Sibai A M, Fletcher A, Hills M, Campbell O
American University of Beirut, Faculty of Health Sciences, Department of Epidemiology and Biostatistics, Beirut, Lebanon.
J Epidemiol Community Health. 2001 Apr;55(4):271-6. doi: 10.1136/jech.55.4.271.
Health priorities in middle to low income countries, such as Lebanon, have traditionally been assumed to follow those of a "typical" developing country, with a focus on the young and on communicable diseases. This study was carried out to quantify the magnitude of communicable and non-communicable disease mortality and to examine mortality pattern among middle aged and older populations in an urban setting in Lebanon.
A representative cohort of 1567 men and women (>/=50 years) who had participated in a cross sectional multi-dimensional health survey in Beirut, Lebanon in 1983 and were followed up 10 years later. Vital status was ascertained and causes of death were obtained through verbal autopsy.
Total mortality rates were estimated at 33.7 and 25.2/1000 person years among men and women respectively. In both sexes, the leading causes of death were non-communicable, mainly circulatory diseases (60%) and cancer (15%). For all cause mortality, men had significantly higher risk than women (age adjusted rate ratio, RR=1.42, 95% confidence intervals (CI) = 1.16, 1.72) especially at younger ages. Except for cerebrovascular diseases, renal problems and injuries attributable to falls and fractures, men were also at higher cause specific mortality risk than women, in particular, for ischaemic heart disease (RR = 2.24, 95% CI = 1.62, 3.12). Comparison with earlier death certificate data in Lebanon and current estimates from other regions in the world showed the magnitude of cardiovascular disease over time.
The results from this first cohort study in the Arab region show, in contrast with popular perception, a mortality pattern more like a developed country than a developing one. Strategies of public health activities, in particular for countries in transition, need to be continuously re-assessed in light of empirical epidemiological data and other health indicators for evidence-based decision making.
传统上认为，黎巴嫩等中低收入国家的卫生重点遵循“典型”发展中国家的模式，重点关注年轻人和传染病。本研究旨在量化传染病和非传染病的死亡率，并研究黎巴嫩城市中老年人群的死亡模式。
选取了1567名男性和女性（年龄≥50岁）作为代表性队列，他们于1983年在黎巴嫩贝鲁特参加了一项横断面多维健康调查，并在10年后进行了随访。通过口头尸检确定生命状态并获取死亡原因。
男性和女性的总死亡率分别估计为33.7/1000人年和25.2/1000人年。在两性中，主要死因是非传染性疾病，主要是循环系统疾病（60%）和癌症（15%）。在所有死因中，男性的死亡风险显著高于女性（年龄调整率比，RR = 1.42，95%置信区间（CI）= 1.16，1.72），尤其是在较年轻的年龄段。除脑血管疾病、肾脏问题以及跌倒和骨折导致的损伤外，男性在特定病因的死亡风险方面也高于女性，特别是缺血性心脏病（RR = 2.24，95% CI = 1.62，3.12）。与黎巴嫩早期的死亡证明数据以及世界其他地区的当前估计值进行比较，显示了心血管疾病随时间的变化情况。
阿拉伯地区的这项首次队列研究结果表明，与普遍看法相反，其死亡模式更类似于发达国家而非发展中国家。公共卫生活动策略，特别是对于转型国家，需要根据实证流行病学数据和其他健康指标不断重新评估，以便进行基于证据的决策。
