| Objective1.Through the analysis of the construction of national demonstration areas for comprehensive prevention and control of non-communicable diseases(hereinafter referred to as;"NDA")based on a mega-city to understand its impacts on prevalence,mortality rate and risk factors of NCDs among the local residents.2.To refine the best practice and find out the weakness,and by which,to provide some evidence for imporvement of NDA construction.MethodsWe use the method of quantitative analysis to evaluate the effect of building NDA.Overall data are from official health authorities and disease surveillance systems,including"The survey of comprehensive prevention and control of NCDs(2017)",chronic disease&nutrition surveillance for adults(2011&2017),cancer registration system(2007-2016),chronic disease management surveillance system(2007-2017)and cause of death registration system(2010?2017).The difference between NDA and non NDA were compared,including comprehensive prevention and control resources of NCDs,prevalence of NCDs and its risk factors,incidence of cancer and cardiovascular events,all-cause mortality rates and premature death probability of major NCDs.Excel 2016 was used to clean and verify the data.Age-standardized morbidity/mortality rate was calculated based on the Year 2010 Population Census of China.SAS 9.4 software was used to analyze the data.?2 test was used to compare the changes before and after intervention,and the trend test was carried out by Cochran-Armitage method.Interrupted time series(ITS)was also used to analyze and the difference of incidence and death before and after intervention in NDA.The Joinpoint regression model was fitted by Joinpoint Regression Program 4.6.0.0 software,the changing trend of NDA and non NDA over the years were described.Results1.Prevention Resources of NCDsIn 2017,the average expenditure on NCDs accounted for 9.67%(239.23/1216.00)of the total funds of Centers for Disease Control and Prevention(CDC)in each NDA,the proportion of non NDA was 4.90%(58.37/1190.40).The number of full-time staff engaged in the comprehensive prevention and control of NCDs accounted for 6.32%(10/158)of all staffs in CDC,while the proportion of non NDA was 6.25%(5/80).The per capita area of sports venues was 2.57m2 and 3.23m2,respectively.The average value of health-supportive environments was about 282 and 198,respectively.2.NCDs and risk factorsIn 2017,the prevalence and control rate of hypertension increased by 1.8%and 10.0%respectively when compared with the results in 2011,the prevalence of glucose increased by 1.7%and the control rate decreased by 0.9%,the prevalence of dyslipidemia decreased by 8.3%.The proportion of overweight and obesity increased by 5.1%and 4.1%respectively,the smoking rate decreased by 7.7%,and the exposure rate of secondhand smoke increased by 3.4%in NDA;In non NDA,the prevalence and control rate of hypertension increased by 2.6%and 5.4%respectively,the prevalence and control rate of glucose increased by 2.1%and 3.0%respectively,the prevalence of dyslipidemia decreased by 6.6%.The proportion of overweight and obesity increased by 0.4%and 2.7%respectively,the smoking rate decreased by 5.2%,and the exposure rate of secondhand smoke increased by 3.9%in NDA;The difference(?)of the prevalence of dyslipidemia and smoking rate between NDA and non NDA were-1.7%and-2.5%respectively.The difference(?)of the control rate of blood pressure was 4.6%,and the differences(?)of prevalence of hypertension,diabetes and secondhand smoke exposure were-0.8%.-0.4%and-0.5%,respectively.3.Incidence of cancer and cardiovascular diseasesThe age-standardized incidence of cancer in male and female in NDA was 229.98/100 000 and 206.07/100 000 in 2007,and it increased to 237.13/100 000 and 264.39/100 000 in 2016,respectively.From 2007 to 2016,the average annual percentage change of lung cancer,colorectal cancer,liver cancer,gastric cancer,prostate cancer(age-standardized incidence)in male residents in NDA were-0.6%(P<0.05).1.6%(P=0.1),-3.9%(P<0.05),-2.2%(P<0.05)and 4.4%(P<0.05),respectively.And they were 0.3%(P=0.6),5.2%(P<0.05),-2.4%(P<0.05),-1.9%(P<0.05)and 8.3%(P<0.05)respectively in non NDA.The average annual percentage change of breast cancer,lung cancer,colorectal cancer ovarian cancer and cervical cancer(age-standardized incidence rate)in female residents were 1.9%(P<0.05),1.0%(P<0.05),1.2%(P<0,05).3.9%(P<0.05)and 0.2%(P=0.8),respectively.And they were 3.9%(P<0.05),1.9%(P<0.05),3.9%(P<0.05),3.2%(P<0.05)and 2.6%(P=0.1)respectively in non NDA.The age-standardized incidence of acute coronary heart disease of the whole population,male and female in NDA was 130.07/100 000,166.08/100 000 and 95.02/100 000 in 2007,and it increased to 150.41/100 000,206.38/100 000 and 95.92/100 000 in 2017.respectively.The average annual percentage change of them were 0.5%(P=0.2),1.2%(P<0.05),-0.9%(P=0.1).In non NDA,they were 140.70/100 000,172.82/100 000 and 108.85/100 000 in 2007,and it increased to 174.14/100 000,229.90/100 000 and 118.40/100 000 in 2017,respectively.The average annual percentage change of them were 1.6%(P<0.05),2.4%(P<0.05),0.2%(P=0.8).The age-standardized incidence of acute stroke events of the whole population,male and female in NDA was 281.74/100 000,358.04/100 000 and 209.06/100000 in 2007,and it increased to 320.65/100 000.420.16/100 000 and 224.55/100000 in 2017,respectively.The average annual percentage change of them were 0.7%(P=0.1),1.0%(P<0.05),0.1%(P<0.05).In non NDA,they were 379.71/100 000,473.06/100 000 and 290.27/100 000 in 2007,and it increased to 515.36/100 000,670.71/100 000 and 364.83/100 000 in 2017,respectively.The average annual percentage change of them were 3.3%(P<0.05),3.7%(P<0.05),2.7%(P<0.05).4.All-cause mortalityThe age-standardized incidence of all-cause mortality rate of the whole population,male and female in NDA was 374.28/100 000,441.07/100 000 and 310.04/100 000 in 2010,and it decreased to 344.83/100 000,427.55/100 000 and 267.82/100 000 in 2017.respectively.The average annual percentage change of them were-1.0%(P=0.2),-0.3%(P=0.7),-2.1%(P=0.1).In non NDA,they were 493.54/100 000,585.12/100 000 and 405.20/100 000 in 2010.and it increased to 416.54/100 000,513.68/100 000 and 325.08/100 000 in 2017,respectively.The average annual percentage change of them were-2.1%(P<0,05),-1.7%(P<0.05).-2.4%(P<0.05).5.Probability of premature mortality cause by four main NCDsThe probability of premature death of the four main NCDs in all people,men and women in NDA was 11.71%,14.99%and 8.48%in 2010,and it decreased to 9.97%,13.44%and 6.46%in 2017,respectively.The average annual percentage change of them were-2.2%(P<0.05),-1.5%(P<0.05),-3.7%(P<0.05).In non NDA,they were 13.97%,17.28%and 10.64%in 2010,and it increased to 11.66%,15.53%and 7.74%in 2017,respectively.The average annual percentage change of them were-1.9%(P<0.05),-1.0%(P=0.1),-3.6%(P<0.05).From 2010 to 2017,the probability of premature death in all people of cancer,cardiovascular diseases and COPD in NDA showed a downward trend,and the AAPC were-0.9%(P<0.05),-3.6%(P<0.05),-1.2%(P=0.2),-5.2%(P<0.05),respectively.And they were 0.5%(P=0.3),-4.0%(P<0.05),-0.9%(P=0.7),-1.0%(P=0.6)in non NDA.The AAPC in men were-0.7%(P=0.1),-2.4%(P<0.05),1.0%(P=0.3),-3.9%(P<0.05)in NDA.and they were 1.2%(P=0.1),-3.2%(P<0.05),4.1%(P=0.3),1.8%(P=0.3)in non NDA.The AAPC in women were-1.5%(P<0.05),-6.4%(P<0.05),-4.1%(P<0.05),-9.0%(P<0.05)in NDA.and they were-0.8%(P=0.2),-5.8%(P<0.05),-5.5%(P<0.05),-5.8%(P<0.05)in non NDA.Conclusion1.The construction of NDA has generated a positive impact on the comprehensive prevention and control of NCDs.With the mechanism of government guidance,multisector cooperation,social mobilization and national participation,this move has been a security for the prevention and control of NCDs in policies and funds.It also has encble supportive and a good healthy environmen.2.The NDA is,in no small measure,superior to the non NDA in terms of prevention and control of NCDs.including cancer and cardiovascular diseases.And the probability of premature death of NCDs in NDA has met the index requirements set in "Healthy 2030 Strategies" in advance,and the prevention and control of NCDs in non NDA still need to be strengthened.3.The quality of monitoring system should be strengthened in order to provide evidence for effect evaluation.Furthermore,combining quantitative and qualitative analysis,the evaluation of construction effect should be carried out objectively and comprehensively. |
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