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[目的]观察不同收入、受教育程度及老龄化人群跌倒伤害的分布情况,以分析上海市城市居民跌倒伤害的流行特征。[方法]于2006年,调查采用分层多阶段概率比例整群抽样的方法,抽取上海市常住居民45 857人进行入户调查;同时采集164家医院跌倒伤害信息及2001—2011年全市居民病伤死亡原因及其相关人口统计学资料。采用logistic多因素回归分析,控制年龄、性别、教育程度及收入的混杂效应。[结果]1在2001—2011年的11年里,上海市人均年工资性收入增加了206.63%,但居民跌倒伤害死亡率从2001年的10.63/10万上升到2011年的14.76/10万。总受伤率为14.70‰。家庭月人均收入低于500元人民币的受伤率约为收入高于5 000元人民币的6.5倍。2小学及以下文化程度人群的跌倒伤害死亡率及受伤率最高,分别是57.85/10万(73.23%)和33.96‰(49.24%),分别约为大学及以上文化程度者的22倍和5.5倍;3老龄化程度最大的卢湾区和静安区,其相应的死亡率也最高,分别为24.10/10万和19.59/10万。5岁以下年龄组死亡率在所有儿童中居于首位,15~64岁劳动力人口的死伤率随年龄增长而加大,其中50~54岁年龄组所占比重最高,受伤率增加幅度显著加快。女性死伤率高于男性。在所有跌倒伤亡者中,因头部受伤致死者近半。生活水准越低、受教育程度越低及老龄化程度越严重,发生跌倒伤害的风险越大,其相对危险性OR值分别为1.39、1.27和1.21。[结论]上海市居民跌倒伤害预防和控制面临着巨大的挑战,收入、受教育程度,年龄是跌倒伤害相关的主要危险因素。干预重点应放在低于小学文化程度、低收入、年龄5岁以下或50岁以上人群,建议在新医改中推出的家庭医生责任制系统中增加跌倒伤害防治服务包。
[Objective] To observe the distribution of fall injuries caused by different incomes, education levels and aging population in order to analyze the epidemiological characteristics of fall injuries among urban residents in Shanghai. [Method] In 2006, the survey adopted stratified multi-stage probabilistic proportion cluster sampling method, and sampled 45 857 permanent residents in Shanghai for household survey. At the same time, 164 hospital fell injury information and 2001-2011 resident’s disease Causes of death and related demographic data. Logistic multivariate regression analysis was used to control for mixed effects of age, gender, education, and income. [Results] 1 In 2001-11, the per capita annual wage income in Shanghai increased by 206.63%, but the death toll of residents fell from 10.63 / 100000 in 2001 to 14.76 / 100000 in 2011. The total injury rate was 14.70 ‰. The monthly injury rate of a family whose monthly income is less than 500 yuan is about 6.5 times of the income of more than 5,000 yuan. There were 57.85 / 100000 (73.23%) and 33.96 ‰ (49.24%) respectively in the fall injuries and the injuries sustained in people with primary school education and below, which were about 22 times and 5.5 times higher than those with education at the university level or above ; 3 The highest rates of death in Luwan District and Jing’an District, with the highest levels of aging, were also 24.10 / 100,000 and 19.59 / 100,000 respectively. The death rate of the under-five age group is the highest among all the children. The death rate of the 15-64-year-old labor force population increases with age, of which the highest in the age group of 50- to 54-year-olds, the rate of injury increase significantly accelerated. Female mortality rate is higher than men. Nearly half of those who died of head injuries among all fell victims. The lower the standard of living, the lower the level of education and the more serious the aging, the greater the risk of falling injuries. The relative risk OR values are 1.39, 1.27 and 1.21 respectively. [Conclusion] The prevention and control of fall injuries in Shanghai residents face great challenges. Income, education level and age are the main risk factors associated with fall injuries. The intervention should be focused on people with educational level lower than primary school, low income, under 5 years of age or over 50 years of age. It is suggested that a fall prevention and treatment service package should be added to the family doctor accountability system introduced in the new medical reform.