山东省居民原发性蛛网膜下腔出血的流行特征分析  

Epidemiological characteristics of spontaneous subarachnoid hemorrhage cases in Shandong province

作　　者：张丙银 张吉玉[2] 楚洁[1] 鹿子龙[1] 徐晓慧 于晓慧 郭晓雷[1] 徐爱强 马吉祥[4] Zhang Bingyin;Zhang Jiyu;Chu Jie;Lu Zilong;Xu Xiaohui;Yu Xiaohui;Guo Xiaolei;Xu Aiqiang;Ma Jixiang(Department of Non-communicable and Chronic Disease Control and Prevention,Shandong Center for Disease Control and Prevention,Jinan 250014,China;Department of Business Management,ShandongProvincial Center for Disease Control and Prevention,Jinan 250014,China;Research Institute of Preventive Medicine of Shandong University,Jinan,250014,China;Shandong Center for Disease Control and Prevention,Jinan 250014,China)

机构地区：[1]山东省疾病预防控制中心慢性非传染性疾病防制所,济南250014 [2]山东省疾病预防控制中心业务管理部,济南250014 [3]山东大学预防医学研究院,济南250014 [4]山东省疾病预防控制中心,济南250014

出　　处：《中华医学杂志》2024年第24期2249-2255,共7页National Medical Journal of China

基　　金：山东省医药卫生科技发展计划项目(202212050992)

摘　　要：目的了解山东省居民原发性蛛网膜下腔出血(SAH)发病特征和流行趋势。方法本研究从山东省慢性病监测信息管理系统收集居民2012—2021年SAH发病数据,包括门诊、急诊或住院以及院外死亡病例基本信息和疾病诊断信息。以粗发病率和年龄标化发病率为指标描述不同性别、年龄组、地区(城市和农村)常住人口SAH发病水平,采用Joinpoint回归分析发病率和发病年龄随年份变化趋势。应用率的差别分解法估计人口老龄化对SAH发病率上升的贡献度。采用DeoDa 1.12软件进行全局和局部空间自相关分析。结果2012—2021年,山东省19个省级监测点共报告SAH发病11629例次;其中,女性占54.11%(6293例次),≥45岁居民占91.87%(10684例次)。报告粗发病率从5.26/10万上升至9.50/10万,年均上升7.75%(Z_(趋势)=7.30,P_(趋势)<0.001),标化发病率整体也呈现上升趋势(Z_(趋势)=3.92,P_(趋势)=0.004)。各年份女性报告粗发病率均高于男性(均P<0.05),除2012和2021年外,各年份女性标化发病率均高于男性(均P<0.05);2012年城市居民粗发病率和标化发病率低于农村(P<0.05),2013—2017年,城市高于农村,2018年以后,农村再次超过城市(均P<0.05)。SAH中位发病年龄从2012年的61.9岁上升至2021年的67.2岁,各年份男性发病年龄低于女性(均P<0.05),多数年份城市和农村居民发病年龄差异无统计学意义(均P>0.05)。SAH发病率随年龄增长呈上升趋势(P_(趋势)<0.001),<45岁居民报告发病率较低,≥45岁发病率快速上升。经季节性分解,SAH发病在1、3—5、10—11月有3个小高峰。2013—2021年,人口老龄化对SAH粗发病率上升的贡献占比由27.86%上升至43.68%。全局空间自相关分析显示,SAH发病呈现明显的空间聚集性分布(Moran′s I>0,P<0.05);局部空间自相关分析发现,高发区县主要集中在鲁西北的德州市和鲁西南的菏泽市。结论山东省居民SAH发病率呈上升趋势,且具有空间聚�Objective To investigate the characteristics and trends of spontaneous subarachnoid hemorrhage(SAH)in Shandong province.Methods In this study,SAH incidence data of residents from 2012 to 2021 were collected from the chronic disease monitoring information management system of Shandong province,including the basic information of outpatient,emergency or inpatient cases and out-of-hospital deaths(name,gender,ID number,address,etc.)and disease diagnosis information(disease diagnosis,date of onset,date of diagnosis,etc.).The crude incidence rate and age-standardized incidence rate were used as indicators to describe the incidence of SAH in different gender,age groups and regions(urban and rural areas).Joinpoint regression was used to analyze the variation of incidence rate and age by year.The rate difference decomposition method was used to estimate the contribution of population aging to the increase of SAH incidence.Global and local spatial autocorrelation analysis was performed using DeoDa 1.12 software.Results From 2012 to 2021,a total of 11629 cases of SAH were reported from 19 provincial monitoring sites in Shandong province.Among them,54.11%(6293 cases)were female and 91.87%(10684 cases)were≥45 years old.The reported crude incidence rate increased from 5.26/100000 to 9.50/100000,with an average annual increase of 7.75%(Z_(trend)=7.30,P_(trend)<0.001),and the standardized incidence rate also showed an upward trend(Z_(trend)=3.92,P_(trend)=0.004).The crude incidence rate of women was higher than that of men in all years(all P values<0.05),and the standardized incidence rate of women was higher than that of men in all years except in 2012 and 2021(all P values<0.05).In 2012,the crude incidence and standardized incidence of urban residents were lower than those in rural areas(P<0.05);from 2013 to 2017,the urban incidence was higher than that in rural areas;and after 2018,the rural incidence exceeded the urban incidence again(all P values<0.05).The median age of onset of SAH increased from 61.9 years in 2012 to 67.

关 键 词：蛛网膜下腔出血 发病率 流行趋势 空间分布 

分 类 号：R743.35[医药卫生—神经病学与精神病学] R181.3[医药卫生—临床医学]