The impact of demographic and risk factor changes on coronary heart disease deaths in Beijing, 1999-2010.
The impact of demographic and risk factor changes on coronary heart disease deaths in Beijing, 1999-2010.
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DOI：
10.1186/1471-2458-9-30
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发表时间：
2009-01-22
影响因子：
4.5
通讯作者：
Capewell, Simon
中科院分区：
文献类型：
--
作者：
Cheng, Jun;Zhao, Dong;Zeng, Zhechun;Critchley, Julia Alison;Liu, Jing;Wang, Wei;Sun, Jiayi;Capewell, Simon
近年来，中国冠心病（CHD）死亡率的急剧上升主要可以解释为主要心血管危险因素的不利变化。我们的研究旨在评估1999年至2010年间北京地区危险因素和人口老龄化的后续变化对冠心病死亡的潜在影响。先前验证的IMPACT模型用于估计2010年预期的冠心病死亡人数，治疗摄入量保持在1999年测量的水平不变，比较三种情况：a)考虑到人口老龄化，但假设1999年以来主要危险因素水平没有进一步变化，b)最近的危险因素趋势持续到2010年，c)每个危险因素每年减少0.5%。与1999年相比，仅人口老龄化一项就将导致2010年的死亡人数增加约1990人，即增加27%。如果目前的危险因素趋势继续下去，2010年的死亡人数将增加约3 015人[增加40%]；这一增长的四分之三归因于总胆固醇水平的上升。因此，人口变化和危险因素的恶化将共同导致冠心病死亡人数增加67%。相反，假设危险因素每年减少0.5%（男女总胆固醇平均人口水平下降0.3 mmol/L，男性吸烟率下降3.0%，女性吸烟率下降4.1%，男性体重指数下降1.3 kg/m2，女性体重指数下降1.4 kg/m2，男性糖尿病患病率下降0.4%，男性舒张压下降4.7 mmHg，女性舒张压下降4.4 mmHg），死亡人数将减少约3,730人，总体减少23%。这些发现在敏感性分析中保持一致。北京的冠心病死亡率持续上升。这反映了不断恶化的风险因素水平，再加上人口趋势。然而，人口老龄化对冠心病负担的不利影响可以通过改善饮食和吸烟来完全抵消。
Recent, dramatic increases in coronary heart disease (CHD) mortality in China can be mostly explained by adverse changes in major cardiovascular risk factors. Our study aimed to assess the potential impact of subsequent changes in risk factors and population ageing on CHD deaths in Beijing between 1999 and 2010. The previously validated IMPACT model was used to estimate the CHD deaths expected in 2010, with treatment uptakes being held constant at levels measured in 1999, comparing three scenarios: a) taking into account the ageing of the population but assuming no further changes in major risk factor levels from 1999 or, b) if recent risk factor trends continued until 2010 or, c) if there was a 0.5% annual reduction in each risk factor. Population ageing alone would result in approximately 1990 additional deaths in 2010 compared with 1999, representing an increase of 27%. Continuation of current risk factor trends would result in approximately 3,015 extra deaths in 2010, [a 40% increase]; three quarters of this increase would be attributable to rises in total cholesterol levels. Thus, demographic changes and worsening risk factors would together result in a 67% increase in CHD deaths. Conversely, assumed 0.5% annual reductions in risk factors (a mean population level decline of 0.3 mmol/L for total cholesterol in both genders, and smoking prevalence declining by 3.0% for men and 4.1% for women, body mass index by 1.3 kg/m2 for men and 1.4 kg/m2 for women, diabetes prevalence by 0.4% in both genders, and diastolic blood pressure by 4.7 mmHg for men and 4.4 mmHg for women) would result in some 3,730 fewer deaths, representing a 23% decrease overall. These findings remained consistent in sensitivity analyses. CHD death rates are continuing to rise in Beijing. This reflects worsening risk factor levels, compounded by demographic trends. However, the adverse impact of population ageing on CHD burden could be completely offset by eminently feasible improvements in diet and smoking.
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