Page 93 - 2022-06-中国全科医学

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has become an important public health problem，but there are still few studies on the urban and rural distribution of diabetes.
Objective To explore the spatial epidemiological characteristics of mortality and probability of premature death caused by
diabetes among residents in Pudong New Area of Shanghai from 2010 to 2020，so as to provide the reference for the development
of the regional strategy for diabetes control and prevention. Methods The diabetes death data reported from 2010 to 2020 were
screened for analysis based on the death surveillance system in Pudong New Area in May 2021. The Crude mortality，age-
standardized mortality，probability of premature death caused by diabetes and the annual percentage change （APC） of the
residents from diabetes in each subdistricts and towns of Pudong New Area，so as to analyze the status and trend of diabetes
death in Pudong New Area. The geographical information system （GIS） was used to plot the spatial distribution map of diabetes
deaths and carry out trend surface analysis and spatial autocorrelation analysis respectively. Results The crude mortality，age-
standardized mortality and probability of premature death caused by diabetes among residents in Pudong New Area between 2010
and 2020 were 37.90/100 000，16.90/100 000 and 0.52%，respectively. The crude mortality rate，the age-standardized mortality
rate and the probability of premature death caused by diabetes had been on the rise in Pudong New Area between 2010 and 2020
（APC for crude mortality rate=5.59%，Z=13.887，P=0.001，APC for age-standardized mortality rate=2.06%，Z=4.547，
P=0.001，APC for the probability of premature death=1.50%，Z=2.476，P=0.035）. The trend surface analysis showed that
the crude and standardized mortality of diabetes in Pudong New Area gradually decreased from north to south，the probability of
premature death was high in the middle and low in the north and south，the APC of crude death rate，standardized death rate
and premature death probability was gradually decreasing from north to south. In the east-west direction，the crude death rate
of diabetes，the standardized death rate and the probability of premature death all showed a trend of high at both ends，and the
rate of crude death，standardized death rate and APC showed a trend of high at the middle and low at the two ends. The results of
global spatial autocorrelation analysis showed that the crude death rate of diabetes，standardized death rate and premature death
probability of residents in Pudong New Area were spatially positively correlated （P crude death rate <0.001，P standardized death rate <0.001，
P premature death probability =0.003）. The results of local spatial autocorrelation analysis showed that the high-high clustering area of the
crude death rate of diabetes and the standardized death rate was located in the west of Pudong New Area，both of which contained
6 streets and 1 town，and there were partial geographic overlaps. The standardized low mortality rate-the low agglomeration areas
were Chuansha New Town and Xuanqiao Town in the middle of Pudong New Area. The area in the west of Pudong New Area with
three streets and two towns was a high-high concentration area with a high probability of early death. Conclusion The status of
diabetes death in Pudong New Area during 2010 to 2020 was at a high level and showed an upward trend over the years. The crude
and standardized mortality of diabetes in the western urban area of Pudong New Area were relatively high，and the mortality among
residents living in the urban fringe rose at a relatively high speed in Pudong New Area. More attention should be paid to the status
of diabetes in these subgroups.
【Key words】 Diabetes mellitus；Mortality；Probability of premature death；Tendency；Spatial epidemiology；
Shanghai

糖尿病（diabetes mellitus）是全球共同面对的公共卫生 资料进行分析。死因数据库依据国际疾病分类第 10 版（The
议题之一。根据全球疾病负担研究（global burden of disease， International Statistical Classification of Diseases and Related
GBD）结果，与 2007 年相比，2017 年全球范围内糖尿病的发 Health Problems 10th Revision，ICD-10）进行编码与归类，其
病数与死亡数分别上升 27.3% 和 25.6% ［1］ 。1990—2017 年全 中糖尿病编码范围为 E10~E14。浦东新区全区及各街道、镇
球糖尿病负担呈上升趋势，其中以西欧等发达地区上升速度 人口学资料由浦东新区公安局提供。浦东新区行政区划电子
最快 ［2］ 。中国是目前糖尿病增长最快的国家之一，约有 11% 地图由易智瑞（中国）信息技术有限公司负责制作并提供。
的人口罹患糖尿病 ［3］ 。浦东新区位于中国一线城市上海市， 行政区域划分标准，采纳 2012 年浦东新区行政区划，包括 12
是上海市最大的市辖区，自成立以来居民的生产生活方式与 个街道及 24 个镇 ［5］ 。根据浦东新区卫生健康委员会针对辖
工作居住环境均发生了较大的变化，糖尿病的健康危害正愈 区内社区卫生服务中心的划分，浦东新区地区类型可以分为
发凸显 ［4］ 。为了解浦东新区居民糖尿病死亡现状，探讨区域 城区、城郊结合、一般农村及偏远农村，其中城区主要位于
间糖尿病死亡的差异性，确定重点区域，为糖尿病防控策略 西部沿黄浦江地区、城郊结合主要位于中部地区、一般农村
的调整提供依据，现对浦东新区 2010—2020 年居民糖尿病死 与偏远农村多位于东部及东南沿海地区 ［6］ 。本研究已通过上
亡数据开展空间流行病学分析，结果报告如下。 海市浦东新区疾病预防控制中心医学伦理委员会的伦理审查。
1 资料与方法 1.2 方法
1.1 资料来源 2021 年 5 月，以上海市浦东新区户籍居民死 1.2.1 分析指标 本研究将粗死亡率、标化死亡率与早死概
亡数据库为基础，从中筛选 2010—2020 年报告的糖尿病死亡 率作为主要分析指标，标化死亡率的计算以 2010 年第 6 次人