2018年中国心血管疾病死亡地点影响因素分析

Analysis on factors associated with the place of death among individuals with cardiovascular diseases in China,2018

目的掌握2018年全国及分省心血管疾病(CVD)死亡地点分布特征,探索人口统计学特征、个人社会经济状况、疾病相关因素、区域社会经济因素等与CVD患者死亡地点之间的关联。方法利用全国人口死亡信息登记管理系统死因监测数据,采用多水平logistic回归模型探索解释变量与CVD医疗卫生机构死亡的关系。结果2018年,我国死因监测地区共有853832人死于CVD,其中,死于家中者,有661625人,占CVD总死亡人数的77.49%;次之的是死于医疗卫生机构者,有156441人(18.32%)。我国发生在医疗卫生机构的CVD死亡主要影响因素有性别、年龄、民族、婚姻状况、文化程度、职业、根本死因、城乡等,且在省级水平上存在显著空间差异,个体因素解释了45.39%的省级空间差异。结论我国CVD患者以家中死亡为主,省级间差异较大,城市地区且个人社会经济状况较好的CVD患者发生在医疗卫生机构死亡的可能性较大,死亡地点影响因素探索应尽可能多纳入潜在因素。在兼顾社会宏观因素和个人意愿的条件下,综合考虑急性和慢性CVD患者具体情况,提高医疗救治能力,并形成“家庭照护+上门医疗服务”的居家临终照护模式,将是我国CVD患者未来的重要发展方向。

Objective To understand the distribution patterns of the place of death(PoD)among individuals with cardiovascular disease(CVD)in the provinces of China in 2018.Relationships between CVD deaths in healthcare/medical institutions and individual demographics,social-economic status(SES),the underlying cause of death,and local cultural factors were also explored.Methods Using data from the National Cause-of-death Reporting System,we examined potential,influential factors of CVD deaths in healthcare/medical institutions through multilevel logistic regression.Results In 2018,there were 853832 CVD deaths in disease surveillance points in the country,with 661625(77.49%)home deaths and 156441(18.32%)occurring in healthcare and medical institutions.Factors including sex,age,nationality,marital status,education level,occupation,the underlying cause of death,criterion for diagnosis,and urban/rural residency,were significantly influential on CVD deaths in healthcare/medical institutions.Meanwhile,spatial variations were shown at factors the subnational level,with 45.39%related to factors at the individual level.Conclusion Home was the dominant place for CVD deaths in the country,with substantial spatial variations in PoD between provinces.The probability of dying in healthcare/medical settings was comparatively higher among CVD patients with superior socioeconomic status and who lived in urban areas.Adequate information should be collected and included in further studies on exploring influential factors of PoD.Since both social factors,individual preferences,and acute and chronic CVD deaths are critical,it is necessary to enhance treatment capacity.A booming approach incorporating home/hospice care with on-site medical services might also improve the quality of end-of-life care among CVD patients in China.