中国农村心血管病防治面临的挑战 Challenges in prevention and control of CVD in Rural...
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中国农村心血管病防治面临的挑战Challenges in prevention and control of
CVD in Rural China
Yangfeng Wu, MD, PhD
The George Institute for Global Health at Peking University Health Science Center
Peking University School of Public Health and Clinical Research Institute
Nov 28-29, 2013
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Outline
• Recent trend of cardiovascular diseases in rural China• Proportion in causes of death• Mortality• Prevalence• Risk factors• Resources for control of CVD
• Data from a case study – China Rural Health Initiative
• Summary and conclusion
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Number One KillerMajor Causes of Death in 2000 and 2009 in Urban and Rural China
Other16%
Comm.1%
Resp.13%
Inj.&Poi.6%
CVD40%
Cancer24%
Comm.2%
Other14%
Resp.21%
Inj.&Poi.18%
CVD28%
Cancer17%
RuralUrban
Data source: Health Statistics Yearbook, MOH, PRC
Other15%
Comm.1%
Resp.10%
Inj.&Poi.6%
CVD41%
Cancer27%
Comm.1%
Other11%
Resp.15%
Inj.&Poi.8%
CVD41%
Cancer24%
2000
2009
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Age-standardized Prevalence of hypertension in China by sex and urbanisation, data from the National Nutrition and Health Survey 2002
0
5
10
15
20
25
% of
hyp
erte
nsio
n
Large city S&M city Class 1rural
Class 2rural
Class 3rural
Class 4rural
Men Women ALL
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Prevalence of Diabetes in China, 2007-8
NEJM 2010; 362: 1090-1101
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Prevalence (%) of smoking in men in China
0
10
20
30
40
50
60
70
1993 1998 2003 2008Urban Rural
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Not only
mortality, morbidity, disability,health-related quality of life,
but also ……
…
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U-R Disparities in Financial Access
0%
20%
40%
60%
80%
100%
Urban Rural
Urban Ins Other Ins Coop Ins Private Unsured
Source: The 3rd National Health Survey, MOH website, 2005
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Patients who did not seek care in the past 2 weeks due to financial difficulty (%)
32
36
23
32
39
31
20
25
30
35
40
Urban Rural1998 2003 2008
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Special Provincial Pref. & County
Town & Village
Total
N 71 487 466 549 1573
Education:
Post-graduate 44 31 1 - 12
Med. College 52 58 53 6 38
3y College 4 10 30 22 20
Special School - 1 15 44 20
High School - - 1 28 10
Distribution(%) of Doctor’s Last Education Achieved, Year 1998Cardiovascular Health Education Training Program for Health Care Professionals in the Community
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Study design:•Cluster-randomized, controlled trial
•120 rural villages from:
─ 120 townships
─ 10 counties
─ 5 provinces
CRHI
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CRHI Study Setting Backgrounds, 2010
InterventionN = 60
ControlN = 60
Village, population size 1,833 1,893
Village, annual income, US$ 869 890
Village clinic, size (m2) 88 100
VHWs, % <high school 34% 39%
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Proportion of High-Risk Individuals among Older Adults (men >50/women >60)Results from the baseline survey, 2010
Total (%)
N
Hypertension 64.4
SBP ≥160 mmHg 23.2
Diabetes Mellitus, self-reported 3.1
Stroke, self-reported 6.8
Coronary Heart Disease, self-reported 7.6
High Cardiovascular Risk (10-yr risk>=10%) 33.9
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• an enormous burden of premature cardiovascular disease
• low awareness, poor control and limited resources
• evidence-based clinical guidelines for the management of hypertension and cardiovascular disease well established, but not implemented in rural areas
Main Challenges in Prevention and Control of Chronic Disease in China
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• Financing and resourcing health system for prevention and control of none-communicable diseases should be well included as an important component of future urbanization plan of China.
Conclusion
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Sydney, AUSTRALIA | Beijing, CHINA | Hyderabad, INDIA | Oxford, UK
www.thegeorgeinstitute.org.cn