江苏省昆山市1993-2016年脑血管病死亡率趋势及率差分解分析

Temporal trend and difference decomposition for cerebrovascular disease mortality in Kunshan city, Jiangsu province, 1993-2016

目的了解1993—2016年江苏省昆山市脑血管病死亡率变化趋势，同时分析人口因素对脑血管病死亡率的影响。 方法收集历年江苏省昆山市分性别和年龄分组脑血管病死亡病例，计算粗死亡率和年龄标化死亡率（依据2000年第5次人口普查年龄结构，简称＂标化死亡率＂）。使用年度变化百分比（annual percentage change，APC）评价脑血管病死亡率时间变化趋势；采用率差分解分析人口因素对脑血管病死亡率的影响。结果1993—2013年，脑血管病标化死亡率年度百分比在男女合计（APC=-4.9%，95%CI：-5.5%--4.3%）、男性（APC=-4.8%，95%CI：-5.5%--4.1%）和女性（APC=-5.5%，95%CI：-5.7%--4.3%）人群显著下降。2013—2016年，脑血管病标化死亡率在男女合计（APC=7.5%，95%CI：3.8%-11.2%）和男性（APC=10.2%，95%CI：4.3%-16.1%）人群明显上升，而女性人群无明显趋势变化（APC=4.3%，95%CI：-1.2%-9.8%）。昆山市总人群脑血管病死亡率的下降是非人口因素作用的结果，在男性、女性及总人群中非人口因素的贡献分别为238.78%、241.09%和245.89%。结论江苏省昆山市脑血管病死亡率总体上大幅下降，这种下降受到人口因素的阻碍；探索脑血管病防控的具体措施从而降低其所致疾病负担异常迫切。

ObjectiveTo explore the mortality trends of cerebrovascular diseases and to quantitatively estimate the influence of population factors on cerebrovascular disease mortality between 1993 to 2016 in Kunshan city, Jiangsu province.MethodsRecords of cerebrovascular disease deaths were obtained from a register of all causes of death. Crude death rate and age standardized rate （ASR） were calculated, and annual percentage change （APC） based on sex and age were estimated. Difference decomposition was used to estimate the contribution of demographic and non-demographic factors to the change in cerebrovascular disease mortality.ResultsBetween 1993 and 2013, the ASR of cerebrovascular diseases declined significantly for both sexes （APC=-4.9%, 95% CI： -5.5% to -4.3%）, males alone （APC=-4.8%, 95% CI： -5.5% to -4.1%）, and females alone （APC=-5.5%, 95% CI： -5.7% to -4.3%）. However, from the year 2013 to 2016, the ASR of cerebrovascular diseases increased for both sexes together （APC=7.5%, 95% CI： 3.8% to 11.2%） and men alone （APC=10.2%, 95% CI： 4.3% to 16.1%）, but there was no significant change for women （APC=4.3%, 95% CI： -1.2% to 9.8%）. The overall decrease in mortality due to cerebrovascular disease was mainly due to non-demographic changes; the proportions of its contribution in men, women, and both sexes were 238.78%, 241.09%, and 245.89%, respectively.ConclusionThe mortality due to cerebrovascular disease decreased substantially in the past two decades, and this decline was hindered by some demographic factors. It is imperative to explore the causes of this decline to decrease the burden caused by cerebrovascular disease.