【作者】 周慧；

【导师】 周小军；

【作者基本信息】 南昌大学 ， 公共卫生与预防医学， 2019， 硕士

【摘要】 目的:慢性病已经成为21世纪的主要卫生和发展挑战之一,不仅给患者造成了精神和物质上的双重打击,更给全国乃至全世界带来了巨大的经济负担和社会压力,阻碍了可持续社会的进一步发展。慢性病及其影响因素的数据监测是改善慢性病患病情况的一项重大举措。西湖区自建成慢性病防控示范区以来,于2011、2015年共进行了两次慢性病及其影响因素的监测,本次课题通过进行第三次慢性病监测,来对比2011、2015年和2018年的慢性病及其影响因素的变化,从而研究分析2011-2018年西湖区慢性病及其影响因素的流行趋势,为西湖区慢性病的预防和控制提供科学依据。方法:本次调查为横断面调查,也是在2011、2015年的调查基础上进行的追踪调查,为保持调查的延续性和调查结果的可比较性,采用的调查方法和方案均与前两次基本一致。2011年按照人口容量比法进行分层整群随机抽样,抽取了南昌市西湖区3个街道的6个社区,其中每个街道抽取了2个社区,2018年延用此2011年的抽样结果,本次课题于2018年5-9月期间随机抽取了3548例18周岁以上的社区居民;通过使用江西省慢病综合防控示范区社区诊断的调查问卷和体格测量来收集西湖区慢性病的患病情况及其影响因素;运用秩和检验、卡方检验、单因素和多因素的logistic回归等方法来描述分析患病率及其影响因素。结果:2011、2015、2018年的慢性病标准化患病率分别为15.05%、27.14%、32.30%,慢性病疾病谱的前四位疾病均为高血压、糖尿病、高血脂、心脏病;调查的社区居民的消瘦和超重率、有疾病家族史的构成率在总体上均有所下降(P<0.005),饮酒率有所降低(P<0.005),口味、性格分别向变淡和变外向转变(P<0.005),平均每天千步当量数、运动达标率有所上升(P<0.005),人日均蔬菜和水果的食用量、刷牙次数、慢性病高危因素的知晓率总体均有不同程度的上升(P<0.005),高盐饮食率有所下降(P<0.005);但是,肥胖、腹部肥胖率均有所上升(P<0.005),主动吸烟率、有压力紧张的比例有所上升(P<0.005),乳及乳制品的饮用率、人日均睡眠时间、充足睡眠达标率有所降低(P<0.005),居民饮食规律率、营养标签知晓率均有所下降(P<0.005);慢性病的主要危险因素是年龄、体型肥胖、腹部肥胖、吸烟(OR>1,P<0.05),主要的保护因素为无高血压、糖尿病家族史,口味淡、高水果食用量(OR<1,P<0.05)。结论:西湖区的卫生部门应积极采取措施控制慢性病患病率的上升,并将高血压、糖尿病、心脏病、高血脂作为四大主要慢性疾病,联合多个部门共同采取行动进行综合防控;西湖区的大部分的不良生活方式得到了改善,但仍应加大对全人群进行健康生活行为方式的教育和宣传,促进吸烟、肥胖等不良影响因素的进一步改善;此外,还应针对年龄、吸烟等主要危险因素来完善预防和控制慢性病的政策措施,并重点加强对高危人群的慢性病预防性筛查和治疗,提高其健康素养,从而提高社区居民的身体健康水平。更多还原

【Abstract】 Objective:Chronic diseases have become one of the major health and development challenges of the 21 st century.They have not only caused psychological and material shocks to patients,but also brought enormous economic burden and social pressure to the whole country and the world,and hindered the further development of sustainable society.Data monitoring of chronic diseases and their influencing factors is a major measure to improve the prevalence of chronic diseases.Since the establishment of the chronic disease prevention and control demonstration zone in Xihu District,two-time chronic diseases and their influencing factors have been monitored in 2011 and 2015.This survey is to compare the survey date from the surveillance done in 2011,2015 and 2018 by conducting the third chronic disease monitoring,so as to study and analyze the epidemic trend of chronic diseases and their influencing factors in Xihu District in 2011-2018,and provide scientific basis for the prevention and control of chronic diseases in Xihu District.Methods:This survey is a cross-sectional survey.It is also a follow-up survey conducted on the basis of the 2011 and 2015 surveys.In order to maintain the continuity of the survey and the comparability of the survey results,the survey methods and schemes adopted are basically the same as the previous two surveys.In 2011,according to the population capacity ratio method,the stratified cluster random sampling was used to extract nine communities in three streets of Xihu District of Nanchang City,each of which extracted two communities,and the results of this 2011 sample were extended in 2018.During the period from May to September 2018,3548 cases of community residents aged 18 and over were randomly selected.The questionnaires and physical measurements of community diagnosis in the chronic disease prevention and control demonstration area of Jiangxi Province were used to collect the date of chronic diseases and its influencing factors in Xihu District;using rank sum test,chi-square test,single factor and multi-factor logistic regression to describe the analysis of theprevalence and its influencing factors.Results:The standardized prevalence rates of chronic diseases in 2011,2015 and 2018 were 15.05%,27.14% and 32.30%,respectively.The top four chronic disease of the spectrum were hypertension,diabetes,hyperlipidemia and heart disease;there is a general downward in the rate of thin and overweight,composition rate of family history of disease from surveyed community residents(P<0.005).Drinking rate of acohol decreased(P<0.005),and taste and personality were lightened and extroversion(P<0.005),the average number of kilosteps per day,the rate of exercise compliance increased(P<0.005),the daily consumption of vegetables and fruits per person,the times of daily brushing,the frequency of physical examination,and the awareness rate of high risk factors of chronic diseases were upward in total(P<0.005),and the high-salt diet rate showed a downward(P<0.005);however,obesity and abdominal obesity all showed an upward(P<0.005),the proportion of active smoking,total smoking rate(both active and passive)and stressfulness increased(P<0.005),drinking rate of milk,daily sleep time per person,rate of adequate sleep compliance and community hospital awareness decreased(P<0.005),the dietary rate and awareness rate of nutrition label of residents showed a downward(P<0.005);The main risk factors of chronic diseases are age,obesity,abdominal obesity,smoking,and high frequency of physical examination(OR>1,P<0.05).In addition,the major protective factors are no family history of hypertension or diabetes,and mild taste,high consumption of fruit(OR<1,P<0.05).Conclusion:The health department of Xihu District should actively take measures to control the increase of the prevalence of chronic diseases,take hypertension,diabetes,heart disease and hyperlipidemia as the four major chronic diseases,and take actions to comprehensively prevent and contro by joint with other departments;the majority of unhealthy lifestyles in Xihu District have been improved,and certain prevention and control effects have been achieved.However,education and publicity on healthy lifestyle behaviors should be increased in order to promote further improvements in adverse factors such as smoke,obesity;in addition,policy to prevent and controlchronic diseases should be improved for high-risk factors,such as age,smoke and so on;and priority should be given to strengthening the preventive screening and treatment of chronic diseases for high-risk groups,and improve their health literacy,thereby improving the health level of community residents.更多还原