1990—2019年江苏省启东市居民死因及对期望寿命的影响分析

Death Causes and Its Impact on Life Expectancy of Residents in Qidong City From Jiangsu Province From 1990 to 2019

目的研究分析1990—2019年江苏省启东市居民死因及对期望寿命的影响,为制定卫生政策提供依据。方法根据1990—2019年启东市全死因监测资料及历年人口资料,对居民总体死亡率及时间趋势、主要死因死亡率及时间趋势分析,采用Joinpoint4.7.0.0软件,计算指标包括粗死亡率(CR)、中国标化率(CASR)及平均年度变化百分比(AAPC),并计算各年期望寿命(e0)及主要死因去死因期望寿命(e’)。结果1990—2019年启东市居民CR为775.55/10万,其中男性为847.61/10万,女性为705.34/10万。CASR为386.98/10万,其中男性为452.12/10万,女性为324.29/10万。时间趋势分析显示,CR的APC为1.18%,其中男性为1.10%,女性为1.29%,CASR的APC为-2.26%,其中男性为-2.39%,女性为-2.16%,P均<0.05,差异有统计学意义。主要死因前5位依次为恶性肿瘤、脑血管病、呼吸系统疾病、心脏病以及损伤和中毒,共计占全死因的84.06%。其中恶性肿瘤的CR为223.46/10万,CASR为128.19/10万;脑血管病的CR为181.13/10万,CASR为74.08/10万;呼吸系统疾病的CR为112.99/10万,CASR为48.24/10万;心脏病的CR为81.20/10万,CASR为32.99/10万;损伤和中毒的CR为53.12/10万,CASR为39.43/10万。主要死因时间趋势分析显示,恶性肿瘤CR的APC值为2.44%(t=23.84,P<0.01),脑血管病为3.39%(t=10.63,P<0.01),呼吸系统疾病为-2.37%(t=-16.25,P<0.01),心脏病为3.58%(t=11.64,P<0.01),损伤和中毒为0.85%(t=2.87,P<0.01),差异均有统计学意义。恶性肿瘤CASR的APC为-0.85%(t=-8.47,P<0.01),脑血管病为-0.71%(t=-2.28,P=0.03),呼吸系统疾病为-6.45%(t值为-45.28,P<0.01),心脏病为-0.47%(t值为-1.69,P=0.10),损伤和中毒为-1.90%(t=-11.14,P<0.01),除心脏病外差异均有统计学意义。启东市居民期望寿命从1990年的73.95岁上升至2019年的82.91岁。去死因期望寿命分析结果显示,去恶性肿瘤后从1990年的77.46岁上升至2019年的87.00岁,去脑血管疾病后从1990年的75.61岁上升至2019年的86.23岁,去呼吸系统疾病后从1990年的77.11岁上升至2019年的83.87岁,去心脏病后从1990年的74.84岁上升至2019年的84.76岁,去损伤和中毒后从1990年的75.82岁上升至2019年的84.04岁。结论三十年来启东市居民粗死亡率上升趋势明显但经标化后死亡率已呈明显下降。恶性肿瘤、心脑血管疾病、呼吸系统疾病和损伤中毒是影响启东市居民健康和期望寿命的主要因素,应加强重点疾病的综合防治。

Objective To analyze the death causes of residents and its impact on life expectancy in Qidong City,Jiangsu Province from 1990 to 2019 so as to provide a basis for formulating health policies.Methods The overall mortality,the main cause death rate and time trend analysis of the residents were analyzed by using Joinpoint 4.7.0.0 software according to the monitoring data of all causes of death in Qidong City from 1990 to 2019 and the population data over the years.Crude death rate(CR),China Standardized Rate(CASR),Average Annual Change Percentage(AAPC),the life expectancy of each year(e0)and the life expectancy of major causes of death(e’)were calculated.Results The CR of residents in Qidong City from 1990 to 2019 was 775.55/105 in overall,and 847.61/105 in males and 705.34/105 in females.The CASR is 386.98/105 in overall,452.12/105 in males and 324.29/105 in females.Time trend analysis showed that the APC of CR was 1.18% in overall,1.10% in males,and 1.29% in females;the APC of CASR was -2.26% in overall,-2.39% in males,and -2.16% in females,and the P values were all<0.05.The top five major causes of deaths were malignant tumors,cerebrovascular diseases,respiratory diseases,heart diseases,injuries and poisonings,accounting for 84.06% of all deaths.Specifically,the CR for malignant tumors,cerebrovascular diseases,respiratory diseases,heart diseases and injury and poisoning is 223.46/105,181.13/105,112.99/105,81.20/105 and 53.12/105,respectively.The CASR for malignant tumors,cerebrovascular diseases,respiratory diseases,heart diseases and injury and poisoning is 128.19/105,74.08/105,48.24/105,32.99/105 and 39.43/105.Time trend analysis of the main causes of deaths showed that the APC values of CR for malignant tumors,cerebrovascular diseases,respiratory diseases,heart diseases and injury and poisoning were 2.44%,3.39%,-2.37%,3.58%,and 0.85%,and both P values were<0.05.The APC values of CASR for malignant tumor,cerebrovascular diseases,respiratory diseases,heart diseases and injury and poisoning were-0.85%,-0.71%,-6.45%,-0.47%,and -1.90%,all P values are<0.05 except heart diseases.The life expectancy of residents in Qidong City has risen from 73.95 years in 1990 to82.91 years in 2019.After removal of malignant tumors,cerebrovascular diseases,respiratory diseases,heart diseases and injury and poisoning,the life expectancy of residents all rose(malignant tumors:77.46 years in 1990 and 87.00 years in 2019;cerebrovascular diseases:75.61 years in 1990 and 86.23 years in 2019;respiratory diseases:77.11 years in 1990 and 83.87 years in 2019;heart diseases:74.84 years in 1990 and 84.76 years in 2019;and injury and poisoning:75.82 years in 1990 and 84.04 years in 2019).Conclusion The crude death rate of residents in Qidong City has increased significantly in the past 30 years,but the death rate has decreased significantly after standardization.Malignant tumors,cardiovascular and cerebrovascular diseases,respiratory diseases and injury and poisoning are the main influencing factors of the health and life expectancy of residents in Qidong.Comprehensive prevention and treatment of key diseases should be strengthened.