本文選題：空氣污染　切入點(diǎn)：心血管死亡　出處：《北京協(xié)和醫(yī)學(xué)院》2016年博士論文

【摘要】：第一部分：中國城市地區(qū)控制空氣污染的心血管健康獲益研究背景與目的空氣污染已經(jīng)成為我國面臨的一個(gè)重要的環(huán)境與公共衛(wèi)生問題。在可改變的危險(xiǎn)因素中,空氣污染位列造成我國疾病負(fù)擔(dān)的第四位。2008年北京奧運(yùn)會(huì)召開期間,中國政府采取了一系列嚴(yán)格的減排措施保證空氣質(zhì)量。流行病學(xué)研究發(fā)現(xiàn),降低細(xì)顆粒物(PM2.5)水平能減少心血管疾病和全因死亡。本研究擬利用數(shù)學(xué)模型預(yù)測在2016～2030年我國城市地區(qū)35-84歲人群中空氣質(zhì)量提高的心血管健康獲益,并與傳統(tǒng)心血管疾病危險(xiǎn)因素控制的健康獲益進(jìn)行比較。研究方法中國心血管疾病政策模型是一種基于計(jì)算機(jī)編程模擬技術(shù)建立的心血管發(fā)病、死亡和干預(yù)措施的投入和效果的預(yù)測評(píng)價(jià)模型,可以用于分析中國35～84歲人群冠心病和卒中的發(fā)病流行趨勢(shì)。依據(jù)聯(lián)合國人口計(jì)劃署預(yù)測的我國總?cè)丝诤统擎?zhèn)化水平,估計(jì)中國城市地區(qū)2016～2030年間的人口數(shù)量。利用中國健康與營養(yǎng)調(diào)查1990～2009年的傳統(tǒng)心血管疾病危險(xiǎn)因素的變化趨勢(shì),預(yù)測2016～2030年危險(xiǎn)因素的變化趨勢(shì)。應(yīng)用meta分析匯總長期PM2.5暴露對(duì)冠心病、卒中死亡以及全因死亡的效應(yīng)。在維持傳統(tǒng)心血管疾病危險(xiǎn)因素的背景趨勢(shì)變化基礎(chǔ)上,模擬2016～2030年間PM2.5水平導(dǎo)致的我國城市地區(qū)35～84歲成年人中因冠心病和卒中死亡數(shù)。其中,現(xiàn)況情境保持PM2.5水平不變(62μg/m3)；空氣污染改善情境包括三種,假定2016～2030年間,PM2.5年平均濃度能逐漸線性地降低到以下三個(gè)PM2.5目標(biāo)值：(1)北京2008年北京奧運(yùn)會(huì)PM2.5濃度(55μg/m3)；(2)我國二級(jí)空氣質(zhì)量標(biāo)準(zhǔn)(35μg/m3)；(3)世界衛(wèi)生組織推薦濃度限值(10μg/m3)。為了進(jìn)一步比較控制空氣污染的健康獲益,假定傳統(tǒng)心血管疾病危險(xiǎn)因素的背景趨勢(shì)變化影響同樣存在、PM2.5濃度保持在現(xiàn)況水平,分析2016～2030年間,以下兩種情景的心血管健康獲益,包括：(1)50%的高血壓患者收縮壓達(dá)標(biāo)(即2030年達(dá)50%的高血壓控制率)；(2)吸煙率(包括主動(dòng)吸煙與被動(dòng)二手煙暴露)降低50%。研究結(jié)果如果PM2.5水平維持在62μg/m3,在僅有傳統(tǒng)危險(xiǎn)因素趨勢(shì)變化和人口數(shù)變化的背景影響,2016～2030年我國城市地區(qū)35～84歲人群中每年約55.3萬冠心病死亡和77.3萬卒中死亡。PM2.5濃度降低到2008奧運(yùn)會(huì)水平每年將減少3.8萬例冠心病死亡和2.0萬例卒中死亡。到2030年,吸煙率逐漸下降到2016年吸煙率的50%,每年將減少6.4萬例冠心病死亡和1.7萬例卒中死亡。收縮壓達(dá)標(biāo)率(140mmHg)達(dá)到50%,每年將減少7.5萬例冠心病和13.0萬例卒中死亡,其健康獲益遠(yuǎn)大于空氣污染達(dá)到2008年北京奧運(yùn)水平,但與達(dá)到中國二級(jí)空氣質(zhì)量標(biāo)準(zhǔn)獲益接近。結(jié)論空氣污染是我國城市地區(qū)重要的且又是可控制的心血管疾病危險(xiǎn)因素。我們的研究結(jié)果提示,空氣污染的小幅度改善(達(dá)到北京奧運(yùn)會(huì)水平)就能取得明顯的心血管疾病健康獲益�？諝馕廴靖纳品仍酱�,其心血管疾病健康獲益越大。我國政府已經(jīng)意識(shí)到經(jīng)濟(jì)發(fā)展不能以犧牲空氣質(zhì)量為代價(jià),有必要從長遠(yuǎn)發(fā)展的角度,采取切實(shí)可行的空氣污染治理措施,將空氣質(zhì)量提升到我國二級(jí)空氣質(zhì)量標(biāo)準(zhǔn)。第二部分：中國成年人腹性肥胖與高血壓發(fā)病風(fēng)險(xiǎn)的前瞻性研究研究背景與目的高血壓是導(dǎo)致我國心血管疾病和全因死亡最重要的危險(xiǎn)因素。2002年我國成年人高血壓患病率為18%,2012年我國高血壓患病率達(dá)25.2%,我國高血壓患病率呈上升的趨勢(shì)。與此同時(shí),我國成年男性腹型肥胖(腰圍≥90cm)和女性腹型肥胖(腰圍≥80cm)患病率分別從1993年的8.5%和27.8%迅猛上升,2009年分別達(dá)到27.8%和45.9%。本研究擬利用前瞻性隊(duì)列研究設(shè)計(jì)探討腹型肥胖與高血壓發(fā)病之間的關(guān)系,為制定健康政策提供科學(xué)依據(jù)。研究對(duì)象與方法研究對(duì)象來自中國心血管流行病學(xué)多中心協(xié)作研究和中國心血管健康多中心研究,兩項(xiàng)研究分別于1998年和2000～2001年開展基線調(diào)查,研究共27020人,年齡35～74歲,其中男性13063人,女性13957人。在2007～2008年和2013～2015年開展兩次隨訪調(diào)查,最終分析納入15289人,其中男性6952人,女性8337人�；�調(diào)查時(shí),收集人口學(xué)指標(biāo)、生活方式、疾病史等信息,并測量腰圍、血壓、身高和體重等。腹型肥胖定義為：男性腰圍≥90cm,女性腰圍≥85cm。隨訪階段測量研究對(duì)象血壓并收集服藥信息。高血壓定義為：收縮壓≥140mmHg和/或舒張壓≥90mmHg,和/或最近兩周內(nèi)服用降壓藥。采用Cox比例風(fēng)險(xiǎn)模型逐步校正混雜因素,評(píng)估腹型肥胖對(duì)高血壓發(fā)病風(fēng)險(xiǎn)比(Hazard ratio, HR)及95%置信區(qū)間(Confidence interval, CI)。研究結(jié)果經(jīng)過平均11.2年隨訪,共有6126例新診斷高血壓,其中男性2857例,女性3269例。在949例男性腹型肥胖者和1187例女性腹型肥胖者中,分別有493例和667例在隨訪階段診斷為高血壓,男女性腹型肥胖者高血壓累積發(fā)病率分別為51.9%和56.2%。與非腹型肥胖(正常)者比較,腹型肥胖者多因素校正的高血壓發(fā)病風(fēng)險(xiǎn)明顯升高,男性HR(95%CI)為1.30(1.17-1.44),女性HR(95%CI)為1.40(1.28-1.54)。與正常腰圍(90cm)男性相比,腰圍90-94cm、95-99cm和≥100cm的男性,多因素校正的高血壓發(fā)病HR(95%CI)分別為1.23(1.08-1.40)、1.36(1.14-1.63)、1.53(1.18-1.99)(P趨勢(shì)0.001)；與正常腰圍(85cm)女性相比,腰圍為85-89cm、90-94cm和≥95cm的女性,高血壓發(fā)病風(fēng)險(xiǎn)明顯升高,HR(95%CI)分別是1.41(1.26-1.58)、1.31(1.11-1.54)、1.55(1.28-1.87)(P趨勢(shì)0.001)。亞組分析和敏感性分析的結(jié)果與主要分析結(jié)果相似。結(jié)論在中國中老年人群中,腹型肥胖(以腰圍值判斷)是高血壓發(fā)病的重要危險(xiǎn)因素,腰圍水平與高血壓發(fā)病風(fēng)險(xiǎn)呈線性關(guān)系。高血壓是最重要的心血管疾病危險(xiǎn)因素,腹型肥胖的流行可能是我國高血壓患病率持續(xù)升高的重要原因之一。加強(qiáng)人群的健康促進(jìn)與教育,提倡健康生活方式,應(yīng)將腹型肥胖(腰圍)作為高血壓防控干預(yù)的重要指標(biāo)之一。
[Abstract]:The first part: the city air pollution control area Chinese cardiovascular health benefit research background and purpose of air pollution has become an important environmental and public health problems in China. The modifiable risk factors, air pollution in China caused by the disease burden of fourth.2008 in Beijing during the Olympics, the government China take a series of strict emission reduction measures to ensure air quality. Epidemiological studies have found that reducing fine particulate matter (PM2.5) levels can reduce cardiovascular disease and all-cause death. This study intends to measure benefit to improve air quality in 2016~2030 people aged 35-84 years in our city in the area of cardiovascular health by using mathematical model of pre, health benefits and control with the traditional cardiovascular risk factors were compared. The method of Chinese cardiovascular disease policy model is a programming model based on computer The incidence of cardiovascular technology was established, the prediction and evaluation of death and intervention measures of investment and the effect of the model can analyze the epidemic trends of the incidence of coronary heart disease and stroke China for people aged 35~84. According to China's total population and urbanization level of the United Nations Population Prediction programme, the estimated 2016~2030 City area China population quantity. Use change the trend of the traditional risk factors of cardiovascular disease Chinese health and Nutrition Survey in 1990~2009 years, the change trend of factors in predicting the risk of 2016~2030 years. The application of meta analysis and summary of long-term PM2.5 exposure on coronary heart disease, stroke, death and all-cause death effect. In the background of traditional cardiovascular risk factors to maintain the changes on the basis of simulation of PM2.5 2016~2030 years the level of city of our country lead to 35~84 years of age in adults due to coronary heart disease and stroke deaths. Among them, the status. PM2.5 environment is kept unchanged (62 g/m3); to improve the situation including three air pollution, assuming that 2016~2030 years, the annual average concentration of PM2.5 gradually decreased linearly to the following three PM2.5 target value: (1) the Beijing 2008 Olympic Games in Beijing PM2.5 concentration (55 g/m3); (2) the two level air quality standards China (35 g/m3); (3) the WHO recommended concentration limit (10 g/m3). In order to further compare the health benefits of air pollution control, the background trend assumes that traditional cardiovascular risk factors also influence the concentration of PM2.5 in the current situation, to maintain the level of analysis, 2016~2030 years, the following two scenarios of the benefit. Cardiovascular health include: (1) 50% hypertensive patients with systolic blood pressure standard (i.e., the control rate of hypertension was 50% in 2030); (2) the smoking rate (including active and passive smoking exposure to secondhand smoke) to reduce the 50%. results if the horizontal dimension PM2.5 In 62 g/m3, in the background of the influence trend of traditional risk factors only changes and population changes, 2016~2030 years of our country city area 35~84 people each year about 553 thousand deaths from coronary heart disease and 773 thousand stroke death.PM2.5 concentration reduced to 2008 games per year will reduce the death of 38 thousand cases of coronary heart disease and 20 thousand cases of stroke death. By 2030. The smoking rate decreased gradually to the 2016 smoking rate of 50% per year will reduce the death of 64 thousand cases of coronary heart disease and 17 thousand cases of stroke death. Systolic blood pressure (140mmHg) compliance rate reached 50%, annual reduction of 75 thousand cases of coronary heart disease and 130 thousand cases of stroke death, its health benefits far outweigh the air pollution reached the 2008 Beijing Olympic Games, but reached two air quality standards Chinese benefit. Conclusion the air pollution is close to the city of our country and it is an important area of cardiovascular disease risk factors can control our research. The results suggest that air pollution improved (up to the Beijing Olympic Games level) can achieve significant health benefits of cardiovascular disease. Air pollution improvement is greater, the cardiovascular health benefits more. Our government has been aware of the economic development must not be carried at the cost of air quality, it is necessary from the perspective of long-term development air pollution control measures, take feasible, will enhance the air quality to two air quality standards in China. The second part: Chinese adult abdominal obesity and the risk of hypertension background and objective prospective study of hypertension cardiovascular disease and all-cause mortality in China the most important risk factors of.2002 in China the adult prevalence rate of hypertension was 18%, in 2012 China's 25.2% prevalence rate of hypertension, the prevalence rate of hypertension was increased. At the same time, China's adult male abdomen Obesity (waist = 90cm) and female abdominal obesity (waist circumference greater than 80cm) prevalence rate from 8.5% in 1993 and 27.8% rapid rise, 2009 reached 27.8% and 45.9%. of this study is to explore the relationship between abdominal obesity and hypertension using prospective cohort study design, and to provide scientific basis for health policy research. China cardiovascular epidemiology research collaboration center and Chinese cardiovascular health centers from research objects and methods, two studies were carried out baseline survey in 1998 and 2000~2001 years of study, a total of 27020 people, aged 35~74, of which 13063 were male, 13957 female. Two to carry out follow-up survey in 2007~2008 years and 2013~2015 years. The final analysis included 15289 people, including 6952 males and 8337 female. The baseline survey, collecting demographic indicators, lifestyle, medical history information, and to measure the waist Circumference, blood pressure, height and weight. Abdominal obesity is defined as: male waistline is more than 90cm, the research object is greater than or equal to 85cm. female waist circumference measurement of blood pressure medication during the follow-up period and collect information. Hypertension is defined as systolic blood pressure greater than or equal to 140mmHg and / or diastolic pressure is above 90mmHg, and / or the last two weeks of taking antihypertensive drugs. Gradual correction confounding factors using Cox proportional hazards model, evaluation of abdominal obesity on the risk of hypertension than (Hazard ratio, HR) and 95% confidence intervals (Confidence, interval, CI). Results after a mean follow-up of 11.2 years, a total of 6126 patients with newly diagnosed hypertension, there were 2857 males and 3269 females. In 949 cases of male abdomen 1187 cases of female obesity and abdominal obesity, there were 493 cases and 667 cases during the follow-up period for the diagnosis of hypertension, abdominal obesity and the cumulative incidence of hypertension was 51.9% and 56.2%. respectively and non abdominal obesity (normal) comparison, The incidence of hypertension abdominal obesity factors correction was significantly elevated in male HR (95%CI) 1.30 (1.17-1.44), HR (95%CI) for 1.40 women (1.28-1.54). And the normal waist circumference (90cm) compared to men, waist 90-94cm, 95-99cm and 100cm than men, multi factor correction of hypertension (HR 95%CI) were 1.23 (1.08-1.40), 1.36 (1.14-1.63), 1.53 (1.18-1.99) (P trend 0.001); and the normal waist circumference (85CM) than women, waist circumference is 85-89cm, 90-94cm and 95cm than women, the incidence of hypertension was significantly increased, HR (95%CI) were 1.41 (1.26-1.58), 1.31 (1.11-1.54), 1.55 (1.28-1.87) (P trend 0.001). Subgroup analysis and sensitivity analysis of the results and the main results were similar. Conclusion in the elderly population China, abdominal obesity (waist circumference to judge) is an important risk factor for hypertension, waist circumference increased linearly with the incidence of hypertension and high blood. Pressure is the most important cardiovascular risk factors, the prevalence of abdominal obesity may be the prevalence of hypertension in China continues to rise is one of the important reasons. To strengthen health promotion and education, promoting a healthy way of life, should be abdominal obesity (waist) is one of the important indexes for prevention and intervention of hypertension.

【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R544.1;R589.2;X513

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相關(guān)期刊論文 前1條

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本文編號(hào)：1657149