Effective coverage of medical treatment for hypertension, diabetes and dyslipidaemia in Japan: An analysis of National Health and Nutrition Surveys 2003-2017
Effective coverage of medical treatment for hypertension, diabetes and dyslipidaemia in Japan: An analysis of National Health and Nutrition Surveys 2003-2017
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DOI：
10.1177/1355819620949574
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发表时间：
2020-10-15
影响因子：
2.4
通讯作者：
Noda, Mitsuhiko
中科院分区：
文献类型：
--
作者：
Ikeda, Nayu;Nishi, Nobuo;Noda, Mitsuhiko
目的 使用指标来评估源自卫生系统绩效评估框架的健康干预措施的有效覆盖率，研究日本高血压、糖尿病和血脂异常的有效医疗覆盖率趋势。方法 我们从第 15 次年度日本国家健康和营养调查（2003-2017 年）中获得了 96,863 名 40-74 岁个体的横断面数据。我们将高血压、糖尿病和血脂异常的治疗需求定义为等于或大于诊断阈值或药物使用的生物标志物。对于需要治疗的个体，我们进行了最近邻匹配来估计治疗效果和有效覆盖范围，有效覆盖范围定义为通过药物在治疗个体中实际实现的生物标志物潜在减少的比例。结果 2003-2017年，高血压、糖尿病和血脂异常的年龄标准化患病率分别保持在40%、7%和33%左右。 2013-2017 年接受治疗的患者的平均治疗效果为，收缩压为 14.8 mmHg（95% 置信区间：14.2-15.4），糖化血红蛋白为 1.2 个百分点（0.8-1.6），非高密度脂蛋白胆固醇为 57.9 mg/dl（56.6-59.2）。 2003-2007 年（高血压：48.4% [44.7-52.0]、糖尿病：43.8% [35.7-51.8]、血脂异常：86.3% [83.1-89.5]）和 2013-2017 年（高血压：76.2% [74.2-78.2]、糖尿病： 74.7% [71.0-78.5]，血脂异常：94.6% [93.3-95.9]）。结论 代谢危险因素医疗有效覆盖率有所提高。大多数非高密度脂蛋白胆固醇的潜在降低是通过他汀类药物实现的。需要进一步努力提高抗高血压和抗糖尿病药物的有效性。
Objective To examine trends in effective medical treatment coverage for hypertension, diabetes and dyslipidaemia in Japan, using a metric to assess effective coverage of health interventions derived from a health system performance assessment framework. Methods We obtained cross-sectional data for 96,863 individuals aged 40-74 years from the 15 annual Japanese National Health and Nutrition Surveys (2003-2017). We defined treatment need for hypertension, diabetes and dyslipidaemia as biomarkers equal to or greater than diagnostic thresholds or medication use. For individuals needing treatment, we conducted nearest-neighbour matching to estimate treatment effects and effective coverage, defined as the fraction of potential reductions in biomarkers actually achieved in treated individuals by medications. Results The age-standardized prevalence of treatment need for hypertension, diabetes and dyslipidaemia remained around 40%, 7% and 33%, respectively, in 2003-2017. Average treatment effects for those treated in 2013-2017 were 14.8 mmHg (95% confidence interval: 14.2-15.4) for systolic blood pressure, 1.2 percentage points (0.8-1.6) for haemoglobin A1c and 57.9 mg/dl (56.6-59.2) for non-high-density lipoprotein cholesterol. Effective coverage significantly increased between 2003-2007 (hypertension: 48.4% [44.7-52.0], diabetes: 43.8% [35.7-51.8], dyslipidaemia: 86.3% [83.1-89.5]) and 2013-2017 (hypertension: 76.2% [74.2-78.2], diabetes: 74.7% [71.0-78.5], dyslipidaemia: 94.6% [93.3-95.9]). Conclusions Effective coverage of medical treatment for metabolic risk factors has increased. Most of the potential reductions in non-high-density lipoprotein cholesterol have been achieved by statins. Further efforts are necessary to improve the effectiveness of antihypertensive and antidiabetic drugs.