云南省汉族、纳西族和白族农村居民脑卒中疾病负担及其对家庭经济影响

Disease burden of stroke and its economic impact on household economic status among Han,Naxi and Bai rural residents in Yunnan province

目的了解云南省汉族、纳西族和白族农村居民脑卒中的疾病负担及其对家庭经济的影响,为不同民族居民脑卒中的防治提供科学依据。方法于2018年1月—2019年2月采用多阶段分层随机抽样方法在云南省抽取3个县(汉族县、纳西族自治县和白族自治县各1个)7534名≥35岁农村常住居民进行问卷调查;采用伤残调整生命年(DALY)测算不同民族居民脑卒中的疾病负担,并采用灾难性卫生支出和因病致贫的发生率评价不同民族居民脑卒中患病对家庭经济的影响。结果云南省汉族、纳西族和白族农村居民的脑卒中患病率分别为4.2%、1.8%和6.2%,白族居民的脑卒中患病率均高于汉族和纳西族居民(均P<0.001);脑卒中每千人口早死导致的生命损失年(YLL)、伤残导致的生命损失年(YLD)和DALY值,汉族居民分别为17.10、10.84和27.94,纳西族居民分别为24.75、4.64和29.39,白族居民分别为11.79、16.00和27.79;汉族、纳西族、白族脑卒中患者家庭的灾难性卫生支出发生率和因病致贫发生率分别为32.08%和33.96%、22.73%和20.45%、25.16%和18.71%,不同民族脑卒中患者家庭的因病致贫发生率不同,差异有统计学意义(χ^(2)=8.375,P=0.015)。结论云南省汉族、纳西族和白族农村居民脑卒中的疾病负担均较重,对家庭经济均造成了较大影响,应根据不同民族特点采取有效措施以降低脑卒中的发生率,从而缓解脑卒中的疾病负担及其对家庭经济的影响。

Objective To examine disease burden of stroke and its impact on household economic status among Han,Naxi and Bai rural residents in Yunnan province for providing evidences to the prevention and treatment of stroke in different ethnic populations.Methods Using stratified multistage random sampling,we conducted a face-to-face questionnaire survey among 7534 Han,Naxi,and Bai permanent residents aged≥35 years and over recruited in three counties(a non-national autonomous county,a Naxi and a Bai autonomous county)in Yunnan province from January 2018 through February 2019.Disability-adjusted life years(DALY)was used to estimate stroke-related disease burden among the participants and the incidence of catastrophic health expenditure and poverty due to stroke were adopted to evaluate the impact of stroke on household economic status.Results The prevalence of stroke for the residents of Han(n=2502),Naxi(n=2531),and Bai(n=2501)were 4.2%,1.8%,and 6.2%,respectively,and the prevalence was significantly higher among the Bai residents than that among the Han and Naxi residents(both P<0.001).For the 1000 Han,Naxi and Bai residents,the years of life lost(YLL)attributed to stroke were 17.10,24.75 and 11.79;the years lived with disability(YLD)were 10.84,4.64 and 16.00;and the DALY were 27.94,29.39 and 27.79,respectively.Among the Han,Naxi,and Bai families with stroke patients,the incidence of catastrophic health expenditure was 32.08%,22.73%,and 25.16%and that of poverty was 33.96%,20.45%and18.71%,respectively,with a significant difference in the stroke-related poverty incidence among the Han,Naxi and Bai families(χ^(2)=8.375,P=0.015).Conclusion The disease burden of stroke is heavy and the burden exerts an obvious impact on economic status of the families with stroke patients among rural Han,Naxi and Bai residents in Yunnan province;the results suggest that effective and specific measures should be taken among the residents of different nationalities to reduce the disease burden and its economic impact.