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 KillerMajor Causes of Death in 2000 and 2009 in Urban and Rural China

Other16%

Comm.1%

Resp.13%

Inj.&Poi.6%

CVD40%

Cancer24%

Comm.2%

Other14%

Resp.21%

Inj.&Poi.18%

CVD28%

Cancer17%

RuralUrban

Data source: Health Statistics Yearbook, MOH, PRC

Other15%

Comm.1%

Resp.10%

Inj.&Poi.6%

CVD41%

Cancer27%

Comm.1%

Other11%

Resp.15%

Inj.&Poi.8%

CVD41%

Cancer24%

2000

2009

*

**

*

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

0

5

10

15

20

25

% of

hyp

erte

nsio

n

Large city S&M city Class 1rural

Class 2rural

Class 3rural

Class 4rural

Men Women ALL

Prevalence of Diabetes in China, 2007-8

NEJM 2010; 362: 1090-1101

Prevalence (%) of smoking in men in China

0

10

20

30

40

50

60

70

1993 1998 2003 2008Urban Rural

Not only

mortality, morbidity, disability,health-related quality of life,

but also ……

…

U-R Disparities in Financial Access

0%

20%

40%

60%

80%

100%

Urban Rural

Urban Ins Other Ins Coop Ins Private Unsured

Source: The 3rd National Health Survey, MOH website, 2005

Patients who did not seek care in the past 2 weeks due to financial difficulty (%)

32

36

23

32

39

31

20

25

30

35

40

Urban Rural1998 2003 2008

Special Provincial Pref. & County

Town & Village

Total

N 71 487 466 549 1573

Education:

Post-graduate 44 31 1 - 12

Med. College 52 58 53 6 38

3y College 4 10 30 22 20

Special School - 1 15 44 20

High School - - 1 28 10

Distribution(%) of Doctor’s Last Education Achieved, Year 1998Cardiovascular Health Education Training Program for Health Care Professionals in the Community

12

Study design:•Cluster-randomized, controlled trial

•120 rural villages from:

─ 120 townships

─ 10 counties

─ 5 provinces

CRHI

13

CRHI Study Setting Backgrounds, 2010

InterventionN = 60

ControlN = 60

Village, population size 1,833 1,893

Village, annual income, US$ 869 890

Village clinic, size (m2) 88 100

VHWs, % <high school 34% 39%

14

Proportion of High-Risk Individuals among Older Adults (men >50/women >60)Results from the baseline survey, 2010

  Total (%)

N

Hypertension 64.4

SBP ≥160 mmHg 23.2

Diabetes Mellitus, self-reported 3.1

Stroke, self-reported 6.8

Coronary Heart Disease, self-reported 7.6

High Cardiovascular Risk (10-yr risk>=10%) 33.9

15

• 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

Main Challenges in Prevention and Control of Chronic Disease in China

16

• 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.

Conclusion

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