2019年中国居民慢性阻塞性肺疾病死亡地点及影响因素分析

Analysis on death places and influencing factors of chronic obstructive pulmonary diseases among Chinese residents in 2019

目的分析中国慢性阻塞性肺疾病(COPD)死亡地点分布及其影响因素,为相关医疗卫生政策的制定提供依据。方法利用2019年全国605个死因监测点根本死因为COPD的居民死亡登记资料,描述其死亡地点的分布情况。采用SAS 9.4软件进行χ2检验,采用多因素logistic回归分析COPD死亡地点的影响因素。结果 2019年,全国605个死因监测点有145 849名居民死于COPD,其中在家死亡人数为120 981人,占比为82.9%,在医疗卫生机构的死亡人数为21 420人,占比为14.7%。2019年中国居民COPD在家中死亡比例最低的3个省(直辖市)分别为北京市(28.5%)、上海市(39.2%)和黑龙江省(46.7%),其在医疗卫生机构死亡比例也最高,分别为68.4%、51.8%和50.7%;在家中死亡比例最高的3个省分别为福建省(95.3%)、海南省(94.9%)及贵州省(94.3%),在医疗卫生机构死亡比例最低的3个省分别为福建省(3.3%)、海南省(4.3%)及云南省(4.5%)。多因素logistic回归分析结果显示,与女性相比,男性(OR=0.88,95%CI:0.85~0.91)在家中死亡的可能性降低;与初中及以下学历者相比,高中(OR=0.19,95%CI:0.18~0.21)和大专及以上(OR=0.08,95%CI:0.07~0.09)学历者在家死亡的可能性降低;与东部地区相比,中部地区居民(OR=0.91,95%CI:0.88~0.94)在家死亡的可能性降低,而西部地区居民(OR=1.33,95%CI:1.28~1.37)在家死亡的可能性增加;与<40岁年龄组人群相比,60~79岁(OR=1.77,95%CI:1.32~2.39)年龄组人群和80岁及以上(OR=1.75,95%CI:1.30~2.36)人群在家死亡的可能性增加;与已婚者相比,丧偶或离婚者(OR=1.55,95%CI:1.50~1.60)在家死亡的可能性增加,均有统计学意义(P<0.01)。结论中国居民COPD死亡地点主要是家中,应重点关注西部地区、低学历、离婚或丧偶人群,提高该类人群医疗服务的可及性,同时加强姑息治疗和临终关怀的发展。

Objective To analyze the distribution of death places and influencing factors for chronic obstructive pulmonary diseases(COPD) in China,and to provide the evidence for developing healthcare policies. Methods The data from 605 death cause surveillance points in 2019 were used to record the death information of residents with COPD and to describe the distribution of death places of COPD. The χ2 test was used to analyze the data,the multivariate logistic regression was used to analyze the influencing factors for the distribution of death places of COPD. The used software was SAS 9.4. Results Among 605 death cause surveillance points in 2019,145 849 residents died from COPD,in which 120 981 residents(82.9%) died at home,21 420 residents(14.7%) died in medical and health institutions. In 2019,Beijing(28.5%),Shanghai(39.2%) and Heilongjiang(46.7%)were three provinces with the lowest death proportions at home,but with the highest proportions in medical and health institutions(68.4%,51.8% and 50.7%). Fujian(95.3%),Hainan(94.9%) and Guizhou(94.3%) were three provinces with the highest death proportions at home;Fujian(3.3%),Hainan(4.3%) and Yunnan(4.5%) were three provinces with the lowest death proportions in medical and health institutions,respectively. The multivariate logistic regression showed that as compared with females,males(OR=0.88,95%CI:0.85-0.91) were less likely to die at home(P<0.01);as compared with subjects with low education level(≤ junior middle school),subjects with senior middle school(OR=0.19,95% CI:0.18-0.21) and ≥college level(OR=0.08,95% CI:0.07-0.09) were less likely to die at home(P<0.01);as compared with subjects in the eastern region,subjects in the central region(OR=0.91,95% CI:0.88-0.94) were less likely to die at home,while those in the western region(OR=1.33,95% CI:1.28-1.37)were more likely to die at home(P<0.01);as compared with subjects aged ≤40 years old,subjects aged 60-79 years old(OR=1.77,95% CI:1.32-2.39) and subjects aged 80 years old and above(OR=1.75,95% CI:1.30-2.36) were more likely to die at home(P<0.01);as compared with married subjects,divorced or widowed subjects(OR=1.55,95%CI:1.50~1.60) were more likely to die at home(P<0.01). Conclusion The death place of COPD in Chinese residents was mainly at home.The attention should be paid to residents in the western region and the residents with low educational level and divorced or widowed. The accessibility of medical services for these residents and development of palliative care and hospice care should be improved.