山东省滕州市50岁及以上居民白内障患病率及手术服务利用研究

发布时间：2018-06-06 16:59

  本文选题：白内障 + 患病率　； 参考：《山东大学》2013年硕士论文

【摘要】：背景我国是全世界3个盲人高发地区之一,约有盲人近700万,占世界盲人总数的18%。其中,有50%是由于白内障所致。手术治疗被公认是根治白内障最有效的方法,提高手术数量并保证手术质量是消除白内障引起的盲和视力损伤的重点所在。目前,白内障发病机制尚不明确,我国白内障手术服务利用情况也鲜有研究。本研究主要从社会医学研究角度出发,探索白内障相关因素,并分析白内障手术服务利用情况及障碍因素,为白内障防制策略制定提供依据。 目的了解山东省滕州市50岁及以上居民白内障患病率、白内障手术率及手术覆盖率,并分析其影响因素。 方法将滕州市所有行政村、居委会划分为基本抽样单位(BSU),随机整群抽取27个调查点,对调查点50岁及以上人群进行眼部检查及问卷调查。现场检查与调查于2008年4-7月间进行,其前先对居民进行检录。视力检查采用标准对数视力表。以协和医院赵家良教授开展的全国眼科流行病学调查采用的界定标准计算白内障患病率、手术率及手术覆盖率。正式调研前进行了预试验。整个研究从调查前、现场调查阶段和调查后三个环节分别采取了相关措施以保证研究质量。 结果本研究共检录50岁及以上居民5557人,实际受检4916人,应答率为88.46%。(1)受检4916人,白内障患者1308人,患病率为26.6%。单因素分析结果显示：女性患病率29.8%,男性患病率为22.6%(P=0.000)；50-59岁组患病率为6.6%,60-69岁组患病率为27.1%,70-79岁组患病率为58.1%,80岁及以上组患病率78.5%(P=0.000)；文盲组患病率为33.4%,小学以下组患病率为15.6%,小学组患病率为14.4%,初中及以上组患病率为12.1%(P=0.000)；在婚者患病率为21.1%,独身者患病率为53.3%(P=0.000)；人均年收入0-元组患病率为50.6%,1000-元组为28.8%,3000-元组为19.4%,5000-元组为14.6%(P=0.000)；低保户居民患病率为48.3%,非低保户居民患病率为25.8%(P=0.000)；自评健康好、中、差者患病率依次为19.5%、31.2%、42.8%(P=0.000)；亲属中有盲与低视力者患病率为34.0%,无者患病率为26.1%(P=0.002)；不吸烟者患病率为24.4%,吸烟者患病率为27.3%,以前吸现已戒者患病率为33.5%(P=0.004)；从不饮酒者患病率为17.3%,偶尔饮者患病率为24.2%,经常饮者患病率为29.4%,以前喝现已戒者患病率为27.0%(P=0.000)；口味偏淡、中等、偏咸者患病率依次为24.2%、27.6%、31.4%(P=0.000)。多因素分析结果显示,性别、年龄、婚姻状况、受教育程度、人均年收入、自评健康、亲属有无盲及低视力及饮酒状况等因素是白内障患病的危险因素。(2)受检4916人中,接受白内障手术患者为65人,手术率为1.3%。单因素分析结果显示：女性手术率1.0%,男性手术率为1.6%(P=0.048)；50-59岁组手术率为0.0%,60-69岁组手术率为1.2%,70-79岁组手术率为3.7%,80岁及以上组手术率4.2%(P=0.000)；文盲组手术率为1.7%,小学以下组手术率为0.1%,小学组手术率为0.3%,初中及以上组手术率为0.7%(P=0.034)；在婚者手术率为0.8%,独身者手术率为3.7%(P=0.000)；人均年收入0-元组手术率为2.8%,1000-元组为1.5%,3000-元组为0.7%,5000-元组为0.7%(P=0.000)；低保户居民手术率为4.5%,非低保户居民手术率为1.2%(P=0.000)；有医疗保障者手术率为1.4%,无医疗保障者为0.4%(P=0.041)；自评健康好、中、差者手术率依次为1.0%、1.3%、3.4%(P=0.000)；自感视力状况好、中、差、盲者手术率依次为0.2%、1.1%、4.1%、9.7%(P=0.000)；自感眼部不适者手术率为2.2%,无不适者为1.2%(P=0.017)；认为白内障可以治愈者手术率为1.8%,不可治愈者为0.7%,不清楚者为1.0%(P=0.024)。多因素分析结果显示,年龄、自感视力状况、白内障能否治愈认知及有无医疗保障是白内障手术率的影响因素。(3)应当施行白内障手术97人中,接受白内障手术人数为35人,白内障手术覆盖率为36.1%。单因素分析结果显示：女性手术覆盖率35.6%,男性手术覆盖率为37.5%(P=0.868)；50-59岁组手术覆盖率为25.0%,60-69岁组手术覆盖率为45.0%,70-79岁组手术覆盖率为46.8%,80岁及以上组手术覆盖率11.5%(P=0.018)；文盲组手术覆盖率为37.2%,小学以下组手术覆盖率为50.0%,小学组手术覆盖率为0.0%,初中及以上组手术覆盖率为33.3%(P=0.587)；在婚者手术率为30.2%,独身者手术覆盖率为40.7%(P=0.284)；人均年收入0-元组手术覆盖率为35.7%,1000-元组为38.7%,3000-元组为20.0%,5000-元组为42.9%(P=0.683)；低保户居民手术覆盖率为55.6%,非低保户居民手术覆盖率为34.1%(P=0.202)；有医疗保障者手术覆盖率为41.3%,无医疗保障者为11.8%(P=0.022)；自评健康好、中、差者手术覆盖率依次为37.5%、33.3%、40.0%(P=0.857)；自感眼部不适者手术覆盖率为42.3%,无不适者为33.8%(P=0.440)；认为白内障可以治愈者手术覆盖率为45.0%,不可治愈者为25.0%,不清楚者为31.1%(P=0.286)。 结论 (1)山东省滕州市50岁及以上居民白内障患病率为26.6%,白内障手术率为1.3%,白内障手术覆盖率36.1%；(2)白内障患病率与性别、年龄、婚姻状况、受教育程度、人均年收入、自评健康、亲属有无盲及低视力及饮酒状况等因素相关；(3)白内障手术率与年龄、自感视力状况、白内障能否治愈认知及有无医疗保障等因素相关；(4)白内障手术覆盖率与年龄及有无医疗保障等因素相关。
[Abstract]:Background Our country is one of the three blind people in the world , about 7 million blind people , accounting for 18 % of the total number of blind people in the world .

Objective To investigate the prevalence of cataract , cataract operation rate and operative coverage rate among residents aged 50 and above in Tengzhou City , Shandong Province , and to analyze the influencing factors .

Methods All administrative villages in Tengzhou city were divided into basic sampling units ( BSU ) , 27 survey points were randomly selected , and eye examinations and questionnaires were carried out on the population aged 50 and above . The field inspection and investigation were conducted in April to July 2008 .

Results A total of 5,57 people aged 50 years and over were enrolled in the study , 4916 were actually tested , and the response rate was 88.46 % . ( 1 ) The prevalence rate was 26 . 6 % . Results of single factor analysis showed that the prevalence rate was 29 . 8 % and the prevalence rate of men was 22.6 % ( P = 0.000 ) .
The prevalence of the 50 - 59 age group was 6.6 % , the prevalence of the 60 - 69 years group was 27 . 1 % , the prevalence of 70 - 79 years group was 58.1 % , and the prevalence rate was 78.5 % ( P = 0.000 ) .
The prevalence of illiterate group was 33.4 % , the prevalence rate was 15.6 % in primary school , 14.4 % in primary school group , 12.1 % in middle school and above group ( P = 0.000 ) .
The prevalence of unmarried persons was 21.1 % and the prevalence rate was 55.3 % ( P = 0.000 ) .
The incidence of per capita annual income 0 - tuple was 50.6 % , 1000 - tuple was 28 . 8 % , 3000 - tuple was 19.4 % , and 5000 - tuple was 14.6 % ( P = 0.000 ) ;
The prevalence of low - income households was 48.3 % , and the prevalence rate of non - low - income residents was 25 . 8 % ( P = 0.000 ) .
The prevalence of poor health was 19.5 % , 31 . 2 % and 42 . 8 % ( P = 0.000 ) .
The prevalence of blindness and low vision in relatives was 34.0 % , and the prevalence rate was 26.1 % ( P = 0.002 ) .
The prevalence of non - smokers was 24 . 4 % , and the prevalence of smokers was 27.3 % , and the prevalence rate was 33.5 % ( P = 0.004 ) .
The prevalence rate of non - drinkers was 17.3 % , the prevalence of occasional drinking was 24.2 % , and the prevalence rate of frequent drinkers was 29 . 4 % , and the prevalence rate was 27.0 % ( P = 0.000 ) .
The results of multivariate analysis showed that the incidence of sex , age , marital status , degree of education , per capita annual income , self - assessment health , relative lack of blindness and low vision and alcohol consumption were the risk factors of cataract .
The operative rate was 0 . 0 % for 50 - 59 year old group , 1.2 % for 60 - 69 year old group , 3.7 % for 70 - 79 year group , and 4.2 % for group 80 and above ( P = 0.000 ) .
The operative rate was 1.7 % in the illiterate group , 0.1 % in the primary school group , 0.3 % in the primary school group , 0.7 % in the middle school and above group ( P = 0.034 ) .
The operative rate was 0.8 % and the rate of single body operation was 3.7 % ( P = 0.000 ) .
The per capita annual income of 0 - tuple was 2.8 % , 1000 - tuple was 1.5 % , 3000 - tuple was 0.7 % , and 5000 - tuple was 0.7 % ( P = 0.000 ) .
The surgical rate of low - care residents was 4.5 % , and the surgical rate of non - low - care residents was 1.2 % ( P = 0.000 ) .
The operative rate of the patients with medical security was 1.4 % and 0.4 % ( P = 0.041 ) .
The operative rate of the self - evaluation was 1.0 % , 1.3 % and 3.4 % ( P = 0.000 ) .
The operative rate of the blind was 0.2 % , 1.1 % , 4.1 % and 9.7 % ( P = 0.000 ) .
The operative rate was 2.2 % for patients with self - feeling and 1.2 % for patients without discomfort ( P = 0 . 017 ) .
The result of single factor analysis showed that the rate of cataract surgery was 35 . 6 % , and the rate of surgical coverage was 37.5 % ( P = 0.868 ) .
The operative coverage rate of the 50 - 59 year - old group was 25.0 % , the operative coverage rate of the 60 - 69 year - old group was 45.0 % , the operative coverage rate of the 70 - 79 year - old group was 46.8 % , and the operative coverage rate was 11.5 % in the 80 - year - old group and the above group ( P = 0 . 018 ) .
The operative coverage rate was 37.2 % in the illiterate group , 50.0 % in primary school group , 0.0 % in primary school group , 33.3 % in junior middle school and above group ( P = 0.587 ) .
The operative rate of the patients was 30 . 2 % , and the coverage rate was 40.7 % ( P = 0.284 ) .
The per capita annual income of 0 - tuple was 35.7 % , 1000 - tuple was 38.7 % , 3000 - tuple was 20.0 % , and 5000 - tuple was 42.9 % ( P = 0.683 ) .
The operation coverage rate of low - care residents was 55.6 % , and the coverage rate of non - low - care residents was 39.1 % ( P = 0.202 ) .
The operative coverage rate was 41.3 % and 11.8 % ( P = 0 . 022 ) .
The coverage of surgical coverage was 37.5 % , 33.3 % and 40.0 % ( P = 0.857 ) .
The operative coverage rate of patients with self - sensing eye discomfort was 42.3 % and 33.8 % ( P = 0.440 ) .
The rate of operation coverage of cataract was 45.0 % and 25.0 % was not clear , and 31 . 1 % was not clear ( P = 0.286 ) .

Conclusion

( 1 ) The incidence of cataract in Tengzhou city of Shandong province was 26 . 6 % , cataract surgery rate was 1.3 % , and cataract surgery coverage was 36 . 1 % ;
( 2 ) The prevalence of cataract is related to sex , age , marital status , educational attainment , per capita annual income , self - assessment health , relatives ' lack of blindness and low vision and alcohol consumption .
( 3 ) The cataract surgery rate is related to age , self - visual acuity , the ability of cataract to cure cognition and the presence or absence of medical security .
( 4 ) The coverage of cataract surgery is related to age and medical security .
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R195.4;R776.1

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