Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, WA, USA.
Chinese Center for Disease Control and Prevention, Beijing, China.
Popul Health Metr. 2023 Feb 6;21(1):2. doi: 10.1186/s12963-023-00300-2.
AMI and stroke are the leading causes of premature mortality and hospitalizations in China. Incidence data at the population level for the two diseases is limited and the reliability and completeness of the existing incidence registry have not been investigated. We aim to assess if the completeness of case ascertainment of AMI and stroke incidence has improved since the implementation of electronic reporting and to estimate the incidence of AMI and stroke in Tianjin, China.
We applied the DisMod II program to model the incidence of AMI and stroke from other epidemiological indicators. Inputs include mortality rates from Tianjin's mortality surveillance system, and the point prevalence, remission rates and relative risks taken from IHME's Global Burden of Disease studies. The completeness of AMI and stroke incidence reporting was assessed by comparing the sex and age-specific incidence rates derived from the incidence surveillance system with the modeled incidence rates.
The age and sex standardized modeled incidence per 100,000 person-year decreased (p < 0.0001) from 138 in 2007 to 119 in 2015 for AMI and increased (p < 0.0001) from 520 in 2007 to 534 in 2015 for stroke. The overall completeness of incidence report was 36% (95% CI 35-38%) for AMI and 54% (95% CI 53-55%) for stroke. The completeness was higher in men than in women for both AMI (42% vs 30%, p < 0.0001) and stroke (55% vs 53%, p < 0.0001) and was higher in residents aged 30-59 than those aged 60 or older for AMI (57% vs 38%, p < 0.0001). The completeness of reporting increased by 7.2 (95% CI 4.6-9.7) and 15.7 (95% CI 14.4-16.9) percentage points for AMI and stroke, respectively, from 2007 to 2015 among those aged 30 or above. The increases were observed in both men and women (p < 0.0001) and were more profound (p < 0.0001) among those aged between 30 and 59 and occurred primarily during the 2010 and 2015 period.
Completeness of AMI and stroke incidence surveillance was low in Tianjin but has improved in recent years primarily owing to the incorporation of an automatic reporting component into the information systems of health facilities.
AMI 和中风是导致中国人口过早死亡和住院的主要原因。这两种疾病的人群水平发病数据有限，现有发病登记处的可靠性和完整性尚未得到调查。我们旨在评估自电子报告实施以来，AMI 和中风发病病例检出的完整性是否有所提高，并估计中国天津的 AMI 和中风发病率。
我们应用 DisMod II 程序，根据其他流行病学指标对 AMI 和中风的发病率进行建模。输入包括天津死亡率监测系统的死亡率，以及 IHME 全球疾病负担研究中采用的时点患病率、缓解率和相对风险。通过比较发病率监测系统得出的性别和年龄特异性发病率与模型化发病率，评估 AMI 和中风发病率报告的完整性。
年龄和性别标准化的每 10 万人年发病率（100,000 person-years）从 2007 年的 138 降至 2015 年的 119（p<0.0001），从 2007 年的 520 增至 2015 年的 534（p<0.0001）。AMI 的总发病率报告完整性为 36%（95%CI 35-38%），中风为 54%（95%CI 53-55%）。AMI 中男性的完整性（42%比 30%，p<0.0001）和中风（55%比 53%，p<0.0001）均高于女性，AMI 中 30-59 岁居民（57%比 38%，p<0.0001）高于 60 岁或以上居民。2007 年至 2015 年，30 岁及以上人群的 AMI 和中风报告完整性分别提高了 7.2（95%CI 4.6-9.7）和 15.7（95%CI 14.4-16.9）个百分点。无论男性还是女性（p<0.0001），30-59 岁人群（p<0.0001）的提高幅度更大，主要发生在 2010 年至 2015 年期间。
天津 AMI 和中风发病监测的完整性较低，但近年来有所提高，主要原因是在卫生机构的信息系统中纳入了自动报告组件。
