日本高血压、糖尿病和血脂异常治疗的有效覆盖：2003-2017 年全国健康和营养调查分析。

Effective coverage of medical treatment for hypertension, diabetes and dyslipidaemia in Japan: An analysis of National Health and Nutrition Surveys 2003-2017.

机构信息

Section Head, Section of Population Health Metrics, International Center for Nutrition and Information, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan.

Chief, International Center for Nutrition and Information, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition, Tokyo, Japan.

出版信息

J Health Serv Res Policy. 2021 Apr;26(2):106-114. doi: 10.1177/1355819620949574. Epub 2020 Oct 15.

DOI:10.1177/1355819620949574

PMID:33059478

Abstract

OBJECTIVE

To examine trends in effective medical treatment coverage for hypertension, diabetes and dyslipidaemia in Japan, using a metric to assess effective coverage of health interventions derived from a health system performance assessment framework.

METHODS

We obtained cross-sectional data for 96,863 individuals aged 40-74 years from the 15 annual Japanese National Health and Nutrition Surveys (2003-2017). We defined treatment need for hypertension, diabetes and dyslipidaemia as biomarkers equal to or greater than diagnostic thresholds or medication use. For individuals needing treatment, we conducted nearest-neighbour matching to estimate treatment effects and effective coverage, defined as the fraction of potential reductions in biomarkers actually achieved in treated individuals by medications.

RESULTS

The age-standardized prevalence of treatment need for hypertension, diabetes and dyslipidaemia remained around 40%, 7% and 33%, respectively, in 2003-2017. Average treatment effects for those treated in 2013-2017 were 14.8 mmHg (95% confidence interval: 14.2-15.4) for systolic blood pressure, 1.2 percentage points (0.8-1.6) for haemoglobin A1c and 57.9 mg/dl (56.6-59.2) for non-high-density lipoprotein cholesterol. Effective coverage significantly increased between 2003-2007 (hypertension: 48.4% [44.7-52.0], diabetes: 43.8% [35.7-51.8], dyslipidaemia: 86.3% [83.1-89.5]) and 2013-2017 (hypertension: 76.2% [74.2-78.2], diabetes: 74.7% [71.0-78.5], dyslipidaemia: 94.6% [93.3-95.9]).

CONCLUSIONS

Effective coverage of medical treatment for metabolic risk factors has increased. Most of the potential reductions in non-high-density lipoprotein cholesterol have been achieved by statins. Further efforts are necessary to improve the effectiveness of antihypertensive and antidiabetic drugs.

摘要

目的

使用一种评估卫生干预措施有效覆盖范围的指标，从卫生系统绩效评估框架中评估高血压、糖尿病和血脂异常的有效治疗覆盖情况，探讨日本在这方面的趋势。

方法

我们从 15 项年度日本国家健康和营养调查（2003-2017 年）中获得了 96863 名 40-74 岁人群的横断面数据。我们将高血压、糖尿病和血脂异常的治疗需求定义为生物标志物等于或大于诊断阈值或药物使用。对于需要治疗的个体，我们进行最近邻匹配以估计治疗效果和有效覆盖率，定义为通过药物实际实现的生物标志物潜在降低的分数。

结果

2003-2017 年，高血压、糖尿病和血脂异常的治疗需求标准化患病率分别约为 40%、7%和 33%。2013-2017 年接受治疗的患者的平均治疗效果分别为收缩压 14.8mmHg（95%置信区间：14.2-15.4）、糖化血红蛋白 1.2 个百分点（0.8-1.6）和非高密度脂蛋白胆固醇 57.9mg/dl（56.6-59.2）。有效覆盖率在 2003-2007 年（高血压：48.4%[44.7-52.0]，糖尿病：43.8%[35.7-51.8]，血脂异常：86.3%[83.1-89.5]）和 2013-2017 年（高血压：76.2%[74.2-78.2]，糖尿病：74.7%[71.0-78.5]，血脂异常：94.6%[93.3-95.9]）之间显著增加。