社区综合防治脑卒中的效果评价:横断面研究(英文)

Effects of community-based comprehensive prevention on incidence and mortality of stroke

目的为探索社区人群中降低脑卒中发病率和死亡率的有效措施。方法1991/2000年在长沙市开福区10万自然人群中,按整群抽样分为干预区和对照区,在干预区进行脑血管病的综合防治。在两区的35～74岁的人群中,干预前后分别在812、831和804、826例亚组人群中调查收缩压、三酰甘油及血糖等变量。结果干预前后两区收缩压及对照区的舒张压均呈显著增高趋势;而干预区的舒张压有下降趋势。两区高密度脂蛋白胆固醇、体重与体重指数均显著增高。干预区干预前后三酰甘油显著下降,对照区干预前后总胆固醇、血糖均显著增高。干预前后男性吸烟率干预区有下降、对照区有上升,饮酒率两区干预前后均有上升,均无统计学意义。2000年两区脑卒中的年发病率和年死亡率(标化率)显著低于1991年,2000年干预区脑卒中的年发病率(粗率和标化率)显著低于对照区,2000年对照区脑卒中的年死亡率(粗率)显著高于干预区。结论社区综合性脑卒中防治是降低脑血管病发病和死亡的有效途径。

Aim To explore the effective measures fo r lowering multiple risk factors for stroke and incidence and mortality of cerebrovascular d isease in community population.Methods In Changsha city,2geographically separated communities with registe red population of approximately 50000each similar demographic characteristics were selected as either intervention or control communities in 1991.During April to May in 1992before inter-vention,eight variables were measu red in 812and 831subjects of random sampling individuals,35to 74years of age,from intervention and contro l community respectively.In intervention community,a program of treatm ent for hypertension,heart disease,an d diabetes was instituted and health edu-cation was provided to the full intervention community.A follow-survey was conducted in 2000in 804and 826subpopulation under the same condition as before it.Comparisons of interve ntion and control communities were p ooled to yield a single summary.Results Systolic blood pressure,body mass i n-dex,body weight and high-density lipoprotein cholesterol significant ly in-creased after intervention in the both communities(P<0.05or 0.01),and diastolic blood pressure,choleste rol and blood glucose also significantly in-creased in the control communities(P<0.05);however,diastolic blood pressure tended to decrease,and triglycerides significantly decrease d after intervention in the intervention area(P<0.05).The prevalence of smoking20cigarettes or more daily in men was44.6%in 1992and 42.4%in 2000in the intervention community,mean while 45.2%in 1992and 46.0%in2000in the control community.Drinking rate tended to rise after interve n-tion,however,no further attempt wa s possible to differentiate between1991and 2000in each community.The crude and adjusted-incidence of stroke an d crude mortality of stroke in 2000in t he intervention community were sign if-icantly lower than those in the contr ol community(P<0.05or 0.01).Conclusion A community-based intervention for stroke reduction is feasible and effective in Changsha.Interven tion measures,focused on health educa-tion and hypertension control,play an important and effective role in lo wering incidence and mortality of stroke.