m********4
发帖数: 607 | 1 这样的结果，很好吗？能够接受吗？问题出在哪？
——————————————————————————————————
http://circ.ahajournals.org/content/127/1/e6.full
Below are a few highlights from this year’s Update.
1， The 2013 Update Expands Data Coverage of the Epidemic of Poor
Cardiovascular Health Behaviors and Their Antecedents and Consequences
Adjusted population attributable fractions for cardiovascular disease (CVD)
mortality were as follows1: 40.6% (95% confidence interval [CI], 24.5–54.6)
for high blood pressure; 13.7% (95% CI, 4.8–22.3) for smoking; 13.2% (95%
CI, 3.5–29.2) for poor diet; 11.9% (95% CI, 1.3–22.3) for insufficient
physical activity; and 8.8% (95% CI, 2.1–15.4) for abnormal glucose levels.
2。 Prevalence and Control of Cardiovascular Health Factors and Risks
Remains an Issue for Many Americans
An estimated 31.9 million adults ≥20 years of age have total serum
cholesterol levels ≥240 mg/dL, with a prevalence of 13.8%.
Based on 2007 to 2010 data, 33.0% of US adults ≥20 years of age have
hypertension. This represents 78 million US adults with hypertension. The
prevalence of hypertension is nearly equal between men and women. African
American adults have among the highest prevalence of hypertension (44%) in
the world.
Among hypertensive adults, ≈82% are aware of their condition and 75% are
using antihypertensive medication, but only 53% of those with documented
hypertension have their condition controlled to target levels.
In 2010, an estimated 19.7 million Americans had diagnosed diabetes mellitus
, representing 8.3% of the adult population. An additional 8.2 million had
undiagnosed diabetes mellitus, and 38.2% had prediabetes, with abnormal
fasting glucose levels. African Americans, Mexican Americans, Hispanic/
Latino individuals, and other ethnic minorities bear a strikingly
disproportionate burden of diabetes mellitus in the United States.
The prevalence of diabetes mellitus is increasing dramatically over time, in
parallel with the increases in prevalence of overweight and obesity.
On the basis of NHANES 2003–2006 data, the age-adjusted prevalence of
metabolic syndrome, a cluster of major cardiovascular risk factors related
to overweight/obesity and insulin resistance, is ≈34% (35.1% among men and
32.6% among women).
3。 Rates of Death Attributable to CVD Have Declined, but the Burden of
Disease Remains High
The 2009 overall rate of death attributable to CVD (International
Classification of Diseases, 10th Revision, codes I00–I99) was 236.1 per 100
000. The rates were 281.4 per 100 000 for white males, 387.0 per 100 000
for black males, 190.4 per 100 000 for white females, and 267.9 per 100 000
for black females.
From 1999 to 2009, the relative rate of death attributable to CVD declined
by 32.7%. Yet in 2009, CVD (I00–I99; Q20–Q28) still accounted for 32.3% (
787 931) of all 2 437 163 deaths, or 1 of every 3 deaths in the United
States.
On the basis of 2009 death rate data, >2150 Americans die of CVD each day,
an average of 1 death every 40 seconds. About 153 000 Americans who died of
CVD (I00–I99) in 2009 were <65 years of age. In 2009, 34% of deaths
attributable to CVD occurred before the age of 75 years, which is well
before the average life expectancy of 78.5 years.
Coronary heart disease alone caused ≈1 of every 6 deaths in the United
States in 2009. In 2009, 386 324 Americans died of coronary heart disease.
Each year, an estimated ≈635 000 Americans have a new coronary attack (
defined as first hospitalized myocardial infarction or coronary heart
disease death) and ≈280 000 have a recurrent attack. It is estimated that
an additional 150 000 silent first myocardial infarctions occur each year.
Approximately every 34 seconds, 1 American has a coronary event, and
approximately every 1 minute, an American will die of one.
From 1999 to 2009, the relative rate of stroke death fell by 36.9% and the
actual number of stroke deaths declined by 23.0%. Yet each year, ≈795 000
people continue to experience a new or recurrent stroke (ischemic or
hemorrhagic). Approximately 610 000 of these are first attacks, and 185 000
are recurrent attacks. In 2009, stroke caused ≈1 of every 19 deaths in the
United States. On average, every 40 seconds, someone in the United States
has a stroke and dies of one approximately every 4 minutes.
In 2009, 1 in 9 death certificates (274 601 deaths) in the United States
mentioned heart failure. Heart failure was the underlying cause in 56 410 of
those deaths in 2009. The number of any-mention deaths attributable to
heart failure was approximately as high in 1995 (287 000) as it was in 2009
(275 000). Additionally, hospital discharges for heart failure remained
essentially unchanged from 2000 to 2010, with first-listed discharges of 1
008 000 and 1 023 000, respectively.
4。 The 2013 Update Provides Critical Data About Cardiovascular Quality of
Care, Procedure Utilization, and Costs
In light of the current national focus on healthcare utilization, costs, and
quality, it is critical to monitor and understand the magnitude of
healthcare delivery and costs, as well as the quality of healthcare delivery
, related to CVD risk factors and conditions. The Statistical Update
provides these critical data in several sections.
5。 Quality-of-Care Metrics for CVDs
Quality data are available from the AHA’s “Get With The Guidelines”
programs for coronary artery disease and heart failure and from the American
Stroke Association/AHA’s “Get With The Guidelines” program for acute
stroke. Similar data from the Veterans Healthcare Administration, national
Medicare and Medicaid data, and Acute Coronary Treatment and Intervention
Outcomes Network (ACTION)–“Get With The Guidelines” Registry data are
also reviewed. These data show impressive adherence to guideline
recommendations for many, but not all, metrics of quality of care for these
hospitalized patients. Data are also reviewed on screening for CVD risk
factor levels and control.
6。 Cardiovascular Procedure Use and Costs
The total number of inpatient cardiovascular operations and procedures
increased 28%, from 5 939 000 in 2000 to 7 588 000 in 2010 (National Heart,
Lung, and Blood Institute computation based on National Center for Health
Statistics annual data).
The total direct and indirect cost of CVD and stroke in the United States
for 2009 is estimated to be $312.6 billion. This figure includes health
expenditures (direct costs, which include the cost of physicians and other
professionals, hospital services, prescribed medications, home health care,
and other medical durables) and lost productivity that results from
morbidity and premature mortality (indirect costs).
By comparison, in 2008, the estimated cost of all cancer and benign
neoplasms was $228 billion ($93 billion in direct costs, $19 billion in
morbidity indirect costs, and $116 billion in mortality indirect costs). CVD
costs more than any other diagnostic group. | M****a
发帖数: 577 | 2 这结果还可以啊，可以接受啊。问题还是出在发病率和基础保健，这更多是公共卫生和
预防医学的问题。不过饮食不合理，工作生活压力大，运动少等问题是不可能解决的，
所以临床医生的贡献就更大了。
我还真不知道心血管疾病死亡率下降这么多了，这得向cardiologist还有PCP致敬。
From 1999 to 2009, the relative rate of death attributable to CVD declined
by 32.7%. Yet in 2009, CVD (I00–I99; Q20–Q28) still accounted for 32.3% (
787 931) of all 2 437 163 deaths, or 1 of every 3 deaths in the United
States.
【在 m********4 的大作中提到】
: 这样的结果，很好吗？能够接受吗？问题出在哪？
: ——————————————————————————————————
: http://circ.ahajournals.org/content/127/1/e6.full
: Below are a few highlights from this year’s Update.
: 1， The 2013 Update Expands Data Coverage of the Epidemic of Poor
: Cardiovascular Health Behaviors and Their Antecedents and Consequences
: Adjusted population attributable fractions for cardiovascular disease (CVD)
: mortality were as follows1: 40.6% (95% confidence interval [CI], 24.5–54.6)
: for high blood pressure; 13.7% (95% CI, 4.8–22.3) for smoking; 13.2% (95%
: CI, 3.5–29.2) for poor diet; 11.9% (95% CI, 1.3–22.3) for insufficient
| A*******s
发帖数: 9638 | 3 CVA也少很多了， 了不起的成就
【在 M****a 的大作中提到】
: 这结果还可以啊，可以接受啊。问题还是出在发病率和基础保健，这更多是公共卫生和
: 预防医学的问题。不过饮食不合理，工作生活压力大，运动少等问题是不可能解决的，
: 所以临床医生的贡献就更大了。
: 我还真不知道心血管疾病死亡率下降这么多了，这得向cardiologist还有PCP致敬。
:
: From 1999 to 2009, the relative rate of death attributable to CVD declined
: by 32.7%. Yet in 2009, CVD (I00–I99; Q20–Q28) still accounted for 32.3% (
: 787 931) of all 2 437 163 deaths, or 1 of every 3 deaths in the United
: States.
| M****a
发帖数: 577 | 4 恩，也得向neurologist致敬！
【在 A*******s 的大作中提到】
: CVA也少很多了， 了不起的成就
| m********4
发帖数: 607 | 5 不知你处在那个阶段－医学生？住院医？初级主治？中级主治？高级主治？
“问题还是出在发病率和基础保健，这更多是公共卫生和预防医学的问题。不过饮食不
合理，工作生活压力大，运动少等问题是不可能解决的， 所以临床医生的贡献就更大
了。“－－临床医生与公共卫生和预防医学割裂？
”心血管疾病死亡率下降这么多了，这得向cardiologist还有PCP致敬“－－如果没有
诊疗技术进步和药物研发，cardiologist还有PCP还能做什么？
肥胖，高血脂，高血压，糖尿病等危险因素的现状不乐观。医学技术创新与新药研发提
高了诊治水平，降低了死亡率，但是医疗消费与社会负担确加重了。这样的医疗体系能
持续发展吗？
假若医者利欲熏心，那么与军火商无异。
对于军火商而言，战争越多，可获得的利益越大。
对于利欲熏心的医者，病人越多，可获得的利益越大。
医者仁心，已经是很遥远的传说了。
【在 M****a 的大作中提到】
: 这结果还可以啊，可以接受啊。问题还是出在发病率和基础保健，这更多是公共卫生和
: 预防医学的问题。不过饮食不合理，工作生活压力大，运动少等问题是不可能解决的，
: 所以临床医生的贡献就更大了。
: 我还真不知道心血管疾病死亡率下降这么多了，这得向cardiologist还有PCP致敬。
:
: From 1999 to 2009, the relative rate of death attributable to CVD declined
: by 32.7%. Yet in 2009, CVD (I00–I99; Q20–Q28) still accounted for 32.3% (
: 787 931) of all 2 437 163 deaths, or 1 of every 3 deaths in the United
: States.
|
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