估算 2000 年、2006 年和 2012 年南非因收缩压升高导致的疾病负担变化情况。

Estimating the changing burden of disease attributable to high systolic blood pressure in South Africa for 2000, 2006 and 2012.

机构信息

Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.

Non-communicable Diseases Research Unit, South African Medical Research Council, Durban, South Africa 3 Department of Medicine, University of Cape Town, South Africa.

出版信息

S Afr Med J. 2022 Sep 30;112(8b):571-582. doi: 10.7196/SAMJ.2022.v112i8b.16542.

DOI:10.7196/SAMJ.2022.v112i8b.16542

PMID:36458347

Abstract

BACKGROUND

Ongoing quantification of trends in high blood pressure and the consequent disease impact are crucial for monitoring and decision-making. This is particularly relevant in South Africa (SA) where hypertension is well-established.

OBJECTIVE

To quantify the burden of disease related to high systolic blood pressure (SBP) in SA for 2000, 2006 and 2012, and describe age, sex and population group differences.

METHODS

Using a comparative risk assessment methodology, the disease burden attributable to raised SBP was estimated according to age, se, and population group for adults aged ≥25 years in SA in the years 2000, 2006 and 2012. We conducted a meta-regression on data from nine national surveys (N=124 350) to estimate the mean and standard deviation of SBP for the selected years (1998 - 2017). Population attributable fractions were calculated from the estimated SBP distribution and relative risk, corrected for regression dilution bias for selected health outcomes associated with a raised SBP, above a theoretical minimum of 110 - 115 mmHg. The attributable burden was calculated based on the estimated total number of deaths and disability-adjusted life years (DALYs).

RESULTS

Mean SBP (mmHg) between 2000 and 2012 showed a slight increase for adults aged ≥25 years (127.3 - 128.3 for men; 124.5 - 125.2 for women), with a more noticeable increase in the prevalence of hypertension (31% - 39% in men; 34% - 40% in women). In both men and women, age-standardised rates (ASRs) for deaths and DALYs associated with raised SBP increased between 2000 and 2006 and then decreased in 2012. In 2000 and 2012, for men, the death ASR (339/100 000 v. 334/100 000) and DALYs (5 542/100 000 v. 5 423/100 000) were similar, whereas for women the death ASR decreased (318/100 000 v. 277/100 000) as did age-standardised DALYs (5 405/100 000 v. 4 778/100 000). In 2012, high SBP caused an estimated 62 314 deaths (95% uncertainty interval 62 519 - 63 608), accounting for 12.4% of all deaths. Stroke (haemorrhagic and ischaemic), hypertensive heart disease and ischaemic heart disease accounted for >80% of the disease burden attributable to raised SBP over the period.

CONCLUSION

From 2000 to 2012, a stable mean SBP was found despite an increase in hypertension prevalence, ascribed to an improvement in the treatment of hypertension. Nevertheless, the high mortality burden attributable to high SBP underscores the need for improved care for hypertension and cardiovascular diseases, particularly stroke, to prevent morbidity and mortality.

摘要

背景

持续量化高血压趋势及其对疾病的影响对监测和决策至关重要。在南非（SA），高血压已得到充分证实，这一点尤为重要。

目的

量化 2000 年、2006 年和 2012 年 SA 与收缩压升高相关的疾病负担，并描述年龄、性别和人群差异。

方法

使用比较风险评估方法，根据年龄、性别和人群，估算 2000 年、2006 年和 2012 年南非≥25 岁成年人中升高的收缩压相关疾病负担。我们对来自 9 项全国性调查（n=124350）的数据进行了荟萃回归分析，以估算所选年份（1998-2017 年）的收缩压平均值和标准差。根据估计的收缩压分布和相对风险，计算了归因于回归稀释偏倚的选择健康结果的归因分数，这些健康结果与升高的收缩压相关，校正值高于理论最低值 110-115mmHg。根据估计的总死亡人数和伤残调整生命年（DALY）计算归因负担。

结果

2000 年至 2012 年，≥25 岁成年人的平均收缩压（mmHg）略有升高（男性为 127.3-128.3mmHg；女性为 124.5-125.2mmHg），高血压的患病率显著增加（男性为 31%-39%；女性为 34%-40%）。在男性和女性中，与升高的收缩压相关的死亡和 DALY 的年龄标准化率（ASR）在 2000 年至 2006 年期间增加，然后在 2012 年下降。2000 年和 2012 年，男性的死亡 ASR（339/100000 与 334/100000）和 DALY（5542/100000 与 5423/100000）相似，而女性的死亡 ASR 下降（318/100000 与 277/100000），年龄标准化 DALY 也下降（5405/100000 与 4778/100000）。2012 年，升高的收缩压估计导致 62314 人死亡（95%置信区间为 62519-63608），占所有死亡人数的 12.4%。在这一时期，升高的收缩压导致的疾病负担中，脑卒中（出血性和缺血性）、高血压性心脏病和缺血性心脏病占 80%以上。