中国不同地区糖代谢状态的心血管疾病归因死亡研究

Attributable risk of cardiovascular mortality associated with different glycometabolic status among different regions in China

目的分析中国不同地区糖代谢状态的归因死亡风险和疾病负担。方法本研究数据基于2012—2015年中国高血压调查和2013年中国居民死因监测数据。共纳入22702名35岁及以上无心血管疾病史的中国高血压调查对象,并于2018—2019年对其随访心血管死亡结局。利用Cox比例风险模型,对糖代谢状态与死亡的风险比进行估计。采用人群归因百分比(PAF)评估不同糖代谢状态造成的心血管疾病负担。结果在随访时间内,共有479例心血管病死亡。与正常血糖人群相比,糖尿病前期和糖尿病人群的心血管病死亡风险[HRs(95%CI)]分别为1.37(1.04~1.80)和1.36(1.06~1.75)。2013年我国心血管死亡归因于糖尿病前期和糖尿病的PAF分别为2.48%(95%CI:2.31%~2.66%)和2.96%(95%CI:2.79%~3.13%),归因于糖尿病前期和糖尿病的心血管病死亡人数分别为11.99万和13.97万。此外,不同糖代谢状态的PAF存在地区和省级差异,心血管病死亡归因于糖尿病的PAF最高为东部地区[3.73%(95%CI:3.44%~4.04%)],其次为西部地区[2.62%(95%CI:2.24%~3.01%)],最低为中部地区[2.42%(95%CI:2.16%~2.68%)]。结论我国糖尿病前期和糖尿病带来的心血管疾病负担较重,且存在地区和省份差异,应当采取相应措施,减少糖尿病前期和糖尿病造成的疾病负担。

Objective To estimate the attributable risk of deaths and disease burden of glycometabolic status among different regions in China.Methods Data of this study were obtained from the China Hypertension Survey(CHS)in 2012 to 2015 and National Disease Surveillance Points System in 2013.The 22702 participants aged 35 or order without self-reported medical history of cardiovascular disease(CVD)were enrolled from CHS,and CVD mortality were followed up in 2018 to 2019.Cox regression was applied to estimate the relationship between glycometabolic status and mortality.Population attributable fraction(PAF)was used to assess the burden of CVD mortality due to different glycometabolic status.Results During the follow-up period,479 CVD deaths were ascertained.The HRs(95%CI)of CVD mortality for prediabetes and diabetes were 1.37(1.04-1.80)and 1.36(1.06-1.75),respectively,compared with those with normal blood glucose.In 2013,the PAFs of CVD mortality associated with prediabetes and diabetes were 2.48%(95%CI:2.31%-2.66%)and 2.96%(95%CI:2.79%-3.13%),respectively.The number of CVD deaths attributed to prediabetes and diabetes were 119900 and 139700,respectively.Besides,significant regional and provincial differences of disease burden to glycometabolic status were observed.The PAF of CVD mortality attributed to diabetes was highest in the east[3.73%(95%CI:3.44%-4.04%)],followed by the west[2.62%(95%CI:2.24%-3.01%)],and the lowest in the middle[2.42%(95%CI:2.16%-2.68%)].Conclusions The CVD burden caused by prediabetes and diabetes is relatively heavy and varies by region and province,corresponding measure should be made to reduce the disease burden caused by prediabetes and diabetes.