【摘要】：目的：分析1992至2007年甘肅居民總死亡率變化趨勢、人群死亡原因分布特點,找出甘肅省居民死亡的主要病種及順位,各主要系統(tǒng)疾病死亡率及變化趨勢、主要單病種死亡率及趨勢,以及在人群分布特點；分析1978-2007年甲乙類法定傳染病發(fā)病率及趨勢,傳染病發(fā)病順位及主要傳染病發(fā)病趨勢,人群分布特點,為未來甘肅省居民健康戰(zhàn)略的制定提供依據(jù)。 方法：甘肅省人口疾病死亡資料來源于1992年-2007年甘肅省疾病監(jiān)測點年度報表及監(jiān)測點居民死亡醫(yī)學證明書；傳染病疾病資料來源于甘肅省疾病預(yù)防控制中心1978-2007年法定傳染病疫情監(jiān)測資料；采用年估計百分比變化(EAPC)來衡量各種率的變化趨勢。 結(jié)果： 1.甘肅省16年全死因趨勢變化狀況 1.1甘肅省16年疾病死亡率趨勢及死因順位變化情況 1.1.1甘肅省居民粗死亡率及其趨勢：1992-2007年,甘肅省居民及男女人群總死亡率略有下降,變化趨勢無統(tǒng)計學差異,男性死亡率高于女性人群。0-4歲、5-14歲組居民死亡率呈現(xiàn)下降趨勢,其死亡率EAPC分別為-4.30%、-4.40%,其他年齡組死亡率變化趨勢沒有統(tǒng)計學意義,0-4歲及60歲以上居民死亡率最高。 1.1.2甘肅省居民死亡的主要疾病類型：1992-2007年呼吸系統(tǒng)疾病、循環(huán)系統(tǒng)疾病、腫瘤、損傷中毒及外部原因四大類疾病死亡人數(shù)占全死因的75%以上,為影響甘肅省居民健康的主要疾病類型。 1.2甘肅省16年主要系統(tǒng)疾病死亡率變化趨勢 1.2.1呼吸系統(tǒng)疾病死亡率趨勢：呼吸系統(tǒng)疾病死亡率波動較大,變化趨勢無統(tǒng)計學意義(P0.05)。男性呼吸系統(tǒng)疾病死因別死亡率高于女性,慢性下呼吸道疾病和肺炎死亡人數(shù)共占呼吸系統(tǒng)疾病死亡人數(shù)96.59%,為主要呼吸系統(tǒng)疾病致死原因。肺炎死亡率呈現(xiàn)下降趨勢,EAPC=-9.79%,肺炎死亡的居民主要集中在0-4歲及60歲以上年齡組,慢性下呼吸道疾病死亡居民集中在45歲-59歲年齡組,60歲以上人群。 1.2.2循環(huán)系統(tǒng)疾病死亡率趨勢：1993-2007年,全省居民循環(huán)系統(tǒng)疾病男女及總?cè)巳核劳雎什▌虞^大,變化趨勢均無統(tǒng)計學差異,男性死亡率明顯高于女性。腦血管疾病和心臟疾病死亡人數(shù)共占91.86%,為循環(huán)致死的主要疾病種類；1992-2007年腦血管疾病死亡率表現(xiàn)為增長趨勢EAPC為2.43%,其中男性腦血管疾病死亡率EAPC為2.33%增長低于女性EAPC的2.53%,心臟病死亡率EAPC=5.97%,其中男性腦血管疾病死亡率EAPC=6.72%高于女性EAPC=5.23%;16年合計腦血管疾病和心臟疾病死亡率,男性死亡率175.33/10萬高于女性的150.43/10萬,腦血管病死亡和因心臟病死亡居民均主要集中在45歲以上人群,其中60歲以上人群所占比例最大,均占到全人群的60%以上。 1.2.3腫瘤死亡率趨勢：1992-2007年男女及全人群腫瘤死亡率變化趨勢較平穩(wěn),趨勢變化無統(tǒng)計學意義。男性腫瘤疾病死因別死亡率高于女性,各年份男性腫瘤死亡率均高于女性。消化器官腫瘤為腫瘤致死的主要病種,男女及全人群消化器官腫瘤死亡率變化趨勢無統(tǒng)計學意義,各年份男性消化器官腫瘤死亡率均高于女性,各年份消化器官腫瘤死亡居民均主要集中在60歲以上年齡組。 1.2.4損傷、中毒及外部原因死亡率趨勢：男性損傷、中毒及外部原因死亡率均低于女性,無意識意外死亡人數(shù)和有意識意外死亡人數(shù)合計為8763人,占到全部的97.04%,為損傷、中毒及外部原因死亡致死的主要類型；各年份無意識死亡率男性均高于女性,有意識意外死亡率的女性略高于男性,差異無統(tǒng)計學意義；無意識意外死亡和有意識意外死亡的居民均集中在以15-44歲年齡組,其次為45-59歲及60歲以上年齡組。 2.甘肅省30年法定傳染病發(fā)病率變化趨勢狀況 2.1傳染病總體發(fā)病趨勢,主要傳染病順位及種類 2.1.1傳染病總體發(fā)病情況：1978-2007年,甘肅省傳染病發(fā)病率EAPC=-4.11%,乙肝、肺結(jié)核和丙肝發(fā)病率處于逐年上升趨勢,其中丙肝發(fā)病率增長最快EAPC=20.56%,其次為肺結(jié)核發(fā)病率EAPC=9.97%,乙肝發(fā)病率EAPC=7.86%。同時痢疾和甲肝發(fā)病率有逐年下降趨勢,甲肝發(fā)病率EAPC=-11.40%,下降快于痢疾發(fā)病率EAPC=-9.34%,而麻疹發(fā)病率EAPC=-7.50%,但是波動較大,變化趨勢無統(tǒng)計學意義。 2.1.2主要傳染病種類：腸道傳染病中痢疾發(fā)病最高占到了總的70.27%,呼吸道傳染病主要是肺結(jié)核占到全部的95.57%,血源性及性傳播傳染病主要是乙肝占89.91%。 2.2各主要傳染病發(fā)病趨勢和人群分布特征 2.2.1乙肝發(fā)病情況：甘肅省乙肝發(fā)病率呈增長趨勢EAPC=11.18%,幅度高于全國乙肝發(fā)病率EAPC=8.44%。乙肝發(fā)病多集中在青壯年,即15-44歲年齡組,平均占全省發(fā)病總數(shù)的69.77%。發(fā)病以農(nóng)民、學生為主,占總報告病例數(shù)的67.20%,,特別是農(nóng)民占49.87%。 2.2.2肺結(jié)核發(fā)病情況：1997-2007年甘肅省與全國肺結(jié)核發(fā)病均表現(xiàn)為上升趨勢,其中甘肅省肺結(jié)核發(fā)病率EAPC=8.44%,上升速度快于全國肺結(jié)核發(fā)病率EAPC=8.00%,男性發(fā)病率高于女性,2007年肺結(jié)核報告病例數(shù)較多的為60歲-、65歲-、70歲-年齡段。農(nóng)民、學生、離退人員、家政和工人為主,占總報告病例數(shù)的91.00%,其中農(nóng)民占73.90%。 2.2.3菌痢發(fā)病情況：1991-2007年甘肅省及全國菌痢發(fā)病率呈現(xiàn)逐年下降趨勢,但甘肅省菌痢發(fā)病率波動較大,趨勢不明顯,發(fā)病主要集中在0-20歲年齡段,占總發(fā)病數(shù)的65.76%,發(fā)病數(shù)以農(nóng)民、散居兒童為主,占發(fā)病總數(shù)的53.75%,其次為學生和幼托兒童,占發(fā)病總數(shù)的30.48%。 2.2.4艾滋發(fā)病情況：自1997年至2007年,艾滋病、HIV感染者和死亡病例的年平均增長速度分別為48.17%、39.94%和40.97%。HIV感染者傳播途徑以經(jīng)注射毒品感染為主,占38.41%。經(jīng)受(供)血感染者占19.53%,經(jīng)異性間性傳播途徑感染者占21.46%,同性傳播占4.94%,母嬰傳播占2.79%,傳播途徑不詳占12.88%。同時,2007年新發(fā)現(xiàn)感染者經(jīng)性接觸感染占33.33%,成為主要的傳播方式。感染者以青壯年為主,20-49歲占全省感染者的86.48%；男女差別逐步縮小,以文化程度較低的農(nóng)民、民工和無業(yè)人員為主。 3.居民平均期望壽命情況：2007年甘肅省居民平均期望壽命為72.10歲,其中男性為70.38歲,女性為74.08歲,1995平均期望壽命為71.21歲,其中男性69.48歲,女性為73.24歲。2007年與1995年相比有所提高,居民平均期望壽命增加了0.89歲,提高1.26%,男性平均期望壽命提高0.90歲提高了1.30%,女性平均期望壽命提高0.84歲提高了1.15%。結(jié)論：甘肅省居民總死因死亡率略微下降,2007年與1995年相比居民的平均期望壽命提高0.89歲,居民健康狀況得到改善；慢性下呼吸道疾病、循環(huán)系統(tǒng)疾病、腫瘤尤其是消化器官、損傷、中毒及外部原因仍然是影響居民健康的主要系統(tǒng)疾病,慢性病如循環(huán)系統(tǒng)疾病死亡率仍然表現(xiàn)為上升的趨勢,上升速度較快的為心臟病,其次為腦血管疾病。肺炎等一些感染性疾病的到控制,呈現(xiàn)出下降趨勢；傳染病整體發(fā)病率表現(xiàn)為下降趨勢,但是丙肝、肺結(jié)核、乙肝及艾滋病增長速度較快,農(nóng)民及學生是乙肝、艾滋病等一些疾病發(fā)病的主要人群。針對以上居民全死因及傳染病的的特點,提示我們在未來政策制定時,應(yīng)該逐步建立其對腫瘤、循環(huán)系統(tǒng)疾病等慢性疾病的監(jiān)測登記制度,加強社區(qū)衛(wèi)生網(wǎng)絡(luò)建設(shè),采用社區(qū)防治的方法,開展對慢性疾病的防控。同時應(yīng)當進一步加強傳染病的監(jiān)控力度,提高監(jiān)測數(shù)據(jù)質(zhì)量,針對疾病重點人群開展有效干預(yù)措施,遏制乙肝、丙肝、艾滋病等傳染病的增長勢頭,降低疾病發(fā)病及死亡率,加強對農(nóng)村、經(jīng)濟水平及衛(wèi)生水平較差地區(qū)的衛(wèi)生投入,關(guān)注低收入、兒童和老人等弱勢群體的健康狀況。
[Abstract]:Objective: To analyze the change trend of total mortality in Gansu Province from 1992 to 2007, the distribution of the cause of death in the population, to find out the main disease and the trend of the death of the residents in Gansu province, the mortality and trend of the main diseases, the mortality and the trend of the main diseases, and the distribution of the population. To analyze the incidence and trend of the legal infectious diseases of the class A and B in 1978-2007, the incidence of infectious diseases and the trend of the main infectious diseases, the distribution of the population, and provide the basis for the development of the health strategy of the residents in Gansu. Method: The data of the death of the population in Gansu Province is from the annual report of the disease monitoring point of Gansu Province from 1992 to 2007 and the medical certificate of the death of the resident of the monitoring point. The data of the infectious disease is derived from the surveillance of the disease surveillance of the disease in Gansu Province from 1978 to 2007 Material; annual estimated percentage change (EAPC) to measure the trend of various rates Potential. Results:1. The whole cause of death in Gansu Province in 16 years The Trend of the Trend of the 16-year Disease Mortality in Gansu Province and the Trend of the Trend of the Trend The change of the cause of death:1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1.1. The mortality rate of the group was-4.30%,-4.40% and the mortality of other age groups. The trend is not statistically significant,0-4 years and 60 years The death rate of the above-mentioned residents is the highest. 1.1.2 The main disease types of the death of the residents in Gansu Province: respiratory disease, circulatory system disease, tumor, injury poisoning and external cause of the four major diseases in Gansu Province, the total cause of death is more than 75% of the total cause of death, in order to affect the Gansu province. The main type of disease in the health of the population. Trends in mortality of major system diseases in the year of 1.2.1. Trends in mortality in the respiratory system: large fluctuations in mortality in the respiratory system, change There was no statistical significance in the trend (P0.05). The death rate of the cause of death of the male respiratory system was higher than that of the female, the number of deaths in the chronic lower respiratory tract and the number of deaths in the case of pneumonia accounted for 96.59. %, for the cause of death for major respiratory diseases. The mortality rate of the pneumonia is decreasing, EAPC =-9.79%, and the population of the death of the pneumonia is mainly concentrated in the age group of 0-4 years and above, and the death population of the chronic lower respiratory disease is concentrated at the age of 45 -59-year-old age group, population above 60 years of age. 1.2.2.2.2.2.2.2.2.2.2.2.2.2.2.2.2.2.2.2.2.2.2.2.2.2.2.2.2.2. The mortality of cerebrovascular disease and heart disease in 1992-2007 was 2.43%, among which, the mortality rate of cerebrovascular disease in men was 2.33%, which was lower than 2.53% of EAPC in female. The mortality rate of heart disease (EAPC) was 5.97%, among which, the death rate of cerebral vascular disease (EAPC) was 6.72% higher than that of female EAPC (5.23%); in 16 years, the death rate of cerebrovascular disease and heart disease was higher than that of female (175.33/10,000), and the mortality of cerebrovascular disease was higher than that of female (150.43/ 100,000), and the death of cerebrovascular disease and the cause of heart disease The death population is mainly concentrated in the population of over 45 years, of which the population of over 60 years of age The proportion is the largest, accounting for more than 60% of the whole population. 1.2.3 The trend of tumor mortality: the deaths of both men and women and all-people in 1992-2007 The trend of the rate of death was stable and the change of the trend was not statistically significant. The death rate of the cause of death of the male tumor was high. In the female, the death rate of the male tumor in all years was higher than that of the female. The cancer of the digestive organs was the main disease of the tumor. The trend of the death rate of the digestive organs of the male and female and the whole population was not statistically significant. The cancer mortality of the digestive organs in each year was higher than that of the female, and the digestive organs in each year were swollen. The death population of the tumor was mainly concentrated in the age group of over 60 years of age. 1.2.4 The trend of death, poisoning and external causes of death: male injury, poisoning and external cause and death rate were lower than that of women, the number of unintentional accidental deaths and the number of intentional accidental deaths were 8763 people, accounting for 97.04% of the total, are the main types of death for injury, poisoning and external causes; in each year, the unconsciousness of the male is higher than that of the female, the female with the conscious accidental death rate is slightly higher than that of the male, the difference is not statistically significant; the unintentional accidental death and the conscious The population of the accidental death was concentrated in the age of 15-44 Age group, followed by age group of 45-59 years and over 60 years. 2. The trend of the incidence of legal infectious diseases in Gansu Province in 30 years State 2.1 General incidence of infectious diseases, major infectious diseases, and type 2.1.1 overall incidence of infectious diseases:1978-20 In 2007, the incidence of infectious disease in Gansu province, EAPC, was-4.11%, and the incidence of hepatitis B, tuberculosis and hepatitis C increased year by year, among which, the incidence of hepatitis C was the fastest, EAPC was 20.56%, followed by the incidence of pulmonary tuberculosis. The rate of EAPC was 9.97%, and the incidence of hepatitis B (EAPC) was 7.86%. The incidence of dysentery and hepatitis A decreased year by year, and the incidence of hepatitis A (EAPC) was-11.40%, which was lower than that of the incidence of dysentery (EAPC =-9.34%), while the incidence of measles was EA. PC =-7.50%, but the fluctuation is large, the change trend is not statistical significance. 2.1.2 Main infectious diseases: the highest incidence of dysentery in the intestinal infectious disease is 70.27%, and the respiratory infectious disease is mainly tuberculosis, accounting for all 95.57%, blood-borne and sexually transmitted infectious diseases are mainly Hepatitis B (89.91%). 2.2 The incidence of major infectious diseases and the distribution of the population. 2.2.1 The incidence of hepatitis B: The incidence of hepatitis B in Gansu is increasing. EAPC = 11.18%, with an amplitude higher than that of the national hepatitis B (EAPC = 8.44%). In the young and middle-aged, that is, the age group of 15 to 44, the average of the total number of the whole province is 69.77%. The incidence of pulmonary tuberculosis in Gansu and the whole country was higher than that of the whole country in 1997-2007. The incidence of tuberculosis in Gansu province was 8.44%, and the rate of increase was faster than that of the national tuberculosis incidence EAPC = 8. 00%, male rate higher than female In 2007, the number of cases of tuberculosis reported was 60,65 and 70. Farmers, students, and retired persons The incidence of bacillary dysentery in Gansu and the whole country is decreasing year by year in 1991-2007, but the incidence of bacillary dysentery in Gansu Province is large, the trend is not obvious, and the main set of disease is the main disease. In the 0-20-year-old age group, 65.76% of the total number of patients and the number of peasants and the scattered children are the main ones. The incidence of AIDS, HIV infection and death was 48.17%,39. 2.4% of the total incidence and 30.48% of the total number of children, and the average annual growth rate of AIDS, HIV-infected persons and deaths from 1997 to 2007 was 48.17%,39. The transmission route of HIV-infected persons was mainly caused by the injection of drug, accounting for 38.41%. The infected persons accounted for 19.53% of the infected persons and 21% of the infected persons. 46%, 4.94% of same-sex transmission, 2.79% of mother-to-child transmission and 12.88 for transmission %. At the same time, in 2007, it was found that the infection of the infected persons accounted for 33.33%, becoming the main mode of transmission. The majority of the infected people were the young and the middle-aged and the 20-49 years of age account for the whole province. The average life expectancy of the residents in Gansu Province in 2007 is 72.10 years. The average life expectancy of the male is 70.38, the female is 74.08, the average life expectancy in 1995 is 71.2. In 2007, compared with 1995, the average life expectancy of the population increased by 0.89, the increase of 1.26%, and the average male's expectation. The life expectancy was increased by 1.30%, the average life expectancy of women was increased by 0.84, and the average life expectancy of the population was increased by 1.15%. Conclusion: The total death rate of the residents in Gansu is slightly lower, and the average life expectancy of the residents in 2007 and 1995 is 0.89. The health status of the residents is improved; chronic lower respiratory diseases, circulatory diseases, tumors, in particular digestive organs, injuries, poisoning and external causes, are the main system diseases affecting the health of the population, and chronic diseases The mortality rate of the circulatory system is still a rising trend, the rising speed is the heart disease, and the second is the cerebrovascular disease. The control of some infectious diseases, such as the pneumonia, presents a downward trend; the overall incidence of the infectious disease is shown to be a descending trend, but the hepatitis C, The rate of tuberculosis, hepatitis B and AIDS is fast, and the farmers and students are the main population of some diseases, such as hepatitis B and AIDS. In view of the causes of the cause of death and infectious diseases of the above-mentioned residents, it is suggested that we should gradually set up their response to the swelling in the development of future policies Chronic disease, such as tumor, circulatory system disease, etc. The system of monitoring and registration of the disease, strengthening the construction of the community health network, adopting the method of community prevention and control, and carrying out prevention and control of the chronic diseases, meanwhile, the monitoring of the infectious diseases should be further strengthened, the quality of the monitoring data can be improved, and the effective drying is carried out on the disease focal groups. Pre-measures to stop the growth of infectious diseases such as hepatitis B, hepatitis C and AIDS, reduce the morbidity and mortality of the disease, and strengthen the rural areas
【學位授予單位】：蘭州大學
【學位級別】：碩士
【學位授予年份】：2010
【分類號】：R195;R181.3

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1 張云;青島市居民死因描述性研究[D];山東大學;2006年

2 楊正輝;威海市1998～2005年居民死亡原因描述性研究[D];山東大學;2007年

3 張承業(yè);桐城市1998-2007年居民死亡原因分析[D];安徽醫(yī)科大學;2008年

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