Abstract: Background　The prevalence of chronic non-communicable diseases（NCDs）is increasing due to economic development and rapid population aging，which imposes a heavy economic burden on patients and their families.Objective　The aim of this study was to estimate the prevalence and economic risks of hypertension，diabetes，coronary heart disease（CHD），stroke and chronic obstructive pulmonary diseases（COPD）among older adults in rural Yunnan Province.Methods　Multi-stage stratified random sampling was used to select the study sample consisted of 4 833 adults aged 60 years and over in rural Yunnan Province from July 2016 to July 2017.Each participant received personal interview survey and physical examination.Information on demographic，economic status，prevalence of hypertension，diabetes，CHD，stroke and COPD，medical expenditure and access to medical service were collected in the interview.Height，weight，blood pressure（BP），fast blood glucose（FBG）and 2-hour postprandial blood were measured.The t-test was used to compare the economic risks〔relative risk（RR）and adjusted relative risk（ARR）〕of five chronic NCDs，and chi-square test was computed to compare the prevalence of chronic NCDs，incidence of catastrophic health expenditure and impoverishing health spending by demographic characteristics.Results　Among the population，the overall prevalence of hypertension，diabetes，CHD，stroke and COPD was 50.63%（2 447/4 833），10.22%（494/4 833），5.56%（269/4 833），6.45%（312/4 833）and 5.48%（265/4 833），respectively.Females had higher prevalence of hypertension and diabetes than males（53.13% vs 47.63%，11.00% vs 9.23%，P<0.05），whereas males had a higher prevalence of COPD than females（6.32% vs 4.78%，P<0.05）．Older adults with poor household assets and poor access to medical services had higher prevalence of hypertension，CHD，stroke and COPD than their counterparts with good household assets and good access to medical services（P<0.05）．CHD，stroke and COPD patients had higher economic risk than the observed population：RR were 1.92，1.91，1.65，respectively，and ARR were 1.69，1.59，1.70，respectively.The incidence of catastrophic health expenditure due to hypertension，diabetes，CHD，stroke and COPD was 17.5%（478/2 477），22.5%（111/494），36.1%（92/269），37.5%（118/312）and 35.8%（95/265），respectively，whereas incidence of impoverishing health spending due to these five diseases was 9.1%（223/2 477），11.7%（58/494），19.3%（52/269），18.3%（57/312）and 18.1%（48/265），respectively.Poor household assets were associated with higher incidence of catastrophic health expenditure and impoverishing health spending due to hypertension，diabetes，and stroke（P<0.05）．Poor access to medical services was associated with higher incidence of catastrophic health expenditure due to hypertension（P<0.05）．Conclusion　In rural Yunnan Province，older adults with stroke，CHD，or COPD have higher economic risk of diseases.Future medical support should be strengthened for families having an older chronic disease member and poor household assets，as well as poor access to medical care.

Key words: Chronic diseases, Economics, Aged, Rural health, Yunnan

摘要： 李潇1，蔡乐1*，崔文龙1，王旭明1，2，黄晶晶1，吴超1，吕思齐1
背景　随着经济的发展，人口老龄化加剧，老年人慢性病患病率增加，带来极大的疾病经济风险。目的　分析云南省农村老年人高血压、糖尿病、冠心病、脑卒中及慢性阻塞性肺疾病（COPD）的流行现状及疾病经济风险。方法　于2016年7月—2017年7月采用多阶段分层随机抽样的方法抽取云南省农村4 833名≥60岁的老年人为研究对象，对老年人进行问卷调查、体格检查及实验室检查。问卷调查的内容包括：基本人口学资料，经济状况，高血压、糖尿病、冠心病、脑卒中及COPD的患病情况，医疗费用情况及医疗服务可及性。体格检查的内容包括身高、体质量、血压。实验室检查包括空腹血糖和餐后2 h血糖。不同人口学特征的慢性病疾病经济风险〔相对风险度（RR）和校正相对风险度（ARR）〕之间的比较采用t检验；不同人口学特征的慢性病患病率、灾难性卫生支出发生率和因病致贫率之间的比较采用χ2检验。结果　云南省农村老年人高血压、糖尿病、冠心病、脑卒中及COPD的患病率分别为50.63%（2 447/4 833）、10.22%（494/4 833）、5.56%（269/4 833）、6.45%（312/4 833）和5.48%（265/4 833）；女性高血压和糖尿病患病率高于男性（53.13%比47.63%、11.00%比9.23%，P<0.05），男性COPD患病率高于女性（6.32%比4.78%，P<0.05）；家庭财产和医疗服务可及性差的老年人高血压、冠心病、脑卒中及COPD患病率高于家庭财产和医疗服务可及性好者（P<0.05）。冠心病、脑卒中及COPD的疾病经济风险高于整体农村老年人群：（RR分别为1.92、1.91、1.65，ARR分别为1.69、1.59、1.70）；高血压、糖尿病、冠心病、脑卒中及COPD老年患者家庭的灾难性卫生支出发生率分别为17.5%（478/2 477）、22.5%（111/494）、36.1%（92/269）、37.5%（118/312）、35.8%（95/265）；因病致贫率分别为9.1%（223/2 477）、11.7%（58/494）、19.3%（52/269）、18.3%（57/312）、18.1%（48/265）。家庭财产差的高血压、糖尿病及脑卒中患者家庭的灾难性卫生支出发生率和因病致贫率高于家庭财产好者，家庭医疗服务可及性差的高血压患者灾难性卫生支出发生率高于医疗服务可及性好者（P<0.05）。结论　云南省农村脑卒中、冠心病及COPD老年患者的疾病经济风险较高，应重点加强低收入和医疗服务可及性差的老年慢性病患者家庭的医疗支持。

关键词: 慢性病, 经济学, 老年人, 农村卫生, 云南