出血死亡率为0.90/10万~1.54/10万，呈上升趋势（APC=6.59%，Z=6.52，P〈0.001）。城市脑内出血死亡率为69.74/10万~41.79/10万，呈下降趋势（APC=-3.18%，Z=-31.43，P〈0.001）；标化死亡率为57.56/10万~20.42/10万，呈下降趋势（APC=-6.59%，Z=-53.43，P〈0.001）。农村脑内出血死亡率为82.99/10万~61.49/10万，呈下降趋势（APC=-1.10%，Z=-14.06，P〈0.001）；标化死亡率为91.55/10万~43.14/10万，呈下降趋势（APC=-3.78%，Z=-43.21，P〈0.001）。各年份农村脑内出血的死亡率均高于城市（P值均〈0.05）。结论 1999—2015年期间天津市居民脑内出血死亡率呈明显的下降趋势。应将男性、小于35岁青年人、农村人群作为脑内出血死亡重点关注人群。

Objective To explore the trends and distribution of intracerebral hemorrhage （ICH） mortality of the residents with different characteristics from 1999 to 2015 in Tianjin.Methods ICH mortality data in 1999-2015 were from Tianjin population based mortality surveillance system. The mortality rate of ICH, difference in the rate by gender, age, and geographic distribution, and trends over the years were analyzed. Standardized mortality rates of ICH were calculated using the year 2000 world standard population. Joinpoint regression and Cochran-Armitage trend were used to examine the trends in mortality.Results A total of 102 279 ICH death cases were observed in Tianjin from year 1999 to 2015. The crude ICH mortality rate in Tianjin decreased from 76.35/100 000 in 1999 to 51.46/100 000 in 2015 （annual percent change （APC）=-1.96%, Z=-31.08, P〈0.001） , and the standardized mortality rate decreased from 72.41/100 000 to 29.00/100 000 （APC=-5.20%, Z=-70.91, P〈0.001）. The crude mortality rate of ICH mortality in males decreased from 87.26/100 000 to 59.89/100 000 （APC=-1.79%, Z=-21.71, P〈0.001） and the standardized mortality rate decreased from 85.65/100 000 to 35.75/100 000 （APC=-4.93%, Z=-52.32, P〈0.001）. The crude mortality rate of ICH mortality in females decreased from 65.21/100 000 to 42.98/100 000 （APC=-2.18%, Z=-22.28, P〈0.001） and the standardized mortality rate decreased from 59.17/100 000 to 22.26/100 000 （APC=-5.63%, Z=-48.15, P〈0.001）. The ICH mortality rate under 35 years old increased from 0.78/100 000 to 0.92/100 000 （APC=4.41%, Z=5.07, P〈0.001）, especially in males increasing from 0.90/100 000 to 1.54/100 000 （APC=6.59%, Z=6.52, P〈0.001）. The crude mortality rate of ICH in urban areas decreased from 69.74/100 000 to 41.79/100 000 （APC=-3.18%, Z=-31.43, P〈0.001） and the standardized mortality rate decreased from 57.56/100 000 to 20.42/100 000 （APC=-6.59%, Z=-53.43, P〈0.001）. The crude mortality rate of ICH in rural areas decreased from 82.99/100 000 to 61.49/100 000 （APC=-1.10%, Z=-14.06, P〈0.001） and the standardized mortality rate decreased from 91.55/100 000 to 43.14/100 000 （APC=-3.78%, Z=-43.21, P〈0.001）. The ICH mortality rate in rural areas was higher than that in urban areas （P〈0.05）.Conclusion ICH mortality rate in Tianjin decreased from 1999 to 2015. Further efforts to reduce ICH mortality in Tianjin is needed, in particular males, under 35 years old, and people in rural areas.