基于DisMod校正法对天津市2007—2015年发病监测系统中急性心肌梗死发病报告完整性判断
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摘要
目的采用DisMod校正法判断天津市2007—2015年发病监测系统中急性心肌梗死(AMI)发病报告的完整性。方法收集天津市2007—2015年发病监测数据和死因登记数据中的AMI发病率和死亡率及健康测量评估研究所公布的AMI缓解率,应用DisModⅡ模型估算校正后的AMI死亡发病比(M/I),对DisMod法和直接法计算的M/I值进行差异性检验,并根据DisMod法估算的发病率估计现有发病检测系统的漏报率。结果天津市2007—2015年AMI的M/I值经DisMod法校正后为0.49～0.97,均<1;在≥65岁人群中,直接法计算AMI的M/I值均较DisMod法计算的M/I值大,差异均有统计学意义(均P <0.05);DisMod法校正估算的总发病数与原始发病数比较,平均每年DisMod法校正估算的发病数(11 837例)大于原始发病数(8 563例),尤其在≥65岁人群;按照DisMod法校正发病死亡的关系后,发病监测系统每年的平均漏报率在26.4%,≥65岁人群平均漏报率为42.9%。结论天津市AMI发病监测系统可能存在一定漏报,尤其是≥65岁人群,可采用DisMod校正法来判断AMI发病/患病监测系统的完整性。
Objective To evaluate the completeness of acute myocardial infarction(AMI) incidence reports in Chronic Disease Incidence Surveillance System(CDISS) of Tianjin between 2007 and 2015 using DisMod II(DisMod stands for DISease MODelling, a software developed by World Health Organization). Methods We extracted the data on AMI incidence and mortality among residents in Tianjin between 2007 and 2015 from CDISS and Death Registry System; we also collected data on remission rate for AMI patients in Tianjin published by Institute of Health Metrics and Evaluation. Then we calculated mortality/incidence ratios(M/I) by original data and DisMod Ⅱ. The difference of M/I values between the above two methods were tested, and then underreporting rate of AMI incidence in CDISS was estimated. Results The DisModadjusted M/I values of AMI were all less than 1(ranging from 0.49 to 0.97) during the period. The directly calculated M/I values for the population aged ≥ 65 years were significantly greater than the DisMod-adjusted M/I values(all P < 0.05).Compared to the reported average annual number of AMI incidence(8 563), a greater average annual number(11 837) of AMI incidence was estimated by DisMod calculation, especially for the number of AMI incidents aged 65 years and above.The estimated average annual underreporting rate of CDISS was 26.4% for all AMI incidents and the rate was 42.9% for the AMI incidents aged 65 years and above. Conclusion There may be some underreporting AMI incidents in CDISS of Tianjin, especially for those aged 65 years and above and calculations with DisMod software could be used to evaluated the completeness of AMI disease surveillance system.
Objective To evaluate the completeness of acute myocardial infarction(AMI) incidence reports in Chronic Disease Incidence Surveillance System(CDISS) of Tianjin between 2007 and 2015 using DisMod II(DisMod stands for DISease MODelling, a software developed by World Health Organization). Methods We extracted the data on AMI incidence and mortality among residents in Tianjin between 2007 and 2015 from CDISS and Death Registry System; we also collected data on remission rate for AMI patients in Tianjin published by Institute of Health Metrics and Evaluation. Then we calculated mortality/incidence ratios(M/I) by original data and DisMod Ⅱ. The difference of M/I values between the above two methods were tested, and then underreporting rate of AMI incidence in CDISS was estimated. Results The DisModadjusted M/I values of AMI were all less than 1(ranging from 0.49 to 0.97) during the period. The directly calculated M/I values for the population aged ≥ 65 years were significantly greater than the DisMod-adjusted M/I values(all P < 0.05).Compared to the reported average annual number of AMI incidence(8 563), a greater average annual number(11 837) of AMI incidence was estimated by DisMod calculation, especially for the number of AMI incidents aged 65 years and above.The estimated average annual underreporting rate of CDISS was 26.4% for all AMI incidents and the rate was 42.9% for the AMI incidents aged 65 years and above. Conclusion There may be some underreporting AMI incidents in CDISS of Tianjin, especially for those aged 65 years and above and calculations with DisMod software could be used to evaluated the completeness of AMI disease surveillance system.
引文
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[2]宁丽娟,李建微.急性心肌梗死患者心理健康状况分析[J].中国公共卫生,2013,29(6):926.
[3]刘晓婷,李镒冲,姜勇,等.2010年我国急性心肌梗死疾病负担分析[J].中国慢性病预防与控制,2013,21(3):271-273.
[4]王德征,张辉,徐忠良,等.天津市1999至2015年急性心肌梗死死亡率变化趋势分析[J].中华心血管病杂志,2017,45(11):985-991.
[5]江国虹,张辉,李威,等.天津市利用全死因监测系统开展吸烟归因死亡的研究[J].中华流行病学杂志,2016,37(3):381-383.
[6]刘阳.天津市2007-2015年35岁以上人群急性心肌梗死发病率的估算[D].北京:北京协和医学院,2017.
[7]Barendregt JJ,Van Oortmarssen GJ,Vos T,et al.A generic model for the assessment of disease epidemiology:the computational basis of DisModII[J].Popul Health Metr,2003,1(1):4.
[8]刘爱民.疾病和有关健康问题的国际统计分类(ICD-10)[M].北京:人民军医出版社,2013.
[9]World Health Organization MONICA Project Principal Investigators.The World Health Organization MONICA Project(monitoring trends and determinants in cardiovascular disease):a major international collaboration[J].J Clin Epidemiol,1988,41(2):105-114.
[10]陈小贞,于运福,杨鹏伟,等.急性心肌梗死患者就诊时间与临床症状的关系[J].中国卫生产业,2013(2):154.