山东省1970-2005年人群死亡率及死因变化与差别分解分析

摘要

Objective To describe the trend of overall mortality and major causes of death in Shandong population from 1970 to 2005,and to quantitatively estimate the influential factors.Methods Trends of overall mortality and major causes of death were described using indicators such as mortality rates and age-adjusted death rates by comparing three large-scale mortality surveys in Shandong province.Difference decomposing method was applied to estimate the contribution of demographic and nondemographic factors for the change of mortality.Results The total mortality had had a slight change since 1970s,but had increased since 1990s.However,both the mortality rates of age-adjusted and age-specific decreased significantly.The mortality of Group Ⅰ diseases including infectious diseases as well maternal and perinatal diseases decreased drastically.By contrast,the mortality of non-communicable chronic diseases (NCDs)including cardiovascular diseases(CVDs),cancer and injuries increased.The sustentation of recent overall mortality was caused by the interaction of demographic and non-demographic factors which worked oppositely.Non-demographic factors were responsible for the decrease of Group Ⅰ disease and the increase of injuries.With respect to the increase of NCDs as a whole.demographic factors might take the full responsibility and the non-demographic factors were the opposite force to reduce the mortality.Nevertheless,for the increase of some leading NCD diseases as CVDs and cancer,the increase was mainly due to non-demographic rather than demographic factors.Conclusion Through the interaction of the aggravation of ageing population and the enhancement of non-demographic effect,the overall mortality in Shandong would maintain a balance or slightly rise in the coming years.Group Ⅰ diseases in Shandong had been effectively under control.Strategies focusing on disease control and prevention should be transferred to chronic diseases,especially leading NCDs,such as CVDs and cancer.%目的 描述1970-2005年山东省人群总死亡及主要死因死亡水平的变化趋势,定量分析死亡率变化的影响因素.方法 对山东省3次死因调查资料的比较分析,利用死亡率和年龄调整死亡率等指标描述不同年代总死亡和主要死因死亡水平的变化趋势,采用死亡率差别分解法计算死亡率变化中人口因素和非人口因素的贡献值和贡献率.结果 自1970年代以来,山东省人群总死亡率变化幅度不大,1990年代后略呈上升趋势,但调整死亡率和各年龄段死亡率均呈现显著下降趋势.包括感染性疾病和母婴疾病在内的第一大类疾病死亡率急剧下降,而以心脑血管疾病和恶性肿瘤为主的慢性非传染性疾病(慢性病)和伤害死亡率上升趋势明显.人口因素和非人口因素对总死亡率作用方向相反,二者交互作用使1990年代以来的总死亡率较为稳定.第一类疾病死亡率的下降和伤害死亡率的升高主要为非人口因素作用的结果,所有慢性病总死亡率的升高全部为人口因素所致,但对于心脑血管疾病和恶性肿瘤死亡率的升高,非人口因素起到主要作用.结论 随人口老龄化趋势的加重和非人口因素作用的增强,未来一段时间内山东省人群总死亡率将维持在目前水平或略有升高.第一类疾病已得到有效控制,以心脑血管疾病和恶性肿瘤为代表的主要慢性病应成为疾病控制工作的重点.