不同城乡划分标准的脑内出血死亡率长期趋势比较

Comparing the long-term mortality trend of intracerebral hemorrhage for different urban and rural division standards

目的分析两种城乡划分标准对天津市1999-2015年脑内出血(ICH)死亡率长期趋势的影响,并开展比较研究,以期科学选择城乡标准,为合理配置卫生资源及更有针对性地开展心脑血管疾病防治提供依据。方法分别根据户籍人口城镇化率和行政区划类别两种城乡划分标准分析1999-2015年天津市居民ICH标化死亡率的长期趋势,分别采用Joinpoint回归和Moses变异度检验比较两种城乡划分标准下ICH的标化死亡率的集中趋势和离散趋势。采用Joinpoint4.3和SPSS 22.0软件进行统计分析。结果 1999-2015年天津市ICH标化死亡率为72.41/10万~29.00/10万,呈下降趋势,年度变化百分比(APC)为-5.20%,差异有统计学意义(P<0.01)。城市ICH标化死亡率低于农村,差异有统计学意义(P<0.01),且下降速度快于农村。相对于行政区划类别城乡标准,户籍人口城镇化率城乡标准的城乡ICH标化死亡率下降趋势更明显,城市(或农村)内部线性集中趋势更好,同时ICH死亡率在城乡间具有较高的离散区分度(P<0.05)。结论农村人群为ICH死亡重点关注人群。单纯行政区划城乡标准变动频繁,可能会对心脑血管疾病长期趋势分析造成错分偏倚。户籍城镇化率城乡标准下,城市或农村心脑血管疾病流行趋势更稳定,城乡差异被发现的可能性更大,选择并优化符合我国国情特别是心脑血管疾病流行规律的城乡划分标准势在必行。

Objective To analyze and compare the long-term mortality trend of intracerebral hemorrhage（ICH） from 1999 to 2015 in Tianjin for two different urban and rural division standards,to select the urban and rural division standards scientifically,and to provide the basis for rational allocation of health resources and prevention and treatment of cardiovascular or cerebrovascular diseases. Methods The long-term mortality trends of intracerebral hemorrhage（ICH） from 1999 to 2015 in Tianjin were analyzed for two different urban and rural division standards according to the urbanization rate of permanent residents and category of administrative division. The Joinpoint regression and Moses variability test were used to compare the concentration trend and discrete trend of ICH standardized mortality for two different urban and rural division standards. The software Joinpoint 4.3 and SPSS 22.0 were used to analyze the data. Results ICH standardization mortality in Tianjin from 1999 to 2015 was 72.41/105-29.00/105 with the decrease trend,the annual percent change（APC） was-5.20%（P〈0.01）. The ICH standardization mortality in urban area was significantly lower than that in rural area（P 0.01）.The ICH standardization mortality in urban area declined quicker than that in rural area. ICH mortality had much stronger statistical central trend in urban or rural area based on urbanization rate of permanent residents than that based on administrative division,and had much stronger statistical discrete trend between urban and rural areas（P 0.05）. Conclusion The rural residents were people with higher risk of ICH. The urban and rural standard of simple administrative division changed frequently,resulting in the misclassification bias of ICH long-term mortality trend. Under the urban and rural division standard of the urbanization rate for permanent residents,the disease trends of ICH in urban and rural areas were stable,there was a bigger possibility to find the difference between urban area and rural area. It is necessary to select the urban and rural division standard conforming to the national conditions of our country and the prevalence of cardiovascular and cerebrovascular diseases.