2012—2018年重庆市脑卒中疾病负担及趋势分析

Disease burden and trend of stroke in Chongqing Municipality,2012-2018

目的分析2012—2018年重庆市脑卒中疾病负担变化趋势,为开展脑卒中防治提供建议。方法从中国疾病预防控制中心"国家心脑血管事件登记报告系统"中选取重庆市2012—2018年脑卒中(ICD-10:I60-I64)个案资料,采用SPSS 25.0统计分析发病率、标化发病率、死亡率、标化死亡率、伤残调整生命年(disability adjusted life years,DALY)、早死所致的寿命损失年(years of life lost,YLL)和伤残所致的健康寿命损失年(years lived with disability,YLD)。率的趋势变化采用年度变化百分比(annual percent change,APC),对APC的检验采用t检验,检验水准α=0.05。结果2012年重庆市脑卒中发病率、标化发病率、YLD率分别为245.24/10万、201.47/10万、3.37‰,2018年发病率、标化发病率、YLD率分别为294.61/10万、222.43/10万、4.03‰,脑卒中发病率与YLD率分别以年均4.19%、3.67%幅度增长,变化趋势差异有统计学意义(t=2.66,P=0.045;t=2.61,P=0.048)。脑卒中YLD率男性高于女性。2012年重庆市脑卒中死亡率、标化死亡率与YLL率分别为96.29/10万、87.66/10万、18.38‰,2018年脑卒中死亡率、标化死亡率与YLL率分别为116.34/10万、95.88/10万、20.10‰,变化趋势差异均无统计学意义(均P>0.05)。脑卒中YLL率男性高于女性,农村高于城市。2012年与2018年重庆市脑卒中DALY率分别为21.75‰与24.13‰,APC为1.51%,变化趋势差异无统计学意义(t=1.33,P=0.240)。脑卒中DALY率男性高于女性,农村高于城市。城市地区脑卒中DALY率以年均5.82%下降,而农村地区脑卒中DALY率以年均3.87%上升,变化趋势差异均有统计学意义(t=3.37,P=0.020;t=3.95,P=0.011)。结论重庆市脑卒中疾病负担低于全国的平均水平,但高于发达地区,男性与农村地区是脑卒中防治的关键,应针对脑卒中重点人群和地区开展三级预防。

Objective To analyze the changing trend of disease burden of stroke in Chongqing Municipality from 2012 to 2018,and to provide suggestions for stroke prevention and treatment.Methods Cases of stroke(ICD-10:I60-I64)in Chongqing Municipality from 2012 to 2018 were sorted from the National Registration and Reporting System for Cardiovascular and Cerebrovascular Events developed by Chinese Center for Disease Control and Prevention.SPSS 25.0 software was used to statistically analyzed the incidence rate,age-standardized incidence rate(ASIR),mortality rate and age-standardized mortality rate(ASMR),disability adjusted life years(DALY),years of life lost(YLL),and years lived with disability(YLD).The trend change of the incidence rate,ASIR,mortality rate,ASMR,DALY,YLL and YLD of stroke were indicated by annual change percent(APC).The trend of APC was tested by t test(α=0.05).Results The incidence rate,ASIR,and rate of YLD of stroke in Chongqing in 2012 were 245.24/100,000,201.47/100,000,and 3.37‰,respectively;while those in 2018 were 294.61/100,000,222.43/100,000,and 4.03‰,respectively.The incidence rate and rate of YLD of stroke increased by 4.19% and 3.67% annually,respectively,and the changing trend showed statistically significant differences(t=2.66,P=0.045;t=2.61,P=0.048).The rate of YLD of stroke in males was higher than that in females.The mortality rate,ASMR and rate of YLL in Chongqing in 2012 were 96.29/100,000,87.66/100,000,18.38‰,respectively;while those in 2018 were 116.34/100,000,95.88/100,000,20.10‰,respectively,without statistically significant differences in the changing trend(all P>0.05).The rate of YLL of stroke was higher in males than in females as well as higher in rural area than in urban area.The rate of DALY of stroke in Chongqing in 2012 and 2018 was 21.75‰ and 24.13‰,respectively,with the APC of 1.51%and without statistically significant differences in the changing trend(t=1.33,P=0.240).The rate of DALY of stroke was higher in males than in females as well as higher in rural area than in urban area.The rate of DALY of stroke in urban area decreased by 5.82% annually,while the rate in rural area increased by 3.87%annually,showing a statistically significant difference in the changing trend(t=3.37,P=0.020;t=3.95,P=0.011).Conclusions Disease burden of stroke in Chongqing was lower than the national level,but higher than that of developed areas.Males and rural area are the key to stroke prevention and control;and hence,it is necessary to implement tertiary measures for stroke prevention and control targeting males and rural area.