1999—2019年天津市肺炎及其合并疾病死亡趋势分析

Analysis on mortality trend of pneumonia and complications in Tianjin from 1999 to 2019

目的了解1999—2019年天津市居民肺炎及其合并疾病的死亡率及变化趋势,探讨其在不同特征人群中的特点,为肺炎的防治提供参考。方法采用天津市疾病预防控制中心收集的1999年1月1日至2019年12月31日的居民全死因监测数据,统计居民死亡证明中提及肺炎的死亡病例,分析肺炎及其合并疾病构成、死亡率的变化趋势以及在不同年龄、性别以及城乡之间分布差异。以2000年世界标准人口计算标化死亡率。采用Joinpoint回归趋势检验对肺炎及其合并疾病死亡进行趋势分析,计算年度变化百分比(APC)。采用SPSS 24.0软件进行χ^(2)检验。结果天津市居民根本死因为肺炎本身的比例呈下降趋势,从1999年的97.31%下降至2019年的21.29%,而死于合并脑血管病、心脏病、恶性肿瘤和糖尿病的比例却呈上升趋势,至2019年分别为23.08%、13.89%、15.99%和4.99%。天津市居民肺炎及其合并疾病粗死亡率由1999年的10.24/10万上升至2019年的63.07/10万,标化死亡率从1999年的12.00/10万上升至2019年的33.71/10万,上升趋势均有统计学意义(APC分别为11.59%、7.14%,P<0.01)。2004年以及2006—2019年男性肺炎及其合并疾病粗死亡率、标化死亡率均高于女性,差异均有统计学意义(P<0.01)。5岁以下儿童肺炎及其合并疾病死亡率从1999年的10.16/10万下降至2019年的2.28/10万,APC=-4.14%,趋势变化有统计学意义(P<0.01);其他年龄组则呈上升趋势,趋势变化均有统计学意义(P<0.01)。天津市城市居民肺炎及其合并疾病粗死亡率由1999年的6.88/10万上升至2019年的102.46/10万,标化死亡率由1999年的7.03/10万上升至2019年的45.36/10万,趋势变化均有统计学意义(APC分别为15.74%、11.12%,P<0.01)。天津市农村居民肺炎及其合并疾病粗死亡率由1999年的13.60/10万上升至2019年的23.27/10万,趋势变化有统计学意义(APC=3.48%,P<0.01);标化死亡率的变化趋势无统计学意义(APC=0.13%,P>0.05)。结论 1999—2019年天津市居民肺炎及其合并疾病死亡率总体呈上升趋势。老年人、男性和城市人群为肺炎及其合并疾病死亡高发人群,同时为死亡风险上升更快的人群,提示肺炎防治应更加关注这些人群。

Objective To understand the trend of mortality of pneumonia and complications in Tianjin from 1999 to 2019,to explore the features of people with different characters and to provide the references for prevention and treatment of pneumonia.Methods The surveillance data for all death causes collected by Tianjin Centers for Disease Control and Prevention from 1999 to2019 were used for obtaining the pneumonia death cases from the resident death certificates data,and the constitute of pneumonia and complications,the mortality trend and the mortality distribution differences among different age,gender and areas were analyzed. The standardized mortality were calculated according to the world standard population of 2000. Joinpoint regression was used to analyze the death trend of pneumonia and complications,the annual percentage change(APC) was calculated. The χ2 test was used to analyze the data,the used software was SPSS 24.0. Results The proportion of pneumonia death in Tianjin decreased from 97.31% of 1999 to 21.29% of 2019,but the proportions of complications death(stroke,heart disease,malignant tumor and diabetes) increased to 23.08%,13.89%,15.99% and 4.99% in 2019,respectively. The crude mortality of pneumonia and complications increased from 10.24/105 in 1999 to 63.07/105 in 2019;the standardized mortality increased from 12.00/105 in 1999 to 33.71/105 in 2019(APCs were 11.59% and 7.14%),P <0.01. The crude mortality and standardized mortality of males were significantly higher than those of females in 2004 and 2006 to 2019(P<0.01). The mortality of pneumonia and complications in children <5 years old decreased from 10.16/105 in 1999 to 2.28/105 in 2019(APC =-4.14%),P <0.01. But the mortality of pneumonia and complications in children of other age groups showed the increase trend(P <0.01). The crude mortality of pneumonia and complications in urban residents of Tianjin increased from 6.88/105 in 1999 to 102.46/105 in 2019,the standardized mortality of pneumonia and complications increased from 7.03/105 in 1999 to 45.36/105 in 2019(APCs were 15.74%and 11.12%,P<0.01). The crude mortality of pneumonia and complications in rural residents of Tianjin increased from 13.60/105 in 1999 to 23.27/105 in 2019(APC= 3.48%,P<0.01);the standardized mortality of pneumonia and complications did not change significantly(APC= 0.13%,P>0.05). Conclusion The mortality of pneumonia and complications generally showed increase trend from 1999 to 2019. The elder,males and residents in urban area are high risk population,more attention should be paid to the prevention and treatment of pneumonia in the high risk population.