文章摘要
方向华,王文志,吴升平,李世绰,程学铭,杜晓立,鲍秋菊.社区干预对高血压和脑卒中预防效果评价[J].中华流行病学杂志,2003,24(7):538-541
社区干预对高血压和脑卒中预防效果评价
Community intervention on hypertension and stroke
收稿日期:2003-01-13  出版日期:2014-09-18
DOI:
中文关键词: 高血压;脑卒中;队列研究;社区防治
英文关键词: Hypertensionc Stroke;Cohort study;Community intervention
基金项目:“十一五”国家科技支撑计划(2006BAl01A02);国家自然科学基金(81170266,81070226,81000109)
作者单位
方向华 首都医科大学宣武医院流行病学和社会医学部 
王文志 北京市神经外科研究所神经流行病学室 北京 100053 
吴升平 北京市神经外科研究所神经流行病学室 北京 100053 
李世绰 北京市神经外科研究所神经流行病学室 北京 100053 
程学铭 北京市神经外科研究所神经流行病学室 北京 100053 
杜晓立 北京市神经外科研究所神经流行病学室 北京 100053 
鲍秋菊 北京市神经外科研究所神经流行病学室 北京 100053 
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中文摘要:
      目的 评价社区干预对中年和老年人群高血压和脑卒中的预防效果.方法 对"中国七城市脑卒中干预试验研究"的资料做进一步分析和评估.在北京等六城市城区选择2个不相邻、框架人口约为1万的自然人群,分别作为干预和对照社区,从两社区 35岁以上人群中分别选取2700名既往无脑卒中病史的居民作为队列人群,进行脑卒中危险因素调查(基线调查)和体格检查,筛查高危对象.3年后对参加过基线调查者随访.在干预队列,对基线调查筛查出的高危人群进行干预,重点是高血压预防与控制,同时对社区居民进行大众健康教育.对照社区则顺其原有医疗条件,不予干预.结果 3年后,无论是干预队列还是对照队列,高血压患病率均有所增加,但以对照队列中年人增加最突出.无论是中年人还是老年人,干预组知晓率、治疗率和控制率都有不同程度的改善.3年中干预队列脑卒中发病的危险减少了29%(HR=0.71,95% CI:0.58~0.87),死亡减少了40%(HR=0.60,95% CI:0.42~0.86).干预可以减少各类型高血压患者的脑卒中,在单纯性收缩期高血压患者组最为显著,其次是复合高血压.与此同时,干预队列全死因死亡率与对照队列相比降11%(HR= 0.89,95 % CI:0.78~0.99).结论 社区干预可以有效地控制高血压,提高人群的高血压知晓率、治疗率和控制率,减少各类型高血压患者的脑卒中发病率和死亡率,同时明显减少人群全死因死亡率.
英文摘要:
      Objective To evaluate the community-based intervention on reduction of hypertension and stroke in different age groups and s-ubtypes hypertension.Methods In 6 cities 2 geographically separated communities with a registered population about 10000 of each were selected as either intervention or control communities.A cohort containing 2700 subjects,35 years or older and free of stroke were sampled from each community.The baseline survey was conducted to screen the subjects for intervention.In each city a program for contr-ol of hypertension heart diseases and diabetes was initiated in the intervention cohort and health education was pro-vided to the whole intervention community.A follow-up survey was conducted 3 years later.Results Within 3 years the preva-lence of hypertension in-creased in both intervention and control cohorts as well as in the middle and eldery cohorts especially in the mid-dle aged in control group.Among hypertensives in the intervention cohort the rates of awareness treatment and control of hyperten-sion got improved. The incidence of stroke was 29% lower(HR=0.71,95% CI:0.58~0.87),and mortality of stroke was 40% lower (HR=0.60,95% CI:0.42~0.86) in the intervention cohort than the control cohort. The intervention was most effective in reduction of stroke for those withisolated systolic hypertension and combined systolic and diastolic hyperten-sion(AllP<0.05).Meanwhile allcause mortality was 11% lower(HR=0.89 95% CI:0.78-0.99) in the intervention cohort than in the control cohort.Conclusion The community-based intervention was effective in controlling the development of hypertension and stroke while the elderly people be-nefit more than the middle aged people from the intervention.
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