独立自然村老年高血压人群流行病学数据获取方法的分析

背景　我国慢性疾病早期发现、实时监测和有效控制情况仍不完善，致使临床工作者不能准确掌握高血压等慢性疾病的流行病学特征，不利于慢性疾病管理和居民健康。人工智能在居民健康档案管理中显现出优势，探索能够准确获取流行病学特征的方法有利于慢性疾病的管理。目的　调查独立自然村老年高血压人群流行病学特征，掌握患者确实数据资料，研究获取高血压流行病学数据的可靠方法，为更有效地开展基层防治高血压工作提供大数据支持。方法　2019年6-7月调查河北省衡水市冀州区门家庄乡某独立自然村65岁以上老年人群。至2019年6月，该村总人口为2 603名，村医自2016年1月开始至2019年6月使用当地卫生信息管理系统共登记管理2 485名（占该村总人口95.47%），其中65岁以上老年人516名（20.76%，方法一研究对象）；2019年6-7月对该村65岁以上老年人进行入户走访调查，实际参与调查416名（方法二研究对象），应答率80.62%（416/516）；该独立自然村从2017年12月开始使用智能辅助诊疗系统，至2019年6月，已对2 460名村民进行健康数据管理，诊疗记录9 856人次，65岁以上老年人337名（方法三研究对象）。分析三种方法采集高血压流行病学数据的优缺点。方法一：根据当地卫生信息管理系统中确诊为高血压者的记录，分析高血压患病率；方法二：采用入户调查和现场检测血压的方法，分析高血压患病率、知晓率、治疗率、控制率；方法三：采用智能辅助诊疗系统中老年人群多次就诊数据记录，分析高血压患病率、知晓率、治疗率、控制率。结果　三种方法中研究对象的年龄及性别构成比较，差异无统计学意义（P>0.05）。方法一确诊高血压患者226名，患病率为43.80%（226/516）。方法二确诊高血压患者313名，患病率75.24%（313/416）；入户调查新发现高血压患者53名，知晓既往有高血压者260名，高血压知晓率为83.07%（260/313）；近两周在服用高血压药物者238名，治疗率为76.04%（238/313）；调查时血压<140/90 mm Hg（1 mm Hg=0.133 kPa）者74名，控制率为23.64%（74/313）。方法三确诊高血压患者176名，患病率为52.23%（176/337）；既往有高血压者172名，高血压知晓率为97.73%（172/176）；近两周在服用高血压药物者168名，治疗率为96.45%（168/176）；有血压测量记录者118名，血压<140/90 mm Hg者32名，控制率为27.12%（32/118）。结论　采用智能辅助诊疗系统和入户调查的方式均能较好了解高血压患病率、知晓率、治疗率，与原有数据登记仅有疾病诊断的方式相比具有优势，其中智能辅助诊疗系统可更加全面、动态地获取数据，有利于疾病流行病学数据的收集和慢性疾病的管理。

Methods of Obtaining Epidemiological Data of Hypertensive Elderly People in an Isolated Natural Village：a Comparative Analysis

Background　In China，imperfections in the early detection，real-time monitoring and effective control of chronic diseases make it impossible to accurately obtain the epidemiological characteristics of hypertension and other chronic diseases，negatively influencing chronic disease management and residents' health. Artificial intelligence（AI）technologies significantly improve health records management. Exploring methods that can accurately obtain epidemiological characteristics is conducive to the management of chronic diseases. Objective　To compare the reliability of three methods used for accurately obtaining epidemiological data of hypertensive elderly people in an isolated natural village，providing a reference for bettering the prevention and treatment of hypertension in primary care. Methods　This study was conducted in an isolated natural village with a population of 2 603 as of June 2019 in Menjiazhuang Township，Jizhou District，Hengshui City，Hebei Province. For obtaining the epidemiological data of hypertension in villagers aged over 65 years，three methods were used，with different numbers of participants. The first method was by searching the data stored in the local health information management system，the number of villagers aged over 65 years was determined〔n=516，accounting for 20.76% of the total villagers registered by the village physician since January 2016 （n=2 485，accounting for 95.47% of the total village residents）〕，and the number of diagnosed hypertensive cases registered was also collected，then the hypertension prevalence was estimated. The second method was by use of a household survey（consisting of completing a blood pressure questionnaire and blood pressure measurement） conducted between June and July 2019，the number of respondents was determined as 416〔accounting for 80.62% of the total surveyed villagers aged over 65 years（n=516）〕，and the hypertension prevalence，awareness level，treatment rate and control rate of hypertension in the respondents were obtained according to the survey results. And the third method was searching the health management data in an AI-assisted diagnosis and treatment system，which has been used since December 2017，and had stored 9 856 visits of 2 460 villagers as of June 2019，including 337 villagers aged over 65 years. By analyzing the healthcare-seeking data of older villagers，the hypertension prevalence，awareness level，treatment rate and control rate of hypertension were obtained. The merits and limitations of these three methods were compared. Results　No significant differences were found in the mean age and sex ratio across the three participant groups（P>0.05）. According to the statistics of hypertension registration，the prevalence of hypertension was 43.80%（226/516）. According to the household survey，the prevalence of hypertension was 75.24%（313/416）；260 cases had a history of definite hypertension，and 53 were newly found with hypertension；the awareness rate of hypertension was 83.07%（260/313）；238 received anti-hypertensive medication treatment in the past two weeks，with a treatment rate of 76.04%（238/313）；74 had a blood pressure reading of<140/90 mm Hg（1 mm Hg=0.133 kPa），with a hypertension control rate of 23.64%（74/313）. According to the analysis of the data in the AI-assisted diagnosis and treatment system，the hypertension prevalence was 52.23%（176/337）；172 had a hypertension history；the awareness rate of hypertension was 97.73%（172/176）；168 received anti-hypertensive medication treatment in the past two weeks，with a treatment rate of 96.45%（168/176）；118 had blood pressure measurement records，and 32 of them had a blood pressure reading of<140/90 mm Hg，with a hypertension control rate of 27.12%（32/118）. Conclusion　The use of AI-assisted diagnosis and treatment system and household surveys can both better obtain the prevalence rate，awareness rate，treatment rate and other epidemiological characteristics of hypertension. In particular，using the AI-assisted diagnosis and treatment system can obtain data more comprehensively and dynamically，which facilitates the collection of epidemiological data and chronic disease management.