prevalence and control of diabetes in chinese adults. jama 宁光.pdf
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1、PrevalenceandControlofDiabetesinChineseAdults YuXu,PhD;LiminWang,PhD;JiangHe,MD,PhD;YufangBi,MD,PhD;MianLi,PhD;TiangeWang,PhD; LinhongWang,PhD;YongJiang,MS;MengDai,BS;JieliLu,MD,PhD;MinXu,PhD;YichongLi,MS;NanHu,MS; JianhongLi,MS;ShengquanMi,PhD;Chung-ShiuanChen,MS;GuangweiLi,MD,PhD;YimingMu,MD,PhD;
2、JiajunZhao,MD,PhD;LingzhiKong,MD;JialunChen,MD;ShenghanLai,MD,MPH;WeiqingWang,MD,PhD; WenhuaZhao,PhD;GuangNing,MD,PhD;forthe2010ChinaNoncommunicableDiseaseSurveillanceGroup IMPORTANCENoncommunicablechronicdiseaseshavebecometheleadingcausesof mortalityanddiseaseburdenworldwide. OBJECTIVEToinvestigate
3、theprevalenceofdiabetesandglycemiccontrolintheChinese adultpopulation. DESIGN, SETTING, AND PARTICIPANTSUsingacomplex,multistage,probabilitysampling design,weconductedacross-sectionalsurveyinanationallyrepresentativesampleof 98 658Chineseadultsin2010. MAIN OUTCOMES AND MEASURESPlasmaglucoseandhemogl
4、obinA1clevelsweremeasured afteratleasta10-hourovernightfastamongallstudyparticipants,anda2-houroralglucose tolerancetestwasconductedamongparticipantswithoutaself-reportedhistoryof diagnoseddiabetes.Diabetesandprediabetesweredefinedaccordingtothe2010American DiabetesAssociationcriteria;whereas,ahemog
5、lobinA1clevelof7.0%wasconsidered adequateglycemiccontrol. RESULTSTheoverallprevalenceofdiabeteswasestimatedtobe11.6%(95%CI,11.3%-11.8%) intheChineseadultpopulation.Theprevalenceamongmenwas12.1%(95%CI,11.7%-12.5%) andamongwomenwas11.0%(95%CI,10.7%-11.4%).Theprevalenceofpreviously diagnoseddiabeteswas
6、estimatedtobe3.5%(95%CI,3.4%-3.6%)intheChinese population:3.6%(95%CI,3.4%-3.8%)inmenand3.4%(95%CI,3.2%-3.5%)inwomen.The prevalenceofundiagnoseddiabeteswas8.1%(95%CI,7.9%-8.3%)intheChinese population:8.5%(95%CI,8.2%-8.8%)inmenand7.7%(95%CI,7.4%-8.0%)inwomen.In addition,theprevalenceofprediabeteswases
7、timatedtobe50.1%(95%CI,49.7%-50.6%)in Chineseadults:52.1%(95%CI,51.5%-52.7%)inmenand48.1%(95%CI,47.6%-48.7%)in women.Theprevalenceofdiabeteswashigherinolderagegroups,inurbanresidents,andin personslivingineconomicallydevelopedregions.Amongpatientswithdiabetes,only25.8% (95%CI,24.9%-26.8%)receivedtrea
8、tmentfordiabetes,andonly39.7%(95%CI, 37.6%-41.8%)ofthosetreatedhadadequateglycemiccontrol. CONCLUSIONS AND RELEVANCETheestimatedprevalenceofdiabetesamonga representativesampleofChineseadultswas11.6%andtheprevalenceofprediabeteswas 50.1%.Projectionsbasedonsampleweightingsuggestthismayrepresentupto113
9、.9million Chineseadultswithdiabetesand493.4millionwithprediabetes.Thesefindingsindicatethe importanceofdiabetesasapublichealthprobleminChina. JAMA.2013;310(9):948-958.doi:10.1001/jama.2013.168118 Editorialpage916 Supplementalcontentat AuthorAffiliations:Author affiliationsarelistedattheendofthis ar
10、ticle. GroupInformation:2010China NoncommunicableDisease SurveillanceGroup,Investigatorsare listedattheendofthisarticle. TheCorrespondingAuthors:Guang Ning,MD,PhD,KeyLaboratoryfor EndocrineandMetabolicDiseasesof MinistryofHealth,Departmentof EndocrineandMetabolicDiseases, Rui-JinHospital,ShanghaiJia
11、o-Tong UniversitySchoolofMedicine,197 Rui-Jin2ndRd,Shanghai,200025, China();Wenhua Zhao,PhD(whzhaoilsichina.org); andWeiqingWang,MD,PhD(wqingw ). Research OriginalInvestigation Downloaded From: http:/ by a SHANGHAI JIATONG UNIVERSITY User on 09/06/2013 N oncommunicable chronic diseases have become
12、the leadingcausesofmortalityanddiseaseburdenworld- wide. It was estimated that 34.5 million deaths glob- allywereduetononcommunicablediseasesin2010,whichre- flected a significant increase from 1990.1,2Mortality from diabetes doubled during this period and increased to 1.3 mil- lion deaths worldwide
13、in 2010.1In addition, diabetes is a ma- jorriskfactorforischemicheartdiseaseandstroke,whichcol- lectively killed an estimated 12.9 million people globally in 2010.1,2As the most populous country, the rapid increase in morbidity and mortality from noncommunicable diseases in China contributed to this
14、 pandemic.3,4According to national data,noncommunicablediseasesaccountedforanestimated 80% of deaths and 70% of total disease burden in China in 2005.4 The prevalence of diabetes has increased significantly in recent decades and is now reaching epidemic proportions in China.5-8The prevalence of diab
15、etes was less than 1% in the Chinese population in 1980.6In subsequent national surveys conductedin1994and2000-2001,theprevalenceofdiabetes was 2.5% and 5.5%, respectively.7,8The most recent national survey in 2007 reported that the prevalence of diabetes was 9.7%, representing an estimated 92.4 mil
16、lion adults in China withdiabetes.5Althoughdifferentsamplingmethods,screen- ing procedures, and diagnostic criteria were used, these data documentarapidincreaseindiabetesintheChinesepopula- tion. Recently, the American Diabetes Association (ADA) inte- gratedglycatedhemoglobinA1c(HbA1c)intothediagnos
17、ticcri- teriafordiabetesinitsupdated2010guidelines.9Justasthere is less than 100% concordance between fasting plasma glu- coseand2-hourplasmaglucosetests,thereisnotfullconcor- dance between HbA1cand either glucose-based test. There- fore, the prevalence of diabetes could be underestimated in theprev
18、iousnationalsurveysbasedontheADA2010criteria. Furthermore, the previous national surveys could not assess diabetescontrolintheChinesepopulationbecauseHbA1cwas not measured. To estimate the prevalence and control of dia- betesinthegeneralChinesepopulation,wemeasuredHbA1c, fasting plasma glucose, and
19、2-hour plasma glucose in a large andnationallyrepresentativesampleof98 658adultswhowere 18 years or older in 2010. Methods China Noncommunicable Disease Surveillance 2010 in- cludedall162studysitesfromtheChineseCenterforDisease Control and Prevention s (CDC s) National Disease Surveil- lancePointSys
20、tem,whichwasdesignedtoselectanationally representativesampleofthegeneralpopulation,coveringma- jor geographic areas of all 31 provinces, autonomous regions, andmunicipalitiesinmainlandChina.10Thefirstlevelofsam- plingwasstratifiedby7geographicregions(Northeast,North, East,South,Southwest,Northwestan
21、dCentralareas)and3mu- nicipalities(Beijing,Tianjin,andShanghai).Thesecondlevel of sampling was stratified by urban and rural locations. The thirdlevelofsamplingwasstratifiedby4socioeconomicstrata in rural areas and 3 population size strata in urban areas. The Surveillance Point System includes appro
22、ximately 1% of the total Chinese population.10 At each site, a complex, multistage, probability sampling design was used to select participants who were representa- tiveofcivilian,noninstitutionalizedChineseadults.Onlyper- sonswhohadbeenlivingintheircurrentresidenceforatleast 6monthswereeligibletopa
23、rticipate.Inthefirststage,4sub- districts in urban areas or townships in rural areas were se- lected from each site with probability proportional to size. In the second stage, 3 neighborhood communities or adminis- trativevillageswereselectedwithprobabilityproportionalto size. In the third stage, ho
24、useholds within each neighbor- hoodcommunityoradministrativevillagewerelisted,and50 households were randomly selected. In the final stage, 1 per- sonwhowasatleast18yearsoldwasselectedrandomlyfrom each household using a Kish selection table.11When the se- lected individual refused or was unavailable,
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