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 Killer Major Causes of Death in 2000 and 2009 in Urban and Rural China RuralUrban Data source: Health Statistics Yearbook, MOH, PRC

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

Prevalence of Diabetes in China, NEJM 2010; 362:

Prevalence (%) of smoking in men in China

Not only mortality, morbidity, disability, health-related quality of life, but also …… …

U-R Disparities in Financial Access Source: The 3 rd National Health Survey, MOH website, 2005

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

Distribution(%) of Doctor’s Last Education Achieved, Year 1998 Cardiovascular 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 Intervention N = 60 Control N = 60 Village, population size 1,8331,893 Village, annual income, US$ Village clinic, size (m 2 ) 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 Hypertension64.4 SBP ≥160 mmHg23.2 Diabetes Mellitus, self-reported3.1 Stroke, self-reported6.8 Coronary Heart Disease, self-reported7.6 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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