山东省中西部农村地区慢病控制项目人群干预效果评估
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摘要
慢性非传染性疾病已成为危害农村居民健康和生命的主要疾病。2008年全国慢病病例数达到2.6亿,每年新增慢病病例1000万例；农村地区慢病患病率在逐年升高,慢病造成的“早死”占到潜在寿命损失的63%。慢病负担是可以预防的,未来10年是防控慢病的一个关键时期。慢病的发生可以通过普及健康知识、改变生活行为方式、降低和消除主要慢病危险因素进行控制。
为探索符合基层农村实际的可持续慢病防控策略与措施,2007年11月-2010年10月,山东省在中西部农村八个县(市、区)实施了由卢森堡政府资助、世界卫生组织提供技术支持的卢森堡-WHO-山东省农村卫生人员培训与慢病控制项目,针对糖尿病、高血压等常见慢病及其主要危险因素,采取基层卫生人员培训、慢病防控政策制定、人群健康知识宣传与行为干预,健康教育与健康促进、慢病信息管理系统完善与慢病筛查与随访规范管理等措施,进行农村居民慢病综合防控策略与措施的探索。
主要目的：通过比较慢病干预项目干预实施前后的人群慢病相关危险因素及患病情况变化,来评估慢病控制项目人群干预效果：人群生活方式及行为变化,人群健康意识和知晓情况变化,人群心理与精神状况变化,人群高血压与肥胖流行情况变化。
研究方法：按照经济发展水平好中差,在山东省中西部地区分别选取了广饶、寿光、沂源、莱芜莱城区、苍山、宁阳、商河、陵县八个农村县(市、区)作为项目县。按分层随机抽样原则,2007年每县随机抽取2个乡镇,每乡镇2个村,为干预前(共18691人)；2010年每县随机抽1个项目村为干预后(共2404人)；从8个县随机选取4个县,从干预乡镇随机选择1个非项目村作为对照组(共1510人)。两个年度按行政村抽样,按户主花名册进行系统抽样,抽取家庭内25岁以上常住人口为调查对象,进行问卷调查,并进行体格检查。2007年11月-2010年10月,在山东省中西部农村地区8个项目县2个乡镇2-7个村中的7岁以上常住居民进行慢病项目干预,采取全人群和特殊人群以及行为干预和病人管理策略,针对全人群,利用新闻媒体信息传播渠开展健康宣传干预,倡导有利于健康的环境,促进全社会参与,降低全人群健康危险因素水平；针对特殊人群,在学校、事业单位创建无烟医院、学校和单位,开展健康教育课。针对重点高危人群,采用全面教育与个体指导相结合,通过自我监测、随访管理和激励机制提高防病治病意识、改变不良的生活行为和习惯,控制病情,提高生活质量。采用描述性统计分析干预和对照组的人口统计特征,用倾向得分匹配来校止选择偏倚,匹配后采用倍差法来评价干预效果。
主要研究结果：1)农村居民每日摄入食用油量减少了3.043g,锻炼比例减少3.13个百分点,干预措施在高校收入和和受教育程度高的居民效应更大。2)农村居民主动获取卫生保健知识、高血压与糖尿病健康知识的意愿以及体重知晓率分别增加了10.75、5.53和10.43个百分；干预在高收入和受教育程度高的居民中效应更大,在高年龄组居民中为负效应。农村居民血压、血糖和血脂检测率分别增加了5.22、12.89和6.82个百分点,而且对于自身是否患有糖尿病和血脂异常的不知晓比例分别下降了11.76和8.18个百分点；干预在高收入和受教育程度高的居民中效应更大。高血压与饮食、吸烟和肥胖关系知晓率分别增加了8.11、7.89和7.06个百分点,糖尿病与饮食和肥胖关系知晓率分别增加7.13和10.61个百分点；干预在高收入和受教育程度高的居民中效应更大。3)农村居民有睡眠状况不好以及生活压力的比率分别下降了4.50和4.42个百分点：干预在高收入和受教育程度高的居民中效应更大。4)Ⅰ级高血压患病率下降了4.5个百分点,干预在高年龄组、女性和非新农合医保人群中为负效应。肥胖率增加了4.4个百分点。高血压发病率下降了6个百分点；干预在高年龄组和女性居民中为负效应。
结论：1)慢病控制项目人群干预摸索了一套符合农村地区实际的慢病防治策略和措施,同时慢性病防治是一个漫长的过程,需探索更为积极有效的方法与措施。2)干预措施改善了农村居民部分膳食行为,没有降低农村居民吸烟率和食盐摄入量。3)农村居民的慢病健康意识和危险因素知晓程度提高。4)农村居民心理与精神状况得到改善。5)干预措施在降低农村居民的高血压患病率和发病率上起到了一定效果。6)干预对于受教育程度高和高收入组别农村居民更为有效。
Chronic non-communicable diseases have become the major diseases that endanger the health and life of rural residents. In2008, the number of cases of chronic disease reached260million in china, increasing10million cases every year; the morbidity in rural areas increased, the "early death" caused by chronic disease accounted for63%of the potential years of life lost. Noninfectious chronic disease (NCD) burden can be avoided, the next10years is a critical period for the prevention and control of chronic disease. The occurrence of chronic disease can be controlled by changing life behavior and inceasing health literacy, reducing and eliminating these risk factors about major chronic disease.
For exploring actual rural sustainable chronic disease prevention and control strategies and models, from the year2007to2010, Luxemburg-WHO-Shandong Project on Rural Personnel Training and Chronic Disease Control was funded by the Luxembourg Government and provided technical support by the World Health Organization (WHO). The interventions were implemented in central and western rural eight counties (cities, districts) of Shandong Province. The interventions were about rural health personnel training and chronic disease control programs for diabetes, hypertension and other common chronic disease and its main risk factors, health education and health promotion, chronic disease management system and the disease screening.
Main objective:through comparing changes of chronic disease risk factors and prevalence before and after the implementation, to assess the effect of chronic disease control programs based intervention:lifestyle and behavioral changes, consciousness and awareness of the health, the changes of psychological and spiritual, the changes in health status.
Methods:Based on the economic status (good, moderate, poor), selected respectively Guangrao County and Shouguang, Yiyuan County and Laicheng District of Laiwu City, and Cangshan County, Ningyang County, Shanghe County, Lingxian eight rural counties (cities, districts) as the project counties. In the light of stratified random sampling principle, each county selected randomly two townships,7villages per township as the baseline group in the year2007; each county selected randomly one project village as the intervention group in the year2010; selected randomly4counties from eight counties, and a non-project village as a control group from the intervention villages and towns. Biennial administrative village sampling, systematic sampling on the basis of the household head roster was proceeded and over25years old resident population as respondents in the extracted household was conducted questionnaire survey. Using descriptive statistical to analysis the demographic characteristics about intervention and control group, and propensity score matching to correct selection bias, then using the DID model to estimate the intervention effect after matching.
The main results:1) monthly intake of edible oil in rural residents declined by103.40g, soy intake an increase of153.70g, the exercise ratio decreased by3.13percentage points, the intervention effects about edible salt and soy sauce in S5and L4residents are greater.2) Rural residents take the initiative to obtain knowledge of health care, of hypertension and diabetes, weight increased awareness increased10.75,5.53and10.43percentage points; the intervention effects in the S5group and J4group are greater, but the effect of the old age group is negative effect. The rates about blood pressure, glucose and lipid testing increased5.22,12.89and6.82 percentage points, and the proportion about those do not know themselve suffering from diabetes and lipid abnormalities decreased by11.76and8.18percentage points; the intervention effects in the S5, L5and J4group are greater. The awareness rates of relationship about High blood pressure with diet, smoking and obesity increased over7percent, and the awareness of the relationship about between diabetes with diet and obesity increased by7.13and10.61percent; the intervention effects in the S5and J4group are greater.3) Insomnia life stress decreased by4.50and4.42percentage points; the intervention effects in S5and J4residents are greater.4) The prevalence of I type hypertension decreased by4.5percentage points, the intervention effects in L2-L5and women group are negative effects. The obesity prevalence increased by4.4percentage points. The incidence of hypertension decreased by6percentage points; the intervention effects in the L2-L5and female group are negative effects.
Conclusion:1) chronic disease control programs set a chronic disease prevention and control system and mode in rural areas, and chronic disease prevention is a long process, need to explore more positive and effective methods and measures.2) the dietary behavior of rural residents improved, smoking rates and salt intake did not reduce;3) the awareness of chronic disease health improved;4) psychological and mental condition improved;5) the level of disease risk factors and the incidence of hypertension prevalence rate reduced;6) the intervention for the rural residents that those had high education and high income are more effective.
为探索符合基层农村实际的可持续慢病防控策略与措施,2007年11月-2010年10月,山东省在中西部农村八个县(市、区)实施了由卢森堡政府资助、世界卫生组织提供技术支持的卢森堡-WHO-山东省农村卫生人员培训与慢病控制项目,针对糖尿病、高血压等常见慢病及其主要危险因素,采取基层卫生人员培训、慢病防控政策制定、人群健康知识宣传与行为干预,健康教育与健康促进、慢病信息管理系统完善与慢病筛查与随访规范管理等措施,进行农村居民慢病综合防控策略与措施的探索。
主要目的：通过比较慢病干预项目干预实施前后的人群慢病相关危险因素及患病情况变化,来评估慢病控制项目人群干预效果：人群生活方式及行为变化,人群健康意识和知晓情况变化,人群心理与精神状况变化,人群高血压与肥胖流行情况变化。
研究方法：按照经济发展水平好中差,在山东省中西部地区分别选取了广饶、寿光、沂源、莱芜莱城区、苍山、宁阳、商河、陵县八个农村县(市、区)作为项目县。按分层随机抽样原则,2007年每县随机抽取2个乡镇,每乡镇2个村,为干预前(共18691人)；2010年每县随机抽1个项目村为干预后(共2404人)；从8个县随机选取4个县,从干预乡镇随机选择1个非项目村作为对照组(共1510人)。两个年度按行政村抽样,按户主花名册进行系统抽样,抽取家庭内25岁以上常住人口为调查对象,进行问卷调查,并进行体格检查。2007年11月-2010年10月,在山东省中西部农村地区8个项目县2个乡镇2-7个村中的7岁以上常住居民进行慢病项目干预,采取全人群和特殊人群以及行为干预和病人管理策略,针对全人群,利用新闻媒体信息传播渠开展健康宣传干预,倡导有利于健康的环境,促进全社会参与,降低全人群健康危险因素水平；针对特殊人群,在学校、事业单位创建无烟医院、学校和单位,开展健康教育课。针对重点高危人群,采用全面教育与个体指导相结合,通过自我监测、随访管理和激励机制提高防病治病意识、改变不良的生活行为和习惯,控制病情,提高生活质量。采用描述性统计分析干预和对照组的人口统计特征,用倾向得分匹配来校止选择偏倚,匹配后采用倍差法来评价干预效果。
主要研究结果：1)农村居民每日摄入食用油量减少了3.043g,锻炼比例减少3.13个百分点,干预措施在高校收入和和受教育程度高的居民效应更大。2)农村居民主动获取卫生保健知识、高血压与糖尿病健康知识的意愿以及体重知晓率分别增加了10.75、5.53和10.43个百分；干预在高收入和受教育程度高的居民中效应更大,在高年龄组居民中为负效应。农村居民血压、血糖和血脂检测率分别增加了5.22、12.89和6.82个百分点,而且对于自身是否患有糖尿病和血脂异常的不知晓比例分别下降了11.76和8.18个百分点；干预在高收入和受教育程度高的居民中效应更大。高血压与饮食、吸烟和肥胖关系知晓率分别增加了8.11、7.89和7.06个百分点,糖尿病与饮食和肥胖关系知晓率分别增加7.13和10.61个百分点；干预在高收入和受教育程度高的居民中效应更大。3)农村居民有睡眠状况不好以及生活压力的比率分别下降了4.50和4.42个百分点：干预在高收入和受教育程度高的居民中效应更大。4)Ⅰ级高血压患病率下降了4.5个百分点,干预在高年龄组、女性和非新农合医保人群中为负效应。肥胖率增加了4.4个百分点。高血压发病率下降了6个百分点；干预在高年龄组和女性居民中为负效应。
结论：1)慢病控制项目人群干预摸索了一套符合农村地区实际的慢病防治策略和措施,同时慢性病防治是一个漫长的过程,需探索更为积极有效的方法与措施。2)干预措施改善了农村居民部分膳食行为,没有降低农村居民吸烟率和食盐摄入量。3)农村居民的慢病健康意识和危险因素知晓程度提高。4)农村居民心理与精神状况得到改善。5)干预措施在降低农村居民的高血压患病率和发病率上起到了一定效果。6)干预对于受教育程度高和高收入组别农村居民更为有效。
Chronic non-communicable diseases have become the major diseases that endanger the health and life of rural residents. In2008, the number of cases of chronic disease reached260million in china, increasing10million cases every year; the morbidity in rural areas increased, the "early death" caused by chronic disease accounted for63%of the potential years of life lost. Noninfectious chronic disease (NCD) burden can be avoided, the next10years is a critical period for the prevention and control of chronic disease. The occurrence of chronic disease can be controlled by changing life behavior and inceasing health literacy, reducing and eliminating these risk factors about major chronic disease.
For exploring actual rural sustainable chronic disease prevention and control strategies and models, from the year2007to2010, Luxemburg-WHO-Shandong Project on Rural Personnel Training and Chronic Disease Control was funded by the Luxembourg Government and provided technical support by the World Health Organization (WHO). The interventions were implemented in central and western rural eight counties (cities, districts) of Shandong Province. The interventions were about rural health personnel training and chronic disease control programs for diabetes, hypertension and other common chronic disease and its main risk factors, health education and health promotion, chronic disease management system and the disease screening.
Main objective:through comparing changes of chronic disease risk factors and prevalence before and after the implementation, to assess the effect of chronic disease control programs based intervention:lifestyle and behavioral changes, consciousness and awareness of the health, the changes of psychological and spiritual, the changes in health status.
Methods:Based on the economic status (good, moderate, poor), selected respectively Guangrao County and Shouguang, Yiyuan County and Laicheng District of Laiwu City, and Cangshan County, Ningyang County, Shanghe County, Lingxian eight rural counties (cities, districts) as the project counties. In the light of stratified random sampling principle, each county selected randomly two townships,7villages per township as the baseline group in the year2007; each county selected randomly one project village as the intervention group in the year2010; selected randomly4counties from eight counties, and a non-project village as a control group from the intervention villages and towns. Biennial administrative village sampling, systematic sampling on the basis of the household head roster was proceeded and over25years old resident population as respondents in the extracted household was conducted questionnaire survey. Using descriptive statistical to analysis the demographic characteristics about intervention and control group, and propensity score matching to correct selection bias, then using the DID model to estimate the intervention effect after matching.
The main results:1) monthly intake of edible oil in rural residents declined by103.40g, soy intake an increase of153.70g, the exercise ratio decreased by3.13percentage points, the intervention effects about edible salt and soy sauce in S5and L4residents are greater.2) Rural residents take the initiative to obtain knowledge of health care, of hypertension and diabetes, weight increased awareness increased10.75,5.53and10.43percentage points; the intervention effects in the S5group and J4group are greater, but the effect of the old age group is negative effect. The rates about blood pressure, glucose and lipid testing increased5.22,12.89and6.82 percentage points, and the proportion about those do not know themselve suffering from diabetes and lipid abnormalities decreased by11.76and8.18percentage points; the intervention effects in the S5, L5and J4group are greater. The awareness rates of relationship about High blood pressure with diet, smoking and obesity increased over7percent, and the awareness of the relationship about between diabetes with diet and obesity increased by7.13and10.61percent; the intervention effects in the S5and J4group are greater.3) Insomnia life stress decreased by4.50and4.42percentage points; the intervention effects in S5and J4residents are greater.4) The prevalence of I type hypertension decreased by4.5percentage points, the intervention effects in L2-L5and women group are negative effects. The obesity prevalence increased by4.4percentage points. The incidence of hypertension decreased by6percentage points; the intervention effects in the L2-L5and female group are negative effects.
Conclusion:1) chronic disease control programs set a chronic disease prevention and control system and mode in rural areas, and chronic disease prevention is a long process, need to explore more positive and effective methods and measures.2) the dietary behavior of rural residents improved, smoking rates and salt intake did not reduce;3) the awareness of chronic disease health improved;4) psychological and mental condition improved;5) the level of disease risk factors and the incidence of hypertension prevalence rate reduced;6) the intervention for the rural residents that those had high education and high income are more effective.
引文
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