基本公共卫生服务项目框架下高血压患者管理服务的效果评价:基于断点回归设计  

Effect of health management service for hypertension patients under framework of Basic Public Health Service Project:a regression discontinuity design

作　　者：李思萱[1] 纪威[2] 魏欣雨 崔军[1] 应焱燕[1] 陈洁平[1] 李辉[4] 刘世炜[5] Li Sixuan;Ji Wei;Wei Xinyu;Cui Jun;Ying Yanyan;Chen Jieping;Li Hui;Liu Shiwei(Department of Chronic and Non-communicable Disease Control and Prevention,Ningbo Municipal Center for Disease Control and Prevention,Ningbo 315010,China;Department of Big Data,Ningbo Municipal Center for Disease Control and Prevention,Ningbo 315010,China;Harris School of Public Policy,The University of Chicago,Chicago,Illinois 60637,USA;Department of Health Promotion,Ningbo Municipal Center for Disease Control and Prevention,Ningbo 315010,China;Tobacco Control Office,Chinese Center for Disease Control and Prevention,Beijing 100050,China)

机构地区：[1]宁波市疾病预防控制中心慢性非传染性疾病防制所,宁波315010 [2]宁波市疾病预防控制中心大数据所,宁波315010 [3]芝加哥大学哈里斯公共政策学院,美国伊利诺伊州芝加哥市60637 [4]宁波市疾病预防控制中心健康促进科,宁波315010 [5]中国疾病预防控制中心控烟办公室,北京100050

出　　处：《中华流行病学杂志》2023年第5期772-777,共6页Chinese Journal of Epidemiology

基　　金：国家自然科学基金(81872721);中国现场流行病学培训项目(720024);宁波市医学品牌学科(PPXK2018-10)。

摘　　要：目的使用断点回归设计评估参与基本公共卫生高血压患者健康管理服务(HMSFHP)对调查对象血压的影响。方法主要数据源为宁波市成人慢性病监测队列。选取2015年基线调查中,SBP为130~150 mmHg和/或DBP为80~100 mmHg的调查对象纳入本研究。此外,通过查阅基本公共卫生服务随访记录、居民体检记录及电话调查等方式获得调查对象参与HMSFHP的日期、血压值等数据。根据SBP≥140 mmHg和/或DBP≥90 mmHg将调查对象分为干预组和对照组。使用局部线性回归模型估计参与HMSFHP对调查对象2019年SBP/DBP的影响。结果对2015年基线调查DBP为80~100 mmHg的调查对象拟合模型,在调整年龄、性别和参与HMSFHP时长后,模型结果提示,参与HMSFHP后,调查对象的DBP从2015年到2019年下降6.66 mmHg。对2015年基线调查SBP为130~150 mmHg的调查对象拟合模型,模型估计值为-6.17 mmHg,差异无统计学意义(P=0.178),提示参与HMSFHP未引起SBP的变化。结论参与HMSFHP可以使调查对象的DBP下降,对高血压患者控制血压具有积极意义。Objective To evaluate the effect of health management service on hypertension patients(HMSFHP)under the framework of the Basic Public Health Service Project by using regression discontinuity design.Methods The participants were enrolled from an observational cohort survey in 2015 and followed up was conducted in 2019.The participants with SBP 130-150 mmHg and/or DBP 80-100 mmHg in the baseline survey of the cohort in 2015 were included in the present study.Additionally,we obtained the dates of participants receiving HMSFHP and their blood pressure data from follow-up records,physical examination records and telephone interview.The participants were divided into intervention group and control group based on the cutoff points,i.e.SBP≥140 mmHg and/or DBP≥90 mmHg.The local linear regression model were used to estimate the effect of HMSFHP on reducing blood pressure of the participants.Results After adjusting for age,sex and time length of receiving HMSFHP,the results of the model including participants with 80-100 mmHg for DBP in 2015 indicated that,for the participants who received HMSFHP,the DBP decreased by 6.66 mmHg from 2015 to 2019.For the participants with SBP 130-150 mmHg in 2015,the reduction estimate of the model was-6.17 mmHg,the difference was not significant(P=0.178),suggesting that receiving HMSFHP did not cause change in SBP for the participants who received HMSFHP.Conclusion Receiving HMSFHP had effect to reduce DBP,and HMSFHP had a positive effect on the control of blood pressure in patients with hypertension.

关 键 词：基本公共卫生服务 高血压 断点回归法 队列研究 

分 类 号：R544.1[医药卫生—心血管疾病]