The Comparative Analysis Of Disease Burden And The Impact Of Major Risk Factors In Jiangsu Province In 2003 And 2016

Purposes The economy has developed rapidly in recent years of Jiangsu Province.With the development of the economy and society,the death spectrum of the population has also changed.This study used the data of Death Registration System and the Third Death Retrospective Surveyin Jiangsu,combined with the Global Burden of Diseases(GBD)research methods to assess the disease burden in Jiangsu Province.A comparative analysis was conducted to describe the changes in mortality,probability of premature mortality,the cause of death,disability adjusted of life years(DALY),life expectancy,and economic burden of the disease in Jiangsu Province.At the same time,this study also carried out a comparative analysis of some modifiable risk factors,such as smoking?drinking?hypertention et al,to quantitative assess the disease burden of these factors.Through a systematic analysis of the disease burden in Jiangsu Province,it is expected to provide a scientific basis for disease prevention and control and health care.Methods 1.Death data were collected from the Death Registration System 2016 and the Third Death Retropsectove Survey in 2003.The population data were collected from local statistics department.Referring to Global Burden of Disease Study(WHO),diseases were classified into four categories,with a total of 206 diseases.SAS 9.2 software was used to redistribute the garbage code(not logical or can not be used as the underlying cause of death).Life expectancy and probability of premature mortality were calculated by the simple life table method.The age-standardized rates were calculated by using the population of the sixth National Population Census in 2010.2.This study used a simple method of GBD to estimate DALY,which included years of life lost(YLL)and years of life lived with disability(YLD),DALY=YLL+YLD.An indirect evaluation method was used to calculate YLD.The economic burden of disease consists of two parts: the direct economic burden and the indirect economic burden.The two-step model method was used to estimate the direct economic burden of diseases,which included the direct economic burden of the outpatient and in hospital service.The relevant indicators of the direct economic burden referred to the Chinese health service surveys and the health statistics yearbooks,the Joinpoint software was used to establish a linear regression to esimate missing data.Indirect economic burden = GDP per capita × DALY × productivity weight.The spatial distribution of age-standardized mortality and age-standardized DALY rates was described using ArcGIS 9.3 software.3.Exposure of Risk factors was collected from two different health surveys in Jiangsu Province,both were carried out based on multi-stage-stratified cluster random sampling method:(1)Jiangsu Health and Nutrition Survey(JCHNS 2002),a total of 8 cities and counties were involved,including 5,995 households and 13,887 participants.(2)In 2015,the Jiangsu Adult Chronic Disease and Nutrition Survey(JACNS 2015),a total of 13 cities or counties were involvred,including 7,992 participants.We used comparative risk assessment methods to evaluate and compare the health loss from several modifiable risk factors(behavioral risk factors: smoking and drinking,metabolic risk factors: hypertension,hyperglycemia,hyperlipidemia,overweight/obesity)in Jiangsu Province.Results 1.There were 524,618 deaths in Jiangsu Province in 2016,the crude death rate and the age-standardized mortality were 676.05/100,000 and 407.83/100,000,respectively.Compared with 2003(507,731 deaths,crude and the age-standardized mortality rate was 682.65/100,000 and 667.22/100,000),the number of deaths increased by 3.33%,and the crude and age-standardized mortality rate decreased by 0.97% and 38.88%,respectively.In 2003 and 2016,the number of deaths of infectious diseases,chronic non-communication diseases(NCDs)and injuries were increased,but age-standardized mortality rates were decreased,and male mortality rate was higher than that of female.In 2016,the mortality of all age groups was lower than that of 2003.In 2016,the age-standardized mortality of 13 cities in Jiangsu Province was between 351.88-476.56/100,000.Stroke was the first leading cause of death,accounted for more than one-fifth of all deaths in both years.The probability of premature mortality caused by four main NCDs(marligant tumor,cardiovascular diseases,chronic obstructive pulmonary disease,Diabetes mellitus)was decreased,among which cancer was the highest,and was higher among male.The average life expectancy of residents in Jiangsu Province in 2003 and 2016 was 76.41 and 82.11 years respectively.The average life expectancy of women was higher than that of men,but the difference between men and women became smaller.Malignant tumors and cardiovascular diseases were the major reasons for life expectancy loss,men's average life expectancy loss due to malignant tumors was higher than that of women,while women were higher in cardiovascular diseases.2.In 2016,DALY due to illness was 14.60 million person-years in Jiangsu,which was 1.83 million lower than that of 2003,and the age-standardized DALY rate decreased by 33.50%.The disease burden caused by malignant tumors and cardiovascular diseases was the most serious.In 2003,the DALY and age-standardized DALY rates of malignant tumors were higher than those of cardiovascular diseases,while by 2016 they were very close.The DALY of male was higher than that of females,and the difference between men and women increased in 2016.For the composition of DALY,YLL was higher than YLD.For YLL,men were higher than that of women;while for YLD women were higher than that of men.In different age groups,the age-standardized DALY rate were different,and the line chart showed a“J” shape.In 2016,the age-standardized DALY rate of 13 cities in Jiangsu Province was between 124.96-182.11/1000 and was high in northern but low in southern Jiangsu.The direct economic burden in 2003 and 2016 was 51.30 and 148.13 billion RMB,respectively.In 2003,the economic burden of outpatient service was higher than hospitalization,but the economic burden of hospitalization in 2016 exceeded outpatient service.The economic burden varied among different age groups.In 2003 and 2016,the indirect economic burden was 137.57 billion RMB and 695.59 billion RMB,respectively,both exceeded the direct economic burden.The ratio of the total economic burden to GDP of Jiangsu Province decreased from 15.17% to 11.09%.3.Of the total deaths in Jiangsu Province in 2015,18.61%(94,848 deaths,1,930,700 YLL)were attributed to smoking and alcohol,and 29.61%(151,304 deaths,2,519,000 YLL)were attributed to four metabolic risk factors(hypertension,hyperglycemia,hyperlipidemia,overweight/obesity).Compared with 2003,the PAF(Population Attributable Fraction)of behavior and metabolic risk factors decreased by 14.43% and increased by 33.9%,respectively.Hypertension was the most important risk factor to be responsible for death,and the increase of hyperglycemia was the fastest.Regarding attributable age-standardized mortality and age-standardized YLL rates,men were higher than women in smoking and drinking,while women were higher in metabolic risk factors.Different age groups showed a large difference in attributable deaths,and the highest age group was over 60 years old.Among the disease burdens caused by smoking and drinking,the highest was cancer;while for metabolic risk factors the highest was cardiovascular diseases.In 2015,smoking and drinking caused 2.24 years loss of the average life expectancy,the loss was reduced compared with 2003,and the average life expectancy loss of men did not change much but women decreased more.Metabolic risk factors caused the average life expectancy loss was 4.39 years old,and was increased compared with 2003,among which high blood pressure was the highest(2.83 years),and women was higher than that of men.Conclusions In the new era,from the perspective of diseases burden model,the public health work should be focused on prevention and control of NCDs,especially malignant tumors and cardiovascular diseases have caused large DALY loss in Jiangsu Province.Secondly,based on the results,more efforts should be paid to control smoking and alcohol drinking,and to prevent the harm caused by four metabolic risk factors(hypertension,hyperglycemia,hyperlipidemia and overweight/obesity)in Jiangsu Province.Finally,it is recommended that in the implementation process of “Healthy Jiangsu 2030” planning,more targeted measures should be taken to decrease diseases burden and increased life expectancy according to the differences of special-causes,regions,gender and age-groups.