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

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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

Outline

• • •

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

* * * *

Age-standardized Prevalence of hypertension in China by sex and urbanisation, data from the National Nutrition and Health Survey 2002

25 Men Women ALL 20 15 10 5 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 ……

U-R Disparities in Financial Access

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

Study design:

Cluster-randomized, controlled trial

120 rural villages from:

─ ─ ─

120 townships 10 counties 5 provinces

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CRHI Study Setting Backgrounds, 2010

Village, population size Village, annual income, US$ Village clinic, size (m 2 ) VHWs, %

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

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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

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Conclusion

Financing and resourcing health system for prevention and control of none communicable diseases should be well included as an important component of future urbanization plan of China.

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Sydney, AUSTRALIA | Beijing, CHINA | Hyderabad, INDIA | Oxford, UK

www.thegeorgeinstitute.org.cn

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