School of Public Health, Peking University, No. 38 Xueyuan Road, Haidian District, 100191, Beijing, China.
Health and Family Planning Commission of Xinjiang Uygur Autonomous Region, Urumqi, China, No.191 Longquan Street Tianshan Region, Urumqi, 830000, Xinjiang, China.
BMC Public Health. 2020 Jun 29;20(1):1034. doi: 10.1186/s12889-020-09157-8.
A recent community-based disease management (CBDM) pilot study reported a 20.5% prevalence of hypertension and a 0.5 and 3.6% prevalence of stroke and coronary heart disease (CHD), respectively, in an elderly population (mean age 65 years) in the Xin Jiang autonomous region of China. The CBDM was initiated in 2013 as an essential public health service; however, the potential long-term impact of CBDM on cardiovascular (CV: CHD and stroke) events is unknown. The objective of the study was to understand the long-term impact of CBDM interventions on CV risk factors using disease-model simulation based on a single-arm experimental study.
A discrete event simulation was developed to evaluate the impact of CBDM on the long-term CV risk among patients with hypertension, in China's Xin Jiang autonomous region. The model generated pairs of identical patients; one receives CBDM and one does not (control group). Their clinical courses were simulated based on time to CV events (CHD and strokes), which are estimated using published risk equations. The impact of CBDM was incorporated as improvement in systolic blood pressure (SBP) based on observations from the CBDM study. The simulation estimated the number of CV events over patients' lifetimes.
During a 2-year follow up, the CBDM led to an average reduction of 8.73 mmHg in SBP from baseline, and a 42% reduction in smoking. The discrete event simulation showed that, in the control group, the model estimated incidence rates of 276, 1789, and 616 per 100,000 individuals for lifetime CHD, stroke, and CV-related death, respectively. The impact of CBDM on SBP translated into reductions of 8, 28, and 23% in CHD, stroke, and CV-related deaths, respectively. Taking into account CBDM's reduction of both SBP and smoking, deaths from CHD, stroke, and CV-related deaths were reduced by 12, 30, and 26%, respectively.
The implementation of CBDM in China's Xinjiang autonomous region is expected to significantly reduce incidences of CHD, strokes, and CV-related deaths.
最近一项基于社区的疾病管理（CBDM）试点研究报告称，在中国新疆自治区的老年人群体（平均年龄 65 岁）中，高血压的患病率为 20.5%，中风和冠心病（CHD）的患病率分别为 0.5%和 3.6%。CBDM 于 2013 年作为一项基本公共卫生服务启动，但 CBDM 对心血管（CV：CHD 和中风）事件的潜在长期影响尚不清楚。本研究的目的是通过基于单臂实验研究的疾病模型模拟来了解 CBDM 干预对 CV 危险因素的长期影响。
开发了一种离散事件模拟来评估 CBDM 对中国新疆自治区高血压患者长期 CV 风险的影响。该模型生成了一对相同的患者；一个接受 CBDM，另一个不接受（对照组）。根据发表的风险方程估计 CV 事件（CHD 和中风）的时间，模拟他们的临床过程。根据 CBDM 研究中的观察结果，将 CBDM 的影响纳入到收缩压（SBP）的改善中。该模拟估计了患者一生中 CV 事件的数量。
在 2 年的随访中，CBDM 导致 SBP 从基线平均降低 8.73mmHg，吸烟率降低 42%。离散事件模拟显示，在对照组中，模型估计每 10 万人中终生 CHD、中风和 CV 相关死亡的发生率分别为 276、1789 和 616。CBDM 对 SBP 的影响导致 CHD、中风和 CV 相关死亡的发生率分别降低 8%、28%和 23%。考虑到 CBDM 对 SBP 和吸烟的降低作用，CHD、中风和 CV 相关死亡的死亡率分别降低 12%、30%和 26%。
在中国新疆自治区实施 CBDM 预计将显著降低 CHD、中风和 CV 相关死亡的发生率。
