Hyduk Alexandra, Croft Janet B, Ayala Carma, Zheng Kan, Zheng Zhi-Jie, Mensah George A
Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA 30341, USA.
MMWR Surveill Summ. 2005 Nov 11;54(5):1-28.
PROBLEM/CONDITION: Pulmonary hypertension, which is listed on hospital records and death certificates as either primary (i.e., idiopathic) pulmonary hypertension or pulmonary hypertension secondary to another underlying condition or disease, is considered rare amongst the U.S. population. Limited reports have been published regarding surveillance data for this debilitating and often fatal condition.
1980-2002.
This report summarizes mortality data from the National Vital Statistic System (NVSS) and hospital discharge data from the National Hospital Discharge Survey (NHDS) for 1980-2002 and Medicare hospital claims data for 1990-2002. NVSS, maintained by CDC's National Center for Health Statistics (NCHS), compiles multiple cause of death information from official death certificates filed in the United States. NHDS, also conducted annually by NCHS, includes information on discharges from a sample of nonfederal, short-stay hospitals. Annual hospital claims and enrollment data for all Medicare beneficiaries aged > or =65 years are provided by the Center for Medicare and Medicaid Services. Because pulmonary hypertension might be reported secondary to other diseases, this report presents data for pulmonary hypertension as any contributing cause of death or any-listed hospital diagnosis. Since 1980, the numbers of deaths and hospitalizations, death rates, and hospitalization rates have increased for pulmonary hypertension, particularly among women and older adults. During 1980-2000, death rates were higher for men than women; however, by 2002, no difference in rate was observed because of increasing death rates among women and declining death rates among men. Hospitalization rates were higher for men than for women until 1995; after 1995, higher rates were observed among women. Death rates since 1985 and Medicare hospitalization rates throughout the reporting period 1990-2002 have been higher for blacks than for whites. In addition, two distinct geographic clusters were observed for the highest hospitalization rates in the Medicare population and the highest death rates for pulmonary hypertension, in the western United States and in the Appalachian region.
Increases in mortality from and hospitalization for pulmonary hypertension might reflect increased physician awareness and changes in diagnosing and reporting this chronic disease. Although pulmonary hypertension historically has been considered a disease of women of childbearing age, it affects all ages and racial populations. Older women represent the majority of patients and decedents with this condition. More research is needed concerning cause, prevention, and treatment of pulmonary hypertension. Public health initiatives should include increasing physician awareness that early detection is needed to initiate prompt, effective disease management. Additional epidemiologic initiatives also are needed to ascertain prevalence and incidence of various pulmonary hypertension disease entities such as pulmonary arterial hypertension.
问题/状况：肺动脉高压在医院记录和死亡证明中被列为原发性（即特发性）肺动脉高压或继发于其他潜在病症或疾病的肺动脉高压，在美国人群中被认为较为罕见。关于这种使人衰弱且往往致命的病症的监测数据的报告有限。
1980 - 2002年。
本报告总结了1980 - 2002年国家生命统计系统（NVSS）的死亡率数据以及国家医院出院调查（NHDS）的医院出院数据，以及1990 - 2002年医疗保险医院理赔数据。由疾病控制与预防中心的国家卫生统计中心（NCHS）维护的NVSS，汇编了在美国提交的官方死亡证明中的多种死因信息。同样由NCHS每年进行的NHDS，包括来自非联邦短期住院医院样本的出院信息。医疗保险和医疗补助服务中心提供了所有年龄≥65岁的医疗保险受益人的年度医院理赔和参保数据。由于肺动脉高压可能作为其他疾病的继发情况被报告，本报告将肺动脉高压的数据呈现为任何促成死亡的原因或任何列出的医院诊断。自1980年以来，肺动脉高压的死亡人数、住院人数、死亡率和住院率都有所增加，特别是在女性和老年人中。在1980 - 2000年期间，男性的死亡率高于女性；然而，到2002年，由于女性死亡率上升和男性死亡率下降，未观察到率的差异。直到1995年男性的住院率高于女性；1995年之后，女性的住院率更高。自1985年以来的死亡率以及1990 - 2002年整个报告期间医疗保险的住院率，黑人高于白人。此外，在美国西部和阿巴拉契亚地区，观察到医疗保险人群中住院率最高和肺动脉高压死亡率最高的两个不同地理聚集区。
肺动脉高压死亡率和住院率的增加可能反映出医生意识的提高以及这种慢性病诊断和报告的变化。尽管肺动脉高压在历史上一直被认为是育龄期女性的疾病，但它影响所有年龄和种族人群。老年女性是患有这种病症的患者和死者的大多数。需要对肺动脉高压的病因、预防和治疗进行更多研究。公共卫生举措应包括提高医生的意识，即需要早期检测以启动及时、有效的疾病管理。还需要额外的流行病学举措来确定各种肺动脉高压疾病实体如肺动脉高压的患病率和发病率。
