中国农村心血管病防治面临的挑战
Challenges in prevention and control of
CVD in Rural China
Yangfeng Wu, MD, PhD
The George Institute for Global Health at Peking
University Health Science Center
Peking University School of Public Health and Clinical
Research Institute
Nov 28-29, 2013

• Recent trend of cardiovascular diseases in rural
China
• Proportion in causes of death
• Mortality
• Prevalence
• Risk factors
• Resources for control of CVD
• Data from a case study – China Rural Health
Initiative
• Summary and conclusion

Number One Killer
Major Causes of Death in 2000 and 2009 in
Urban and Rural China
2000
Comm.
1%
Urban
Other
16%
Inj.&
Poi.
6%
Resp.
13%
Cancer
24%
CVD
40%
2009
Comm.
1%
Inj.&
Poi.
6%
Resp.
10%
Other
15%
Cancer
27%
CVD
41%
Comm.
2%
Inj.&
Poi.
18%
Rural
Other
14%
CVD
28%
Resp.
21%
Cancer
17%
Inj.&
Poi.
8%
Comm.
1%
Other
11%
Resp.
15%
Cancer
24%
CVD
41%
Data source: Health Statistics Yearbook, MOH, PRC

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*
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*

Age-standardized Prevalence of hypertension in China by sex and urbanisation, data from the
National Nutrition and Health Survey 2002
25
Men Women ALL
10
5
20
15
0
Large city S&M city Class 1 rural
Class 2 rural
Class 3 rural
Class 4 rural

Prevalence of Diabetes in China,
2007-8
NEJM 2010; 362: 1090-1101

Prevalence (%) of smoking in men in China

Not only mortality, morbidity, disability, health-related quality of life,
… but also ……

100%
80%
60%
40%
20%
0%
Urban Rural
Urban Ins Other Ins Coop Ins Private Unsured
Source: The 3 rd National Health Survey, MOH website, 2005

Patients who did not seek care in the past 2 weeks due to financial difficulty (%)
4 0
3 5
3 0
2 5
2 0
32
3 6
32
3 9
Urban
1 9 9 8
2 3
2 0 0 3
Rural
2 0 0 8
3 1

Distribution(%) of Doctor’s Last Education Achieved,
Year 1998
Cardiovascular Health Education Training Program for Health Care
Professionals in the Community
N
Education:
Post-graduate
Med. College
3y College
Special School
High School
Special Provincial Pref. &
County
Town &
Village
71
44
52
4
-
-
487
31
58
10
1
-
466
1
53
30
15
1
549
-
6
22
44
28
Total
1573
12
38
20
20
10

CRHI
• Cluster-randomized, controlled trial
• 120 rural villages from:
─ 120 townships
─ 10 counties
─ 5 provinces
12

Village, population size
Village, annual income, US$
Village clinic, size (m 2 )
VHWs, % <high school
Intervention
N = 60
1,833
869
88
34%
Control
N = 60
1,893
890
100
39%
13

Proportion of High-Risk Individuals among Older
Adults (men >50/women >60)
Results from the baseline survey, 2010
N
Hypertension
SBP ≥160 mmHg
Diabetes Mellitus, self-reported
Stroke, self-reported
Coronary Heart Disease, self-reported
High Cardiovascular Risk (10-yr risk>=10%)
Total (%)
64.4
23.2
3.1
6.8
7.6
33.9
14

Main Challenges in Prevention and
Control of Chronic Disease in China
• an enormous burden of premature cardiovascular disease
• low awareness, poor control and limited resources
• evidence-based clinical guidelines for the management of hypertension and cardiovascular disease well established, but not implemented in rural areas
15

• Financing and resourcing health system for prevention and control of nonecommunicable diseases should be well included as an important component of future urbanization plan of China.
16

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