基于15省城镇医疗保险数据测算我国成人进行性肌萎缩患病率

doi:10.19723/j.issn.1671-167X.2020.03.019

摘要/Abstract

摘要：

目的分析进行性肌萎缩(progressive muscular atrophy,PMA)患者的基本人口学特征并测算其患病率。方法研究基于我国15省2016年1月1日至12月31日的城镇职工和城镇居民医疗保险数据,排除18岁以下儿童。通过疾病诊断名称和疾病诊断编码来识别PMA患者,按照性别、地区和年龄进行亚组分析,并依据我国2010年全国人口普查数据计算PMA按年龄调整后的患病标化率,通过不估算诊断信息缺失的参保人群中潜在的PMA患者数和剔除诊断信息缺失率前10%的省份(湖北、山东)进行敏感性分析。结果纳入的总参保人年数为99 609万,其中男性为51 841万,女性为47 767万。研究人群与我国2010年人口普查性别年龄结构类似,研究人群具有全国代表性。2016年我国PMA患病率为0.28/10万人年(95%CI:0.24~0.33),其中女性为0.21/10万人年(95%CI:0.16~0.26),男性为0.35/10万人年(95%CI:0.28~0.42)。我国PMA患病率存在地区差异,表现为西南地区患病率最低(0.11/10万人年,95%CI:0.07~0.15),西北地区患病率最高(3.47/10万人年,95%CI:0.80~7.99)。各年龄段患病率差异较小,其中70岁以上人群患病率相对较高。全国患病标化率为0.29/10万人年(95%CI:0.27~0.31)。不估算诊断信息缺失的参保人群中潜在的PMA患者数和剔除诊断信息缺失率前10%的省份后所得的敏感性分析结果分别为0.17/10万人年(95%CI:0.14~0.20)和0.24/10万人年(95%CI:0.20~0.28)。结论通过测算我国城镇人口中成人PMA的患病率,为PMA相关医疗政策的制定提供基础数据,也为PMA疾病机制的研究提供线索。

关键词: 进行性肌萎缩, 患病率, 医疗保险

Abstract:

Objective: To analyze the characteristics of patients with progressive muscular atrophy (PMA) and calculate the prevalence of PMA in China in 2016.Methods: A retrospective analysis based on China’s urban employee basic medical insurance data and the urban residence basic medical insu-rance data from January 1, 2016 to December 31, 2016 was carried out. Children under 18 years old were excluded. Patients with progressive muscular atrophy were identified by disease names and codes. Subgroup analyses by gender, region and age were carried out to calculate the gender-specific, region-specific and age-specific prevalences. Age-adjusted national prevalence was estimated based on 2010 Chinese census data. Sensitivity analyses were done by only considering the observed cases and by excluding the top 10% provinces regarding the missing rate of diagnostic information, respectively.Results: A total of 996.09 million person-years were included in this study, with 518.41 million person-years in males and 477.67 million person-years in females. The age and gender distribution of the study population was similar to that of the 2010 Chinese census data, therefore the study population was nationally representative. The prevalence of PMA in China in 2016 was 0.28 per 100 000 person-years (95%CI: 0.24-0.33), with 0.21 per 100 000 person-years (95%CI: 0.16-0.26) and 0.35 per 100 000 person-years (95%CI: 0.28-0.42) for females and males, respectively. Regional disparity existed in the Chinese PMA prevalence, with the lowest prevalence in Southwest region (0.11 per 100 000 person-years, 95%CI: 0.07-0.15) and the highest prevalence in Northwest region (3.47 per 100 000 person-years, 95%CI: 0.80-7.99). Age trend in the PMA prevalence was not obvious, but the prevalence among those aged 70 years and older was relatively higher. The age-adjusted prevalence based on 2010 Chinese census data was 0.29 per 100 000 person-years (95%CI: 0.27-0.31). The national prevalences calculated by only considering the observed cases and by excluding the top 10% provinces regar-ding the missing rate of diagnostic information were 0.17 per 100 000 person-years (95%CI: 0.14-0.20) and 0.24 per 100 000 person-years (95%CI: 0.20-0.28), respectively.Conclusion: This study is to calculate the prevalence of PMA among adults in urban China, which can provide basic statistics for the enactment of PMA related medical policies, and clues for the studies on the mechanisms of PMA.

Key words: Progressive muscular atrophy, Prevalence, Medical insurance

中图分类号:

R195.4

许璐,陈璐,樊东升,冯菁楠,刘立立,詹思延,王胜锋. 基于15省城镇医疗保险数据测算我国成人进行性肌萎缩患病率[J]. 北京大学学报（医学版）, 2020, 52(3): 521-526.

Lu XU,Lu CHEN,Dong-sheng FAN,Jing-nan FENG,Li-li LIU,Si-yan ZHAN,Sheng-feng WANG. Calculation of the prevalence of progressive muscular atrophy among adults in China based on urban medical insurance data from 15 provinces[J]. Journal of Peking University (Health Sciences), 2020, 52(3): 521-526.

图/表 5

表1

图1

表2

2016年我国15省城市地区进行性肌萎缩患者人口学基本特征"

Characteristic	Total	Male	Female	Statistic^*	P value
n	131	70	61
Age/years, $x ?$ ±s	46.21±16.86	49.20±17.31	42.77±15.77	-2.21	0.029
Age group/years, n(%)				7.07	0.289
18-29	26 (19.85)	11 (15.71)	15 (24.59)
30-39	22 (16.79)	11 (15.71)	11 (18.03)
40-49	27 (20.61)	13 (18.57)	14 (22.95)
50-59	26 (19.85)	13 (18.57)	13 (21.31)
60-69	16 (12.21)	12 (17.14)	4 (6.56)
70-79	12 (9.16)	9 (12.86)	3 (4.92)
≥80	2 (1.53)	1 (1.43)	1 (1.64)
Area, n (%)				7.82	0.157
East	15 (11.45)	8 (11.43)	7 (11.48)
North	3 (2.29)	3 (4.29)	0 (0)
Northeast	3 (2.29)	0 (0)	3 (4.92)
Northwest	2 (1.53)	1 (1.43)	1 (1.64)
Southcentral	106 (80.92)	56 (80.00)	50 (81.97)
Southwest	2 (1.53)	2 (2.86)	0 (0)

表2

表3

图2

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Items	Total (×10⁶)	Male (×10⁶)	Female (×10⁶)
Person-years	996.09^a	518.41	477.67
Age group/years, n (%)
18-29	283.82 (28.49)	149.75 (28.89)	134.08 (28.07)
30-39	190.23 (19.10)	99.21 (19.14)	91.02 (19.05)
40-49	204.55 (20.54)	105.55 (20.36)	98.99 (20.72)
50-59	143.84 (14.44)	76.18 (14.69)	67.66 (14.16)
60-69	97.81 (9.82)	50.81 (9.80)	47.01 (9.84)
70-79	50.77 (5.10)	25.58 (4.93)	25.19 (5.27)
≥80	25.08 (2.52)	11.34 (2.19)	13.74 (2.88)
Area^b, n (%)
East	421.35 (43.07)	217.51 (42.71)	203.83 (43.46)
North	40.18 (4.11)	20.12 (3.95)	20.05 (4.27)
Northeast	117.13 (11.97)	58.61 (11.51)	58.52 (12.48)
Northwest	20.18 (2.06)	10.70 (2.10)	9.48 (2.02)
Southcentral	252.14 (25.77)	135.96 (26.70)	116.18 (24.77)
Southwest	127.35 (13.02)	66.36 (13.03)	60.99 (13.00)

Items	Prevalence (95%CI)	P^*
Gender		<0.001
Male	0.35 (0.28-0.42)
Female	0.21 (0.16-0.26)
Area		<0.001
East	0.22 (0.17-0.28)
North	0.65 (0.34-1.05)
Northeast	0.35 (0.18-0.58)
Northwest	3.47 (0.80-7.99)
Southcentral	0.38 (0.29-0.48)
Southwest	0.11 (0.07-0.15)
Age group/years		0.222
18-29	0.31 (0.17-0.49)
30-34	0.35 (0.18-0.57)
35-39	0.31 (0.16-0.51)
40-44	0.26 (0.14-0.41)
45-49	0.23 (0.12-0.37)
50-54	0.22 (0.12-0.34)
55-59	0.22 (0.12-0.35)
60-64	0.22 (0.12-0.36)
65-69	0.26 (0.14-0.41)
70-74	0.41 (0.21-0.67)
75-84	0.41 (0.23-0.64)
≥85	0.45 (0.15-0.91)