Swe Ei Ei, Htet Kyaw Ko Ko, Thekkur Pruthu, Aung Lwin Lwin, Aye Lwin Lwin, Myint Thazin
1Department of Medical Research (Pyin Oo Lwin Branch), Pyin Oo Lwin, Myanmar.
2International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.
Trop Med Health. 2020 Apr 24;48:24. doi: 10.1186/s41182-020-00209-8. eCollection 2020.
Globally, cardiovascular diseases, chronic respiratory diseases, cancers, and diabetes are the four major non-communicable diseases (NCDs) contributing to more than 80% of mortality and morbidity due to NCDs. In Myanmar, the proportional mortality rate due to NCDs increased from 46.9% in 2000 to 68% in 2017. However, the trends and patterns of four major NCDs or their hospital admissions are not known. In this regard, we aimed to assess the trends and profile of admissions with four major NCDs using final diagnosis coded in International Classification of Diseases-2010 version (ICD-10) from medical record data of the large tertiary hospitals in different regions of Myanmar.
Of the 774,970 total admissions in the study hospitals, the median and interquartile range (IQR) age was 39 (25-55) years and 51.6% were males. Over a 6-year period, there was not only 2.2-fold increase in the number of admissions due to any of four major NCDs but also their proportion increased significantly from 18.8% in 2012 to 25.4% in 2017 (chi-square for trend, value < 0.001). The number of admissions due to cancers, cardiovascular diseases, and chronic respiratory diseases also showed linear increasing trends at the rate of 1741 (95% CI 766 to 2715), 1797 (95% CI 345 to 3249), and 597 (95% CI 530 to 612) per year, respectively. Though the admissions with diabetes increased over the years, the rate of increase of 284 (95% CI - 60 to 628) per year was not statistically significant. Among cancer admissions, colorectal (13.1%), breast (13.0%), and lung (11.0%) cancers were the commonest. Stroke (30.6%) and ischemic heart disease (21.9%) admissions were the highest among the cardiovascular diseases. Chronic obstructive pulmonary disease (35.5%) and type 2 diabetes (53.9%) were commonest among chronic respiratory diseases and diabetes, respectively.
There was a disproportionate increase in NCD admissions which requires tertiary health facilities to increase their infrastructure and trained workforce to cater to such admissions. The primary health care facilities have to be strengthened for prevention, early detection, and efficient management of NCDs to prevent life-threatening complications requiring hospitalization.
在全球范围内，心血管疾病、慢性呼吸道疾病、癌症和糖尿病是四大非传染性疾病，占非传染性疾病所致死亡率和发病率的80%以上。在缅甸，非传染性疾病所致的比例死亡率从2000年的46.9%上升至2017年的68%。然而，四大非传染性疾病的趋势和模式或其住院情况尚不清楚。在这方面，我们旨在利用缅甸不同地区大型三级医院病历数据中按照《国际疾病分类-2010版》（ICD-10）编码的最终诊断，评估四大非传染性疾病的住院趋势和概况。
在研究医院的774970例住院病例中，年龄中位数和四分位间距（IQR）为39（25-55）岁，男性占51.6%。在6年期间，四大非传染性疾病中任何一种疾病的住院病例数不仅增加了2.2倍，其比例也从2012年的18.8%显著增加到2017年的25.4%（趋势卡方检验，P值<0.001）。癌症、心血管疾病和慢性呼吸道疾病的住院病例数也呈线性增加趋势，每年分别增加1741例（95%CI 766至2715）、1797例（95%CI 345至3249）和例597（95%CI至530至612）。尽管糖尿病住院病例数多年来有所增加，但每年284例（95%CI -60至628）的增加率无统计学意义。在癌症住院病例中，结直肠癌（13.1%）、乳腺癌（13.0%）和肺癌（11.0%）最为常见。中风（30.6%）和缺血性心脏病（21.9%）的住院病例在心血管疾病中最多。慢性阻塞性肺疾病（35.5%）和2型糖尿病（53.9%）分别是慢性呼吸道疾病和糖尿病中最常见的。
非传染性疾病住院病例数不成比例地增加，这就要求三级卫生设施增加其基础设施和训练有素的工作人员，以应对此类住院病例。必须加强初级卫生保健设施，以预防、早期发现和有效管理非传染性疾病，防止出现需要住院治疗的危及生命的并发症。
