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北京大学学报（医学版） ›› 2020, Vol. 52 ›› Issue (3): 527-534. doi: 10.19723/j.issn.1671-167X.2020.03.020

• 论著 • 上一篇    下一篇

基于城镇医保数据库骨关节伤病的流行病学研究

邓思危1,陈则亦2,刘志科1,王健2,卓琳3,高双庆4,余家阔2,詹思延1,△()   

  1. 1. 北京大学公共卫生学院流行病与卫生统计学系,北京 100191
    2. 北京大学第三医院运动医学研究所,北京 100191
    3. 北京大学第三医院临床流行病学研究中心,北京 100191
    4. 北京北方医药健康经济研究中心,北京 100021
  • 收稿日期:2020-02-05 出版日期:2020-06-18 发布日期:2020-06-30
  • 通讯作者: 詹思延 E-mail:siyan-zhan@bjmu.edu.cn
  • 基金资助:
    国家自然科学基金(81973146)

Epidemiological study of bone and joint injury based on urban medical insurance database

Si-wei DENG1,Ze-yi CHEN2,Zhi-ke LIU1,Jian WANG2,Lin ZHUO3,Shuang-qing GAO4,Jia-kuo YU2,Si-yan ZHAN1,△()   

  1. 1. Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
    2. Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China
    3. Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China
    4. Beijing North Medical & Health Economic Research Center, Beijing 100021, China
  • Received:2020-02-05 Online:2020-06-18 Published:2020-06-30
  • Contact: Si-yan ZHAN E-mail:siyan-zhan@bjmu.edu.cn
  • Supported by:
    National Natural Science Foundation of China(81973146)

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摘要：

目的 了解我国骨关节伤病的患病率及三间分布特征。方法 采用横断面设计,回顾性分析2013—2017年中国城镇基本医疗保险抽样数据库中骨关节伤病的流行病学特征。以市为单位抽样,首先计算各城市骨关节伤病的患病率,使用Meta分析对城市患病率进行加权,获得各区域以及全国的患病率及其95%CI,并进一步描述其空间(区域)、时间(年份)和人群(年龄、性别)等的分布特征。结果 纳入研究对象28 419 264人,其中骨关节伤病患者705 793人。2013—2017年城镇医保数据库中,骨关节伤病的患病率为141.5(95%CI:90.4~203.7)/万人,其中非特指或多关节疾病、膝关节疾病和肩关节疾病的患病率依次为101.6(95%CI:63.5~148.4)/万人,22.5(95%CI:15.1~31.4)/万人和10.9(95%CI:6.4~16.4)/万人;就空间分布而言,骨关节伤病在不同地区的患病率差异较大,华北地区最高,达310(95%CI:12.6~989.7)/万人、西南地区最低,为59.0(95%CI:37.5~85.2)/万人;就时间分布而言, 2013—2017年骨关节伤病的患病率逐年上升, 从2013年的111.1(95%CI:56.0~182.5)/万人上升至2017年的175.5(95%CI:116.8~245.5)/万人;就人群分布而言,女性人群的患病率为149.1(95%CI:94.2~215.9)/万人,高于男性133.6(95%CI:86.2~190.9)/万人,膝关节疾病、非特指或多关节疾病,以及骨关节伤病整体在较大的年龄组中患病率较高,而肩关节疾病的患病率在40~59岁达到峰值[20.6(95%CI:12.5~30.5)/万人]。结论 2013—2017年城镇医保数据库中,骨关节伤病的患病率较低,但呈现逐年上升的变化趋势。骨关节伤病的患病率在华北地区最高,且在不同年龄和性别的人群中具有差异,女性高于男性,在0~17岁人群中最低,而在60岁及以上人群中最高。

关键词: 关节, 损伤, 疾病, 患病率, 流行病学

Abstract:

Objective: To estimate the prevalence rate of bone and joint injury in China and to describe the three-dimension distribution of the disease (area, time and people).Methods: Based on a cross-sectional design, a retrospective study was conducted by using Chinese basic medical insurance database from January 1, 2013 to December 31, 2017 to analyze the epidemiological characteristics of bone and joint injury. The prevalence rate of bone and joint injury in each city was calculated, and then using meta-analyses to estimate the pooled prevalence of each area and the whole country. The pooled prevalence rates were compared among the different groups of populations, in terms of geographical area, time and population characteristics (age and gender).Results: A total of 28 419 264 subjects were included in this study, including 705 793 patients with bone and joint injury. From 2013 to 2017, in Chinese basic medical insurance database, the overall prevalence rate of bone and joint injury was 141.5(95%CI: 90.4-203.7) per 10 000 population, and the prevalence rates of non-specific or polyarticular disease, knee disease, and shoulder disease were 101.6 (95%CI: 63.5-148.4)per 10 000 population, 22.5(95%CI:15.1-31.4)per 10 000 population and 10.9 (95%CI: 6.4-16.4)per 10 000 population. The prevalence rates varied across the areas, the highest rate was observed in North China, with the prevalence of 310.6 (95%CI: 12.6-989.7) per 10 000 population, and the lowest rate was observed in Southwest China, with the prevalence of 59.0 (95%CI: 37.5-85.2) per 10 000 population. The prevalence rate of bone and joint injury increased over the study period, from 111.1 (95%CI: 56.0-182.5)per 10 000 population in 2013 to 175.5 (95%CI: 116.8-245.5)per 10 000 population in 2017. The prevalence of bone and joint injury in the female population was 149.1 (95%CI: 94.2-215.9) per 10 000 population, which was higher than that of men [133.6(95%CI: 86.2-190.9) per 10 000 population]. The higher prevalence of knee disease, unspecified or polyarticular disease, and bone and joint injury were observed in people aged 60 years and older, while the prevalence of shoulder disease peaked in 40-59 years old people [20.6 (95%CI: 12.5-30.5) per 10 000 population].Conclusion: This study reported a relative low prevalence of bone and joint injury in China from 2013 to 2017. The prevalence increased over the study period, and the highest prevalence rate was observed in North China. The prevalence rate showed differences among different groups of populations, and higher rates were observed in females and people aged 60 years and older.

Key words: Joint, Injury, Disease, Prevalence rate, Epidemiology

中图分类号: 

  • R181.2

表1

2013—2017年城镇医保数据库31省参保人数分布及抽样比"

Province The number of people include in database The number of people covered by basic medical insurance Sampling ratio/%
Anhui 193 648 88 845 340 0.218
Beijing 817 659 82 560 649 0.990
Fujian 3 249 097 89 445 848 3.632
Gansu 77 823 50 438 706 0.154
Guangdong 2 269 451 496 351 534 0.457
Guangxi 390 587 94 454 751 0.414
Guizhou 337 101 42 895 901 0.786
Hainan 50 179 19 898 496 0.252
Hebei 384 220 185 910 109 0.207
Henan 291 723 197 535 003 0.148
Heilongjiang 144 458 92 540 840 0.156
Hubei 1 599 905 135 046 786 1.185
Hunan 788 623 168 316 881 0.469
Jilin 220 926 69 009 533 0.320
Jiangsu 757 759 228 428 961 0.332
Jiangxi 1 278 921 110 707 182 1.155
Liaoning 645 367 117 701 562 0.548
Inner Mongoria 855 504 61 736 140 1.386
Ningxia 446 367 29 413 197 1.518
Qinghai 250 592 13 126 170 1.909
Shandong 474 368 411 142 358 0.115
Shanxi 121 369 76 378 786 0.159
Shaanxi 106 821 62 366 643 0.171
Shanghai 1 494 426 86 945 828 1.719
Sichuan 627 635 20 4847 778 0.306
Tianjin 564 884 52 344 187 1.079
Tibet 94 434 3 107 091 3.039
Xinjiang 391 936 46 160 791 0.849
Yunnan 1 775 649 90 228 549 1.968
Zhejiang 1 592 744 241 776 143 0.659
Chongqing 6 125 088 162 657 986 3.766

图1

2013—2017年城镇医保数据库人群的人口金字塔图(与2010年全国人口普查数据对比)"

表2

2013—2017年城镇医保数据库骨关节伤病患者基本特征"

Variables Total Male Female χ2 P value
Patients, n(%) 705 793 (100) 312 784 (44.32) 393 009 (55.68)
Area, n(%) 630.68 <0.001
Northeast China 21 281 (3.02) 8 783 (2.81) 12 498 (3.18)
East China 138 191 (19.58) 62 439 (19.96) 75 752 (19.27)
North China 306 502 (43.43) 132 251 (42.28) 174 251 (44.34)
South and central China 162 162 (22.98) 73 222 (23.41) 88 940 (22.63)
Southwest China 59 861 (8.48) 28 524 (9.12) 31 337 (7.97)
Northwest China 17 796 (2.52) 7 565 (2.42) 10 231 (2.60)
Year, n(%) 25 764.57 <0.001
2013 103 119 (14.61) 47 046 (15.04) 56 073 (14.27)
2014 125 062 (17.72) 52 005 (16.63) 73 057 (18.59)
2015 121 024 (17.15) 53 138 (16.99) 67 886 (17.27)
2016 156 236 (22.14) 69 836 (22.33) 86 400 (21.98)
2017 200 352 (28.39) 90 759 (29.02) 109 593 (27.89)
Age/years, n(%) 4 421.50 <0.001
0-17 18 244 (2.58) 10 761 (3.44) 7 483 (1.90)
18-39 131 112 (18.58) 65 968 (21.09) 65 144 (16.57)
40-59 283 189 (40.13) 118 960 (38.03) 164 229 (41.79)
≥60 271 225 (38.43) 116 041 (37.10) 155 184 (39.49)
Missing 2 023 (0.29) 1 054 (0.34) 969 (0.25)

表3

2013—2017年城镇医保数据库骨关节伤病患者基本特征"

Variables Total Male Female χ2 P
Type of medical insurance, n(%) 100.14 <0.001
Urban resident basic medical insurance 131 231 (18.59) 59 782 (19.11) 71 449 (18.18)
Urban employee basic medical insurance 574 562 (81.41) 253 002 (80.89) 321 560 (81.82)
Disease type, n(%) 1 429.13 <0.001
Knee disease 106 342 (13.61) 41 824 (12.24) 64 518 (14.68)
Shoulder disease 69 454 (8.89) 30 872 (9.03) 38 582 (8.78)
Ankle disease 28 177 (3.61) 13 577 (3.97) 14 600 (3.32)
Hip disease 4 161 (0.53) 1 762 (0.52) 2 399 (0.55)
Elbow disease 2 606 (0.33) 1 312 (0.38) 1 294 (0.29)
Wrist disease 4 131 (0.53) 1 730 (0.51) 2 401 (0.55)
Hand and foot diseases 7 343 (0.94) 3 625 (1.06) 3 718 (0.85)
Pelvic disease 184 (0.02) 74 (0.02) 110 (0.03)
Spinal disease 17 921 (2.29) 8 721 (2.55) 9 200 (2.09)
Unspecified or polyarticular disease 541 003 (69.24) 238 306 (69.72) 302 697 (68.87)

表4

2013—2017年城镇医保数据库骨关节伤病患者地区分布"

Disease type Prevalence (per 10 000 population)
China Northeast China East China North China South and central China Southwest China Northwest China
Bone and joint injury 141.5
(90.4,203.7)		 111.5
(46.4,204.4)		 126.7
(61.4,215.0)		 310.6
(12.6,989.7)		 189.8
(93.4,320.1)		 59.0
(37.5,85.2)		 119.8
(76.8,171.9)
Knee disease 22.5
(15.1,31.4)		 18.0
(8.5,31.9)		 20.4
(12.4,30.5)		 41.1
(1.6,133.8)		 28.2
(15.2,45.2)		 11.3
(6.0,18.2)		 23.7
(13.6,36.9)
Shoulder disease 10.9
(6.4,16.4)		 7.7
(1.7,17.9)		 10.4
(3.3,21.6)		 16.9
(0.0,65.7)		 16.2
(5.5,32.6)		 7.5
(3.6,12.8)		 8.0
(3.8,13.7)
Unspecified or
polyarticular disease		 101.6
(63.5,148.4)		 83.1
(32.7,156.5)		 93.0
(43.6,160.7)		 241.7
(10.3,771.6)		 136.6
(63.8,236.9)		 36.0
(22.2,53.2)		 82.1
(50.8,120.5)

表5

2013—2017年城镇医保数据库各地区不同医保类型人群中骨关节伤病的患病率"

Area Prevalence (per 10 000 population)
Urban resident basic medical insurance Urban employee basic medical insurance
Northeast China 142.7 (93.7, 201.6) 156.5 (64.5, 287.7)
East China 142.3 (75.5, 229.8) 169.2 (81.8, 287.2)
North China 250.7 (135.3, 400.2) 399.0 (12.7, 1284.2)
South and central China 171.1 (106.9, 250.0) 268.8 (131.5, 452.9)
Southwest China 120.3 (92.3, 151.8) 73.9 (40.0, 117.9)
Northwest China 186.4 (133.1, 248.4) 147.5 (85.0, 226.8)

图2

2013—2017年城镇医保数据库骨关节伤病年患病率的变化趋势"

图3

2013—2017年城镇医保数据库骨关节伤病患病率的性别分布"

图4

2013—2017年城镇医保数据库骨关节伤病患病率的年龄分布"

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