【作者】 李琼；

【导师】 周亮； 付志勇；

【作者基本信息】 中南大学 ， 公共卫生， 2012， 硕士

【摘要】 目的：描述2006～2011年长沙市天心区居民的死亡水平与死因顺位变化,分析居民性别死亡率、年龄别死亡率、死因别死亡率等死亡特征,探讨天心区居民的死因谱和重点死因,为天心区制定社会经济发展策略和卫生资源配置规划提供依据。方法：以天心区疾病监测点收集的2006年1月1日至2011年12月31日死亡的长沙市天心区辖区管理的所有死亡个案为研究对象,以天心区统计局出具的户籍登记人口学资料为人口基数,对长沙市天心区死因监测资料进行分析,探讨该区居民死亡特征,包括人口特征、居民死因谱构成、死亡率变化趋势、主要死因等。采用全国疾病监测系统软件DeathReg2005,按照国际疾病分类ICD-10将上报资料归类分编,经整理、编码后录入数据库。获取2006～2011年按照《国际疾病分类ICD-10》进行编码的死因监测数据,采用SPSS17.0软件包进行描述性统计分析。结果：长沙市天心区2006～2011年共死亡12223人,其中男性7065人,女性5158人,男女性别比为1.37,平均年龄70.21±15.99岁。6年的平均粗死亡率为496.60/10万,平均增长速度为8.5%。全死因构成以循环系统疾病所占比例最高,占43.2%,死亡率215.12/10万；其次为肿瘤,占28.5%,死亡率138.18/10万；第三为呼吸系统疾病,占11.4%,死亡率56.50/10万；死因诊断不明者占2.4%,各年比例均符合规范要求(低于5%)。2006～2011年死因顺位前四位均保持未变,分别为循环系统疾病、肿瘤、呼吸系统疾病、疾病和死亡的外因,四类疾病的死亡率均逐年升高,至2011年分别达到234.28/10万、164.72/10万、67.29/10万和24.61/10万。2006～2011年男女死亡率呈逐年升高,6年间男性死亡率均高于女性。男女死因顺位前10位的疾病类型相同,但构成比有差别。根据天心区户政人口登记信息将人群分为0～17岁,18～34岁,35～59岁,60岁及以上四个年龄段,各年龄段死亡人数的构成比分别为1.06%、1.88%、19.6%和77.46%,平均年死亡率分别为44.00/10万、26.26/10万、261.72/10万和2462.34/10万。各年龄段死因构成不同,顺位前3位分别是：0-17岁组,起源于围生期的某些情况(25.6%)、疾病和死亡的外因(23.3%)、先天畸形,变性和染色体异常(13.2%)；18～34岁组,疾病和死亡的外因(43.0%)、肿瘤(33.0%)、循环系统疾病(5.7%)；35～59岁组,肿瘤(44.7%)、循环系统疾病(26.8%)、疾病和死亡的外因(11.4%)；60岁及以上组,循环系统疾病(49.2%)、肿瘤(23.9%)、呼吸系统疾病(13.8%)。2006～2011年天心区居民循环系统疾病死亡率为215.13/10万,以慢性缺血性心脏病、脑内出血、急性心肌梗死、脑梗死和高血压心脏病较高。肿瘤死亡率为138.18/10万,以支气管和肺恶性肿瘤、肝和肝内胆管恶性肿瘤、胃恶性肿瘤、食管恶性肿瘤、直肠恶性肿瘤较高,女性中乳腺癌顺位则居第三。呼吸系统疾病死亡率为56.50/10万,以慢性支气管炎、肺气肿、肺炎、单纯性和粘液化脓性慢性支气管炎、细菌性肺炎较高。疾病和死亡的外因死亡率为26.32/10万,以平面摔倒、车祸、自害、跌落为主。内分泌、营养和代谢的其他疾病死亡率为12.72/10万,以各种类型糖尿病为主,其中非胰岛素依赖型糖尿病居首位。结论：长沙市天心区2006-2011年前四位死因顺位保持为循环系统疾病、肿瘤、呼吸系统疾病、疾病和死亡的外因不变。循环系统疾病中的首位死因是慢性缺血性心脏病,肿瘤中的首位死因是支气管和肺恶性肿瘤,呼吸系统疾病中的首位死因是慢性支气管炎,疾病和死亡的外因中的首位死因是同一平面滑倒、绊倒或摔倒。更多还原

【Abstract】 Objective:To provide scientific evidence for the policy making of economic development and health resource allocation in Tianxin District of Changsha by describing the fluctuation in the mortality and rank of the death causes of citizens in Tianxin District, analyzing character of gender, age and cause-specific mortality, and discussing the major death cause of the citizens.Methods:All the death cases collected by the disease monitoring points in Tianxin District from1/January/2006to31/December/2011were treated as objects in the study. Annually average population was provided by Tianxin statistical bureau according to household registers. The data was analyzed to reveal the trait of the death, including socio-demographic characteristics, proportion of various death causes, mortality tendency, and major cause of death. The software DeathReg2005was applied in the surveillance of death causes which were categorized according to ICD-10, and then all the data were encoded and entered into the computer. Descriptive statistical analysis was implemented with SPSS software package17.0.Results:A total of12223deaths whose average age was70.21±15.99years old were collected from2006to2011, with a gender ratio of1.37(7065 males and5158females). Annually, the average crude mortality was496.60/105and the average growth rate was8.5%. Disease of the circulatory system made up most (43.2%) of all death cases and the specific mortality was215.12/105; neoplasms made up the second most (28.5%) and the specific mortality was138.18/105; the third most was diseases of respiratory system (11.4%) with a mortality of56.50/105; unclassified death cases (there are symptoms, signs and abnormal clinical and laboratory findings, but not elsewhere classified) made up2.4%which is conform to the requirement (<5%).The top forth causes of death kept unchanged during the six years, which were diseases of the circulatory system, neoplasms, diseases of the respiratory system, and external causes of morbidity and mortality, respectively. The mortality of the four diseases kept increasing year by year which reached234.28/105,164.72/105,67.29/105, and24.61/105in2011respectively.Gender-specific mortality of both male and female kept increasing, and the mortality of male was higher than that of female in each year. The top tenth causes of death of male were identical to that of female but the proportion was different. According to the household register in Tianxin, citizens were categorized by age into4groups:0-17years old,18-34years old,35-59years old and more than60years old. The proportion of death in each group was1.06%,1.88%,19.6%and77.46% respectively, and the mortality of each group was44.00/105,26.26/105,261.72/105, and2462.34/105respectively. The major causes of death in each group were different. For0-17group, the top third causes were: pregnancy, childbirth and the puerperium (25.6%); external causes of morbidity and mortality (23.3%); and congenital malformations, deformations and chromosomal abnormalities (13.2%). For18-34group, the top third were:external causes (43.0%); neoplasms (33.0%); and diseases of the circulatory system (5.7%). For35-59group, the top third were:neoplasms (44.7%); diseases of the circulatory system (26.8%); and external causes (11.4%). For more than60group, the top third were: diseases of the circulatory system (49.2%); neoplasms (23.9%); and diseases of the respiratory system (13.8%).Cause-specific mortality of diseases of the circulatory system was215.13/105; chronic ischaemic heart disease, intracerebral haemorrhage, acute myocardial infarction, cerebral infarction, and hypertensive heart disease were the major causes in this category. Mortality of neoplasms was138.18/105; malignant neoplasm of bronchus and lung, liver and intrahepatic bile ducts, stomach, oesophagus, and rectum were the major causes in cancer; specifically, breast cancer in female death was the third common. Mortality of external causes was26.32/105; fall on same level, transport accidence, intentional self-harm, and fall from building or structure were the major causes in injury. Mortality of endocrine, nutritional and metabolic diseases was12.72/105; non-insulin-dependent diabetes mellitus and other types of diabetes were the major causes.Conclusions:The top four causes of death of citizens in Tianxin varied among diseases of the circulatory system, neoplasms, diseases of the respiratory system, external causes of morbidity and mortality. Chronic ischaemic heart disease was the most common cause of death in diseases of the circulatory system; likewise, unspecified chronic bronchitis in respiratory diseases, non-insulin-dependent diabetes mellitus in endocrine diseases, and fall on same level in external causes.更多还原