Mortality and Years of Life Lost of Ischemic Heart Disease among Residents in Pudong New Area of Shanghai between 2002 and 2018

doi:10.12114/j.issn.1007-9572.2019.00.775

Abstract

Abstract: Background　Ischemic heart disease（IHD） is the leading cause of death on a global scale.At present，the epidemiological data of IHD among residents in Pudong New Area are absent.Objective　To explore the mortality and potential years of life lost in residents with IHD in Pudong New Area of Shanghai from 2002 to 2018，providing a basis for the development of targeted interventions.Methods　This study was performed in March 2019，targeting the registered residents in Pudong New Area.Records of IHD mortality data between January 1，2002 and December 1，2018 were derived from the universal death surveillance database.The data were coded and classified according to International Classification of Disease 10th Revision.Acute myocardial infarction and chronic IHD were encoded as I21 and I25，respectively.The gender- and disease-specific crude mortality rate（CMR），standardized mortality rate（SMR），potential years of life lost（PYLL），potential years of life lost rate（PYLLR），average years of life lost（AYLL），standardized potential years of life lost（SPYLL） and standardized potential years of life lost rate（SPYLLR） were taken as the main outcome measures to analyze the situation of IHD mortality.The tendency of mortality was estimated by annual percent change（APC） Difference decomposition was applied to estimate the contribution of aging to the change of IHD mortality.Results　The CMR and SMR of IHD among these residents between 2002 and 2018 were 101.32/100 000 and 33.98/100 000，respectively，and both of them increased over the years（APCCMR=6.00%，ZCMR=22.051，P<0.001；APCSMR=1.33%，ZSMR=4.755，P<0.001）.Disease classification analysis showed that the CMR of acute myocardial infarction rose year by year during 2002 to 2011（APC=1.83%，Z=2.792，P=0.016），and declined between 2012 and 2018（APC=-2.58%，Z=-2.744，P=0.018）.The SMR declined over the years（APC=-3.62%，Z=-12.457，P<0.001）.Both the CMR and SMR of chronic IHD showed an upward trend during 2002 to 2018（APCCMR=6.96%，ZCMR=22.052，P<0.001；APCSMR=2.22%，ZSMR=6.931，P<0.001）.The CMR of IHD among male residents between 2002 and 2018 was lower than that of female residents（Z=-24.532，P<0.001），but the SMR was higher（Z=-20.197，P<0.001）.Both the CMR and SMR of acute myocardial infarction among males were higher than those of females（ZCMR=7.848，P<0.001；ZSMR=-19.828，P<0.001）.For chronic IHD，the CMR among the males was lower than that of females（Z=-29.929，P<0.001），but the SMR was higher（Z=-13.184，P<0.001）.Both the CMR of IHD among male and female residents rose year by year during 2002 to 2018（APCmale=5.76%，Zmale=19.997，P<0.001，APCfemale=6.19%，Zfemale=20.405，P<0.001），and the SMR among male and female population also showed an upward trend（APCmale=1.15%，Zmale=3.730，P=0.002；APCfemale=1.35%，Zfemale=4.535，P<0.001）.There existed the diversity in the tendency of IHD across different age groups.For the population aged 15 to 59，the age-specific CMR rose over years（APC=3.54%，Z=7.326，P<0.001）.For the population aged 60 to 79，there showed a downward trend（APC=-2.85%，Z=-9.099，P<0.001）.For the population over 80 years old，there showed an upward trend（APC=3.21%，Z=10.550，P<0.001）.The PYLL of IHD was 37 649 years，the PYLL rate was 0.81‰，and the AYLL was 0.80 year per person.The PYLL，PYLLR，AYLL，SPYLL and SPYLLR of IHD among males were all higher than those of females.The PYLL，PYLLR，SPYLL，SPYLLR，due to acute myocardial infarction were lower than those of chronic IHD，but the AYLL was higher.The CMR of IHD in 2018 was higher than that in 2002，demographic and non-demographic factors associated with age contributed to the increase of IHD mortality.The gender-specific analysis showed that both the contributions of demographic and non-demographic factors associated with age to the rise of IHD mortality in males were lower than those of females.The disease classification analysis showed that the demographic factors associated with age enhanced the mortality of acute myocardial infarction，and the non-demographic factors associated with age declined the mortality.But demographic and non-demographic factors associated with age promoted the mortality of chronic IHD.Conclusion　The IHD mortality in Pudong New Area showed an upward tendency during 2002—2018，and caused serious life loss.Both demographic and non-demographic factors associated with age were enhancement factors.More attention should be paid to IHD mortality among males and people of age groups of 15 to 59 and over 80.

Key words: Myocardial ischemia, Mortality, Temporal trend, Difference decomposition, Potential years of life lost

摘要： 背景　缺血性心脏病是全球人群的首位死亡原因，但目前浦东新区居民缺血性心脏病流行病学资料依然缺乏。目的　了解2002—2018年上海市浦东新区居民缺血性心脏病的死亡情况与减寿情况，为制定针对性的干预措施提供依据。方法　2019年3月，以浦东新区户籍居民作为本研究对象，从浦东新区居民死因数据库中筛选出死亡时间在2002-01-01至2018-12-31的缺血性心脏病死亡病例进行分析。死因资料根据ICD-10进行编码及归类，其中急性心肌梗死编码为I21，慢性缺血性心脏病编码为I25。以不同病种、性别居民缺血性心脏病粗死亡率、标化死亡率、潜在减寿年数（PYLL）、潜在减寿率（PYLLR）、平均减寿年数（AYLL）、标化潜在减寿年数（SPYLL）以及标化潜在减寿率（SPYLLR）为主要观察指标。缺血性心脏病死亡率的变化趋势采用年均变化百分比（APC）进行分析，采用差别分解分析法评估人口老龄化因素对死亡率的影响。结果　2002—2018年浦东新区居民缺血性心脏病粗死亡率与标化死亡率分别为101.32/10万，33.98/10万。2002—2018年浦东新区居民缺血性心脏病粗死亡率与标化死亡率均逐年上升（APC粗死亡率=6.00%，Z粗死亡率=22.051，P<0.001；APC标化死亡率=1.33%，Z标化死亡率=4.755，P<0.001）。分病种分析：2002—2011年浦东新区居民急性心肌梗死粗死亡率逐年上升（APC=1.83%，Z=2.792，P=0.016），2012—2018年呈下降趋势（APC=-2.58%，Z=-2.744，P=0.018）；2002—2018年急性心肌梗死标化死亡率呈下降趋势（APC=-3.62%，Z=-12.457，P<0.001）；2002—2018年慢性缺血性心脏病的粗死亡率与标化死亡率均呈逐年上升的趋势（APC粗死亡率=6.96%，Z粗死亡率=22.052，P<0.001；APC标化死亡率=2.22%，Z标化死亡率=6.931，P<0.001）。2002—2018年浦东新区男性居民缺血性心脏病粗死亡率低于女性（Z=-24.532，P<0.001），标化死亡率高于女性（Z=-20.197，P<0.001）。其中男性居民急性心肌梗死粗死亡率与标化死亡率均高于女性（Z粗死亡率=7.848，P<0.001；Z标化死亡率=-19.828，P<0.001）；男性居民慢性缺血性心脏病粗死亡率低于女性（Z=-29.929，P<0.001），标化死亡率高于女性（Z=-13.184，P<0.001）。2002—2018年浦东新区男性与女性居民缺血性心脏病粗死亡率均逐年上升（APC男性=5.76%，Z男性=19.997，P<0.001；APC女性=6.19%，Z女性=20.405，P<0.001），男性与女性居民缺血性心脏病标化死亡率均逐年上升（APC男性=1.15%，Z男性=3.730，P=0.002；APC女性=1.35%，Z女性=4.535，P<0.001）。2002—2018年不同年龄段居民缺血性心脏病死亡变化趋势存在差异，其中15~59岁居民缺血性心脏病粗死亡率逐年上升（APC=3.54%，Z=7.326，P<0.001），60~79岁居民粗死亡率呈下降趋势（APC=-2.85%，Z=-9.099，P<0.001），80岁及以上居民粗死亡率逐年上升（APC=3.21%，Z=10.550，P<0.001）。2002—2018年浦东新区居民缺血性心脏病死亡PYLL为37 649人年，PYLLR为0.81‰，AYLL为0.80年/人；男性居民缺血性心脏病的PYLL、PYLLR、AYLL、SPYLL、SPYLLR均大于女性，急性心肌梗死居民PYLL、PYLLR、SPYLL、SPYLLR小于慢性缺血性心脏病、AYLL大于慢性缺血性心脏病。2018年浦东新区居民缺血性心脏病粗死亡率高于2002年，人口老龄化因素与非人口老龄化因素均促进粗死亡率升高。性别分析显示，人口老龄化因素对于男性缺血性心脏病粗死亡率上升的贡献值小于女性，非人口老龄化因素对于男性缺血性心脏病粗死亡率上升的贡献值小于女性。病种分析显示，人口老龄化因素对于浦东新区居民急性心肌梗死粗死亡率上升发挥促进作用，非人口老龄化因素则发挥保护作用。人口老龄化因素与非人口老龄化因素对居民慢性缺血性心脏病死亡均发挥促进作用。结论　2002—2018年浦东新区居民缺血性心脏病死亡率逐年上升，导致了严重的寿命损失，人口老龄化因素与非人口老龄化因素均发挥促进作用，男性和15~59岁、80岁及以上居民缺血性心脏病死亡应予以关注。

关键词: 心肌缺血, 死亡率, 变化趋势, 差别分解法, 潜在减寿年数

CHEN Yichen,SUN Lianghong,LI Xiaopan, et al. Mortality and Years of Life Lost of Ischemic Heart Disease among Residents in Pudong New Area of Shanghai between 2002 and 2018　[J]. Chinese General Practice, 2020, 23(18): 2242-2248. DOI: 10.12114/j.issn.1007-9572.2019.00.775.
陈亦晨,孙良红,李小攀等. 2002—2018年上海市浦东新区居民缺血性心脏病死亡特征及减寿率分析[J]. 中国全科医学, 2020, 23(18): 2242-2248. DOI: 10.12114/j.issn.1007-9572.2019.00.775.

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