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目的了解中国老年人群心绞痛患病率水平,比较医生诊断和Rose问卷诊断心绞痛之间的差异及其影响因素。方法采用入户调查的方式对广东、黑龙江、上海、山西和湖北5省(市)5 315名60岁及以上老年人进行问卷调查;Rose心绞痛(RA)是经Rose问卷诊断的心绞痛,医生诊断心绞痛(DDA)为任何经医生确诊的心绞痛事件,对两种方法的一致性进行kappa检验。结果发现DDA患者382例,RA 399例。DDA年龄标准化患病率7.11%(95%CI 6.40%~7.83%),其中男性是5.77%(95%CI 4.80%~6.75%),女性是8.16%(95%CI 7.13%~9.18%);RA年龄标准化患病率7.59%(95%CI 6.85%~9.34%),男性是5.85%(95%CI 4.86%~6.83%),女性是8.95%(95%CI 7.88%~10.0%)。DDA和RA之间的一致性较弱(kappa=0.360,P<0.001)。对于DDA,RA的灵敏度、特异度、阳性预测值、阴性预测值分别是41.6%,95.1%,39.8%,95.5%。结论中国老年人心绞痛患病率低于西方国家,女性患病率高于男性。性别、城乡受教育水平和职业地位是影响Rose问卷诊断与医生诊断心绞痛一致性的主要因素。
Objective To understand the prevalence of angina in Chinese elderly population and to compare the differences between the diagnosis of physician and Rose questionnaire in angina pectoris and its influencing factors. Methods A total of 5 315 elderly people aged 60 and above from 5 provinces (cities) in Guangdong, Heilongjiang, Shanghai, Shanxi and Hubei provinces were surveyed by means of household survey. Rose angina pectoris (RA) was angina pectoris diagnosed by Rose questionnaire and the doctor diagnosed Angina (DDA) is a kappa test of any physician-diagnosed angina pectoris. The results found 382 cases of DDA patients, RA 399 cases. The standardized prevalence of DDA was 7.11% (95% CI: 6.40% -7.33%), with 5.77% (95% CI 4.80% -6.75%) in men and 8.16% (95% CI 7.13% ~ 9.18%) in women. The standardized prevalence of RA was 7.59% (95% CI 6.85% to 9.34%) in men, 5.85% (95% CI 4.86% to 6.83%) and 8.95% (95% CI 7.88% to 10.0%) in women. Consistency between DDA and RA was weak (kappa = 0.360, P <0.001). For DDA, the sensitivity, specificity, positive predictive value and negative predictive value of RA were 41.6%, 95.1%, 39.8% and 95.5%, respectively. Conclusions The prevalence of angina in Chinese elderly is lower than that in western countries, and the prevalence of female is higher than that of male. Gender, urban and rural education levels and occupational status are the main factors influencing the consistency of Rose questionnaire diagnosis with doctors’ diagnosis of angina pectoris.