【作者】 张承业；

【导师】 叶冬青；

【作者基本信息】 安徽医科大学 ， 流行病与卫生统计学， 2008， 硕士

【摘要】 目的通过对桐城市1998-2007年居民死亡原因进行分析,描述桐城市居民死因分布特点,探索十年间桐城市居民死因变化规律,进一步了解桐城市居民健康状况,为桐城市制订医疗保健政策和卫生部门进行卫生规划和卫生资源的合理配置提供依据。方法根据桐城市1998-2007年《居民病伤死亡原因年报表》及其相关资料,从桐城市人口的数量、结构、人口变动特征、人口死亡特征、各年龄段的主要死因特征、主要死亡原因的死亡构成等方面进行了统计计算、分析和阐述;从不同的角度出发,了解桐城市居民的死亡结构特点及其对居民寿命、健康状况的影响。资料分析采用中国疾病预防控制中心开发的《疾病监测统计软件》、SPSS10.0及EXCEL处理。分析指标有:1.人口学指标:人口发展速度、增长速度、年龄构成比、性别比、出生率、死亡率、自然增长率。2.死亡水平测量指标:粗死亡率、标化死亡率、分年度死亡率、分年龄段死亡率、分性别死亡率、分病因死亡率。3.反映死因构成和死因顺位的指标:分年龄分性别的死因顺位及构成、分病因的死因顺位及构成。4.全人群期望寿命及去死因期望寿命、重要疾病的潜在减寿年数、减寿率。结果1.桐城市年平均人口为713,250~748,023,男女比为1.05,2.粗死亡率为7.85‰～9.62‰,标化死亡率为5.10‰～6.35‰;男性粗死亡率为8.23‰～8.87‰,标化死亡率为5.22‰～5.18‰;女性粗死亡率为7.16‰～8.05‰,标化死亡率为4.7‰～5.3‰。3.年龄别总死亡率曲线无论男女均呈“√”字型,15岁以前0岁组死亡率最高,15岁以后死亡率随年龄的增加而递增,各年龄组死亡率除1998-2007年1-4岁组女性高于男性外,其余男性均高于女性。4.儿童死亡率在0.86‰～0.92‰波动。5.前10位死因依次为恶性肿瘤、脑血管病、心脏病、呼吸系病、损伤与中毒、消化系疾病、内分泌等病、泌尿生殖系病、精神病和神经系病,不同年份稍有出入。6.儿童和青壮年年龄组死因主要为损伤与中毒,中年年龄组为恶性肿瘤,而老年年龄组则以脑血管病为主。7.恶性肿瘤前5位死因依次为胃癌、食管癌、肺癌、肝癌、直肠癌,占恶性肿瘤死亡构成的75%以上,前4位死亡率均男性高于女性,直肠癌死亡率男女接近8.心脏病主要死因依次为冠心病、风心病、肺心病和高心病,冠心病死亡占心脏病死亡总数超过80%,其中心肌梗塞死亡占冠心病死亡的一半以上。9.损伤与中毒的五大死因依次为车祸、自杀、跌落、淹死、中毒,占损伤中毒死亡总数的80%左右,男性死亡率高于女性,男性的第一死因是车祸,占40%左右,女性的第一死因是自杀,占50%以上。10.桐城市人口期望寿命波动于74.67-75.82之间,女性期望寿命高于男性,男女寿命差平均为4.56岁.11.桐城市死因中造成潜在减寿年数最多的是恶性肿瘤、损伤中毒、脑血管病和心脏病。2007年与1998年比,全死因PYLL率男女均有所下降,但肿瘤、脑血管病PYLL率呈上升趋势。男性PYLL率均比女性高,尤其是损伤中毒。结论1.桐城市人口呈缓慢增长趋势,自然增长率出现正增长,桐城市尚未进入老龄化社会。2.死亡率呈先升后降趋势,同期男性死亡率均高于女性。3.婴儿死亡率下降;婴儿年龄愈小,死亡率和死亡百分比愈高。4.年龄、性别不同,死亡的主要原因和死亡率差别较大。儿童( 0-14岁组)和青壮年(15-44岁组)死亡构成比呈下降趋势,中年(45-64岁组)死亡比例为青壮年的2.1-2.7倍,且随时间的后移呈上升趋势,老年(65岁以上)死亡人口将近死亡总数的70%,保持稳定。5.脑血管病、呼吸系病、消化系病、泌尿系病和传染病死亡率呈下升趋势,恶性肿瘤、心脏病、内分泌病、损伤与中毒、神经病和精神病死亡率呈上升趋势。慢性非传染性疾病成为致死的主要原因,恶性肿瘤逐步成为危害人们健康的第一杀手。6.期望寿命随年龄上升而逐渐减少,男女性期望寿命差距随年龄上升而减小。损伤与中毒的PYLL构成远高于其死亡的构成,为青年型死因,寿命损失较大。建议1.进一步巩固和完善人口出生与死亡登记报告制度,严格质量控制.2.加强重点慢病如:恶性肿瘤、脑血管病、损伤与中毒等的监测工作,探索病因和主要危险因素,进行有效干预,实施近期、远期效果评价,调整卫生政策。3.重视健康教育这一现代疾病预防的重要手段,将健康教育视为一种健康投资行为。4.建立健全社区卫生服务网络,拓展和完善社区卫生服务预防、医疗、保健、康复、健康教育及计划生育技术服务等功能。5.做好充分思想和物质准备,迎接人口老龄化的挑战和应对慢性非传染性疾病的威胁。更多还原

【Abstract】 ObjectiveThrough the analyses of residents’death cause of Tongcheng city from 1998 to 2007, the research describes the distributional characterizations of death causes and explores the trend during the ten years, which can further find out health status of residents, and offer evidences to draw policy for medical and reasonable program and disposition of medical recourses in Tongcheng city.MethodsBased on the annual report on death causes of residents’diseases and injuries of Tongcheng city and its relevant data from 1998 to 2007, statistical calculations and analyses were performed from the quantity, structures, characteristics of population changes, characteristics of deaths ,characteristics of major death causes in all age group, the composition of major death causes , etc. characteristics of residents’death composition in Tongcheng and its influence on their life span and health status were also understand from different angles。The data was managed with disease surveillance statistical software developed by Chinese CDC; together with SPSS11.0and Microsoft office excel2003.the indexes to be analyzed were as follows.1.demographic indexes: population develop rate , growth rate ,constituent ratio of age ,dependency ratio, the ratio of the aged to the younger, sex ratio ,birth rate ,mortality rate ,natural increase rate(NIR).2.Indexes of death level: crude birth rate (CBR), crude mortality rate (CDR), standardized mortality rate, year-specific mortality rate, age-specific mortality rate, sex- specific mortality rate, cause-specific mortality rate.3. Indexes of population and sequence of death cause proportion and sequence of death causes in different age, gender and causes.4. Infant life expectancy, life expectancy, cause eliminated life expectancy, potential years of life lost (PYLL), PYLL%.Results1. The average number of population of Tongcheng city is 730636, ratio of male with female was 1.05.2. CBR was 7.85% and 9.62%, standardized mortality between 5.10% and 6.35%; male CDR was 8023% to 8.87%. Standardized mortality 5.22% to 6.18%; female CDR was 7.16% to 8.05%. Standardized mortality was 4.7% to 5.3%.3.The curve of total age-specific mortality fit with the word“√”,regardless male or female. Mortality rate of 0-age group was the highest before the age of fifteen, and mortality rate increased with age after fifteen. Female’s mortality rate was higher than male except 1 to 4 age groups in the years of 1999 to 2003. 4. Children’s mortality rate was 0.66% to 0.82%.5. the ten leading death causes ,in turn ,was malignant neoplasm , cerebrovascular diseases, cardiovascular diseases ,respiratory system diseases, injury and poisoning ,digestive system diseases, incretion diseases, urinary Andréproduction system diseases, mental disorder and nervous system disease .the death causes of the different years had slight differences .6. The main death causes for children’s and young adults’’were injury and poisoning, while the middle age were malignant neoplasm and the old age were cerebrovascular disease.7. Five leading causes of malignant neoplasm were cancers off lung, lever, stomach, esophagus and rectum, which occupy 75% of all malignant neoplasm death the four leading mortality rate of male were higher than female ,while the mortality rate of rectum cancer access to female .8. The main death causes of heart disease were coronary, rheumatic, pulmonary and hypertensive heart disease. The death toll of coronary heart disease occupied over 80 percent of that of total heart disease. Moreover the death toll of acute myocardial infarction occupied over half of that of coronary heart disease.9. Five leading death causes of injury and poisoning were traffic accident, suicide, falling down, drowning and poisoning, which occupied 80 percent of injury and poisoning death. The death rate of male was higher than that of female. The primary death cause of male was traffic accident, which occupied about 40 percent. However the primary death cause of female was suicide, which occupied more than 50 percent.10. Life expectancy of people in Tongcheng city varied from 73.8 to 75.5, life expectancy of female was higher than that of male. The average difference of life expectancy between male and female was 3.56.11. What contributed most to potential life expectancy decreasing were malignant tumor, injury and poisoning, cerebrovasculardisease and heart disease. Compared with 1998, the whole death cause PYLL rate of male and female both decreased in 2007.Whereas the PYLL rates of tumor and cerebrovascular disease increased. The PYLL rate of male was higher than that of female, especially in injury and poisoning.Conclusion1. The population of Tongcheng city is slowly increasing. The natural increasing rate takes on positive rise, and Tongcheng city has not became an aging society yet.2. The death rate presents a trend that going up before going down. The death rate of male is higher than that of female in the corresponding period. 3. The infant death rate is decreasing. The younger infants are, the higher death rate and percentage show.4. The main death causes and rate are obvious different according to age and sex. The mortality rate of Children (0-14 year-old group) and young adults (15-44 year-old group) presents a downtrend; and the death ratio of middle-aged adults (45-64 year-old group) is 2.1-2.7 times than that of young adults, which presents an uptrend as time passes by; the death ratio of senior citizens was about 70% of the total death ratio, and remained stability.5. The death rates of cerebrovascular disease, respiratory system disease, digestive system disease, urinary system disease and infectious disease present a downtrend. The death rates of malignant tumor, heart disease, endocrinopathy, injury and poisoning, psychopathy and neuropathy present an uptrend. Chronic non-infectious disease becomes the most important death cause. Malignant tumor gradually becomes the first killer to people’s health.6. Life expectancy is decreasing as age increasing, and difference of life expectancy between male and female is decreasing as age increasing too. The PYLL ratio of injury and poisoning is higher than death ratio, which is the young adults` main death cause with the larger loss of life. Suggestions:1. We should control the quality through further consolidating and improving the registration and reporting system of birth and death.2. We should strengthen the monitoring of chronic disease such as malignant tumor, cerebrovascular disease, injury and poisoning. Meanwhile explore the causes and main hazards, do effective interventions, evaluate the long-term and short-term effect, then adjust health policies.3. We should stress on health education which is an important mean to prevent modern disease, and take health education as a healthy investment.4. We should establish a perfect community sanitation service network and consummate the functions of community sanitation service concerning prevention, medical care, rehabilitation, health education, and family planning etc.5. We should prepared mentally and materially to handle the coming challenge of ageing society and threaten of chronic non-infectious disease.更多还原