海岛社区居民伤害流行病学及其疾病负担研究

发布时间：2018-03-03 11:12

本文选题：伤害　切入点：社区　出处：《浙江大学》2008年硕士论文　论文类型：学位论文

【摘要】： 背景和目的伤害已成为全球面临的威胁人民健康的重要公共卫生问题之一,严重制约了社会生产力和经济的发展。据世界卫生组织统计,伤害每年导致全球500多万人死亡和更多人的残疾,是大多数国家居民的前5位死亡原因之一。在美国,每年有1/4的人发生伤害,因伤害造成的经济损失高达2600亿美元。在我国,每年各类伤害发生约2亿人次,因伤害死亡人数约70-75万人,占死亡总人数的9%左右,是继恶性肿瘤、脑血管病、呼吸系统疾病和心脏病之后的第五位死亡原因。估算每年发生各类需要就医的伤害约为6200万人次,占全年居民患病需要就诊总人次数的4.0%,每年因伤害引起的直接医疗费达650亿元,因伤害休工而产生的经济损失达60多亿元。伤害所造成的经济损失和社会负担超过任何一种传染病或慢性非传染性疾病,预计今后20年内,发展中国家慢性非传染性疾病和伤害将取代传染病和营养不良,成为致残和早死的主要原因。我国的伤害预防与控制工作起步较晚,伤害的发生率与严重程度在居民疾病和死亡中处于较为突出的状态,伤害预防与控制的规划、策略和手段与预防控制工作的需要之间还有一定的差距。目前尚未建立完善的全国伤害监测系统,伤害相关信息的来源主要包括社区调查、家庭医生记录、急诊室记录、住院病历记录、重症监护病房记录以及死亡登记等。其中对社区居民进行的伤害现况调查针对性更强,更能准确说明特定人群伤害发生的主要伤害类型、危险环境及其危害程度。普陀区此前尚未在社区人群中开展过伤害的流行病学调查,对伤害的流行状况和危害程度不甚明了。本研究全面系统地分析了普陀海岛社区居民伤害的流行特点及其疾病负担,为相关部门制订决策提供科学依据,也为进一步的伤害预防研究提供基础资料。材料与方法参考2003年浙江省城乡4社区居民伤害发生率(15.30%),为了增加统计的把握度,以10%的居民伤害发生率为样本估算基线,估算样本量为3600人,根据普陀区统计局提供的人口资料显示,平均每户人口为3.1人,则需调查1200户居民。采用多阶段整群随机抽样方法,随机抽取3个(街道)乡镇,每个(街道)乡镇随机抽取2个社区(行政村),每个社区(行政村)按区域划分为60户左右的若干群,随机抽取4个群,共抽取1440户居民作为调查样本。完成对1200户共3181名社区居民的入户问卷调查,回顾性调查户内所有家庭成员2007年5月1日至2008年4月30日期间交通伤、跌伤/坠落、钝器伤、刀/锐器伤、烧烫伤、动物咬伤、溺水/窒息、电击伤、爆炸伤、中毒以及其他伤等11种伤害的发生情况及经济损失。伤害判断标准:具有下列三种情况之一者:①到医疗单位诊治,诊断为某一种伤害;②由家人、老师、同事或同伴对受伤者作紧急处置或看护;③因伤请假(休工、休学、休息)半日以上。用Epidata3.1软件进行数据录入,采用SPSS13.0统计软件进行统计分析。以率、比为主要分析指标,采用普陀区2007年底人口资料进行标化计算。对部分频数小于5的观察值,在统计分析的时候运用Fisher精确概率检验方法。结果本研究共调查了6个社区1200户3181名居民,一年内共发生各种伤害132人次,总发生率为4.51%,标化发生率为3.71%。发生率居前三位的伤害依次为跌伤/坠落(1.95%)、交通伤(0.94%)、钝器伤(0.60%)。发生伤害的男性有86人(65.15%),女性有46人(34.85%),男女性伤害发生率分别为5.33%和2.93%,标化发生率分别为4.31%和1.99%。男性伤害发生率明显高于女性(P＜0.01),在两个性别中发生率最高的伤害类型均为跌伤/坠落。不同年龄组伤害事件发生率不同(P＜0.01),65岁以上老年人群伤害发生率最高(7.27%),其次是45-64岁组(4.45%)。伤害病例的职业构成以家务/待业为主(41.67%),其次是农牧渔水利业生产人员(24.24%)。受教育程度与伤害的发生率存在明显的相关性,受教育程度越高,伤害发生率越低(P＜0.01)。同时伤害的发生也具有明显的季节性,伤害事件的时间分布以6-9月份为主,占全部伤害总数的59.02%,采用圆形分布统计方法分析,伤害发生的时间具有集中趋势。伤害造成总的经济损失为73.18万元,其中直接经济损失为56.28万元,间接经济损失为16.90万元。结论普陀海岛社区居民老年人群的伤害问题和道路交通伤害问题比较突出,并导致了严重的疾病负担。因此,应根据伤害的流行特点,选择发生强度高的伤害类型如跌伤、交通伤等对老年人、农牧渔水利业生产人员等重点人群采取有针对性的干预措施以最大限度地减少和防止伤害的发生。
[Abstract]:Background and objective harm has become one of the world is facing an important public health problem, has seriously restricted the social and economic development. According to the WHO statistics, damage each year as a result of about 5000000 deaths worldwide and more people are disabled, most residents in the country before the 5 cause of death. In the United States, 1/4 people injured each year, due to injuries caused economic losses of up to $260 billion. In China, about 200 million people each year due to various kinds of injuries, injury deaths of about 70-75 million, accounting for 9% of the total number of deaths left and right, is the malignant tumor, cerebrovascular disease, respiratory system disease after death reason and heart disease fifth. The estimated annual occurrence of various types of damage would need to be hospitalized for about 62 million people, accounted for the prevalence of the total number of visits to the 4% people, the direct medical expenses each year due to injury 65 billion yuan, due to injury on the economic loss of about 6000000000 yuan. The damage caused by the economic loss and social burden than any infectious disease or chronic non communicable diseases, is expected in the next 20 years, developing chronic non communicable diseases and injuries will replace infectious diseases and malnutrition, become a major cause of death and disability.
And control work of the late start of China's injury prevention, incidence and severity of injury is more prominent in the residents of state of illness and death, injury prevention and control planning, there is a certain gap between the need of strategy and means of prevention and control work. There has not yet established the national injury surveillance system, the source of damage the relevant information including community survey, family doctor records, emergency room records, hospital records, ICU records and death registration. The damage status of community residents survey more targeted, more accurate description of the main types of damage specific population injury, dangerous environment and harm degree.
Putuo District had not been in the community conducted epidemiological survey of injuries, epidemic situation and harm degree of injury is not very clear. This study comprehensively and systematically analyze the epidemic characteristics and disease burden of injuries among the residents of Putuo island community, for the relevant departments to formulate decision-making to provide a scientific basis, also provide basic data for further research on damage prevention.
Materials and methods 4 damage of community residents in urban and rural areas of Zhejiang province in 2003 the reference incidence rate (15.30%), in order to increase the statistical confidence, in 10% of the residents injury rate for the sample estimate baseline, estimation of sample size for 3600 people, according to the Putuo District Bureau of statistics data show that the average household population, population of 3.1 people, need investigation 1200 residents. By stratified cluster random sampling method, a random sample of 3 villages and towns (street), each township (street) 2 communities (villages), randomly selected from each community (administrative village) by region for about 60 of the number of group, randomly selected 4 groups, a total of 1440 households were selected residents as the survey sample.
Complete the questionnaire survey of 1200 households with a total of 3181 residents, a retrospective survey of all family members during the indoor traffic injury from May 1, 2007 to April 30, 2008, fall / fall, blunt injury, knife / sharp injuries, burns, animal bites, drowning or suffocation, electrical injury, blast injury, and the incidence of poisoning and other economic losses 11 kinds of injury injury. Injury criteria: with one of the following three cases: the treatment in hospital and diagnosed as a kind of injury; the family, teachers, colleagues or peers on the injured for emergency treatment and nursing; the injury (leave off work, leave the rest of) more than half a day.
The data was input by using Epidata3.1 software, statistical analysis was performed using SPSS13.0 software. The rate ratio of the main indicators, with Putuo District at the end of 2007, population data were standardized calculation. To observe the part frequency value less than 5, while the statistical analysis using Fisher exact probability test method.
The results of this study investigated a total of 6 households in 1200 communities of 3181 residents within a year there were various injuries to 132 passengers, the total incidence rate was 4.51%, the standardized incidence rate of 3.71%. incidence ranked the top three of the injuries were falling / fall (1.95%) (0.94%), traffic injury, blunt injury (0.60%). There were 86 men (65.15%), female 46 (34.85%) were 5.33% and 2.93%, the rate of occurrence of sexual harm, standardized incidence rate of injury and 4.31% 1.99%. incidence rate of male was higher than female (P < 0.01), the two highest incidence rate of injury in gender type of fall / fall. Injury incidence rate of different age group and different (P < 0.01), the highest rate of occurrence of people aged over 65 damage (7.27%), followed by the 45-64 year old group (4.45%). The occupation injury cases constituted by housework / unemployed groups (41.67%), followed by agriculture and fishery and water conservancy industry production staff education (24.24%). The degree of damage and the incidence of significant correlation, the higher the level of education, the lower the incidence rate (P < 0.01). At the same time, the occurrence of the injury has obvious seasonal distribution in 6-9 months, mainly injury time, accounted for 59.02% of the total damage, analyzed by circular distribution statistical method. The injury time is concentrated. Damage caused by the total economic loss of 731 thousand and 800 yuan, the direct economic loss of 562 thousand and 800 yuan, the indirect economic loss of 169 thousand yuan.
Injury problems and road traffic injury problems in elderly community residents of Putuo Island conclusion is more prominent, and led to a severe disease burden. Therefore, according to the epidemiological characteristics of injury, injury type selection of high strength such as falls, traffic accidents on the elderly, agriculture and fishery, water conservancy production personnel and other key groups to take the intervention measures to minimize and prevent the occurrence of injury.

【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R181.3

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