江西省常住居民脑血管病流行病学分析

Prevalence of cerebrovascular disease among permanent residents in Jiangxi province

目的了解江西省常住居民脑血管病流行特征,为开展居民脑血管病防控工作提供依据。方法采取多阶段整群随机抽样方法,根据江西省地理分布特征,抽取5个县(区)为调查点;在每个调查点按与人口规模成比例的抽样方法随机抽取1个乡镇(街道),每个乡镇(街道)随机抽取1个或多个村(居委会)至少1300户,户中所有在该地区居住满6个月者均为本次调查对象。入户收集信息并初筛出可疑或自报脑血管病患者和死者,再由神经科医生面访可疑患者或死者亲属,通过询问病史、体检和复核已做的特殊检查方式进行确诊。结果共收回19560份有效问卷,有效率为98.41%,调查对象平均年龄为(37.59±20.91)岁。发现脑血管病患者257例,患病率为1323.58/10万,标化率为1195.13/10万;脑卒中患病率、发病率和死亡率分别为1066.08/10万、297.48/10万和92.32/10万,标化率分别为958.42/10万、265.82/10万和78.57/10万;脑卒中患病率、发病率和死亡率均随年龄增加而上升(P<0.05),死亡率男性高于女性(P<0.05),发病率城镇高于农村(P<0.05)。脑卒中CT和(或)MRI诊断率为94.69%;从亚型来看,脑梗死比例最高(73.45%),其次为脑出血(21.74%)和蛛网膜下腔出血(3.37%),难以分类比例仅为1.44%。短暂性脑缺血发作患病率为257.51/10万,标化率为278.08/10万;女性高于男性、农村高于城镇(P<0.05),复发率高达74.00%。结论江西省常住居民脑血管病流行形势严峻,迫切需要采取有效的措施进行防控。

Objective To investigate epidemiological characteristics of cerebrovascular disease (CVD) among permanent residents in Jiangxi province and to provide references for the prevention and control of CVD. Methods We first selected 5 counties (districts) as study sites according to their geographical distribution in Jiangxi province using stratified multi-stage cluster sampling;secondly, we randomly selected one or more villages or communities (at least with 1 300 households or more) under the administration of a township or a neighbourhood committee from each of the five study sites using probabilities proportional to size sampling;then we conducted a household survey on morbidity and mortality of CVD among all permanent residents (living at a local residence for 6 months or more) in the selected villages or communities to screen out suspected CVD patients or reported CVD death;finally, face-to-face surveys were carried out by neurologists among suspected CVD patients or relatives of CVD deaths to diagnose CVD and to confirm the CVD deaths. Necessary clinic examinations were also performed in the surveys. Results Valid information were collected from 98.41%(19 560/19 670) of the residents surveyed. The average age of the participants was 37.59 ± 20.91 years. Among the participants, totally 257 CVD patients were identified, with a crude and standardized prevalence rate of 1 323.58/100 000 and 1 195.13/100 000. For all the participants, the prevalence, morbidity, and mortality rate of stroke were 1 066.08/100 000, 297.48/100 000, and 92.32/100 000 and standardized prevalence, morbidity, and mortality rate were 958.42/100 000, 265.82/100 000, and 78.57/100 000, respectively. The rate of stroke prevalence, morbidity and mortality increased significantly with the increment of age among the participants (P < 0.050);the stroke mortality rate of the male participants was significantly higher than that of the female participants and the stroke morbidity rate of the urban participants was significantly higher than that of the rural participants (both P < 0.05). Among the CVD patients identified, 94.69% were diagnosed based on computed tomography (CT) and/or magnetic resonance imaging (MRI);the proportion of cerebral infarction, cerebral hemorrhage, subarachnoid hemorrhage, and not been classified were 73.45%, 21.74%, 3.37%, and 1.44%, respectively. The prevalence rate and the standardized prevalence rate of transient ischemic attack (TIA) was 257.51/100 000 and 278.08/100 000 among the participantas;the prevalence rate of TIA was significantly higher among the female participants than among the male participants and significantly higher among the rural participants than among the urban participants (both P < 0.05). The recurrence rate of TIA was 74.00% among the TIA patients diagnosed. Conclusion Cerebrovascular disease is prevalent among permanent residents in Jiangxi province and effective measures for prevention and control of the disease need to be promoted among in the population.