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六安市老年人慢性病类型与发病因素调查研究

发布时间:2019-04-19
  摘要
  
  目的 了解安徽省六安市老年人超重/肥胖、腹型肥胖、血脂异常、高血压、2 型糖尿病(以下简称“糖尿病”)患病情况及高血压、糖尿病知晓、治疗、控制率(以下简称“三率”),分析主要慢性病的影响因素,为下一步主要慢性病防控提供依据。
  
  方法 采取整群抽样的方法,抽取六安市金安区城北、裕安区北市社区,于 2016年 6-9 月集中面对面对两社区 1080 个老年人进行问卷调查、身体指标测量,抽取空腹静脉血进行血脂、血糖等指标检测。分析六安市社区老年人 5 类主要慢性病患病、高血压和糖尿病“三率”,并采用多因素 logistic 回归分析其影响因素。
  
  结果 (1)六安市社区老年人超重/肥胖率为 50.20%。多因素研究显示,女性、机关事业单位老年人的超重/肥胖风险分别是男性、农林业者 1.51、2.11 倍,农村超重/肥胖率低于城市,随着年龄增大超重/肥胖风险逐渐降低,与年收入 1 万元以下的老年人相比,年收入在 5 万以上者超重/肥胖风险较低。
  
  (2)六安市社区老年人腹型肥胖率为 50.49%。多因素分析显示,老年女性、年收入 5 万以上的老年人腹型肥胖的风险分别是老年男性、年收入 1 万以下老年人的 2.84、2.37 倍;血脂异常与腹型肥胖有关联;在农村居住是腹型肥胖的保护因素,80 岁以上组腹型肥胖风险低于 60-69 岁组。

六安市老年人慢性病类型与发病因素调查研究
  
  (3)有效调查 1029 个老年人低 HDL-C 率为 1.17%、高 LDL-C 率为 15.16%、高 TG 率为 19.73%、高 TC 率为 38.69%、总血脂异常率为 51.41%。多因素研究显示,农村血脂异常患病风险为城市的 2.42 倍,女性高于男性,文化程度较高、患有高血压增加血脂异常患病风险,80 岁及以上风险低于 60-69 岁组,年收入较高患病风险较低。
  
  (4)有效调查的 1049 个老年人高血压患病率为 73.88%。多因素分析显示,高WHR、血脂异常是高血压患病风险分别是 WHR、血脂正常组的 2.17、1.48 倍。高血压患病知晓率为 69.90%、治疗率为 36.39%、血压控制率为 20.16%。调整混杂因素分析结果显示,高血压患病知晓率与居住地和 WHR 有关,其中农村低于城市;高 WHR 高于正常 WHR。治疗率与居住地、婚姻状况、职业有关,其中,农村低于城市;与离婚/丧偶相比,已婚者治疗率相对较低;与农林业相比,机关事业单位、其他职业治疗率相对较高。血压控制率与居住地、职业、年收入、糖尿病有关,其中,农村低于城市,职业为其他的老年人血压控制率较农林业高,随着年收入增多血压未控制的危险增加,糖尿病患者血压控制率高于非患者。
  
  (5)有效调查 1011 个对象中糖尿病患病率为 24.63%。调整混杂因素分析结果显示,糖尿病患病与性别、文化程度、WHR 有关,女性高于男性、初中及以上高于小学及以下文化程度、高 WHR 高于 WHR 正常的老年人。糖尿病知晓率为60.08%、治疗率为 26.10%、血糖控制率为 22.27%。调整混杂因素后,知晓率、治疗率均与居住地、BMI 有关,知晓率、治疗率均表现为农村低于城市、超重/肥胖者低于体质指数正常者。纳入的研究因素中,暂未发现与血糖控制有关联的因素。
  
  结论 六安市社区老年人超重/肥胖、腹型肥胖、血脂异常、高血压、糖尿病的患病率均较高,高血压、糖尿病“三率”均较低,且高患病率和低“三率”的高危人群各有不同,故本地区慢性病应针对性的进行防控。
  
  关键词: 老年人 /慢性病 /患病率 /三率。
  
  Abstract
  
  Object The study was to explore the prevalence of overweight or obesity, abdominal obesity, dyslipidemia, hypertension, type 2 diabetes (hereinafter referred to as “diabetes”); the rate of awareness, treatment, and control (hereinafter referred to as "three rate") of hypertension, type 2 diabetes; and the influencing factors of majorchronic diseases among the elderly people in Lu’an, Anhui province, so as to provide the basis for the next step of prevention and control of major chronic diseases.
  
  Methods The cluster sampling method was used to select the 1080 elderly people in Chengbei community in Jin’an district and Beishi community in Yu’an district of Lu’an,from June to September 2016. Then the questionnaire survey and body indicators measurement was conducted face to face, and extracting the fasting venous blood for lipid and blood glucose detection. The prevalence of 5 major chronic diseases and the"three rate" of hypertension and diabetes in the community of Lu’an city were analyzed,and the influencing factors were analyzed by multiple factors non-conditional logistic regression.
  
  Results (1) The overweight or obesity rate was 50.20% for the elderly people in the communities in Lu’an. Multi-factor analysis show that,the risk of overweight or obesityamong female, public institutions were 1.51, 2.11 times compared to male, agroforestry; the rate of overweight or obesity in rural were lower than in cities; the risk ofoverweight or obesity decreased with age; the elderly people with an annual income of more than 50,000¥had a lower risk of overweight or obesity than with an annualincome of less than 10,000¥.
  
  (2) The abdominal obesity rate was 50.49% for the elderly people in the communities in Lu’an. Multi-factor analysis showed that the risk of abdominal obesity among male, who with an annual income of more than 50,000¥ were 2.84 and 2.37 times compared to female and who with an annual income of less than 10,000¥;dyslipidemia was associated with abdominal obesity; living in rural was the protective factors for abdominal obesity and that of the group over 80 years old was lower than that of 60-69 years old.
  
  (3) The low HDL-C rate was 1.17%, high HDL-c rate was 15.16%, high TG rate was 19.73%, high TC rate was 38.69% and total dyslipidemia rate was 51.41% in the 1029 elderly people who were effectively surveyed. Multi-factor analysis showed that,the prevalence of dyslipidemia in rural was 2.42 times higher than in urban, females higher than males, the higher education level and had hypertensive increased risk of dyslipidemia; the rate of dyslipidemia was lower in the group aged 80 and above than that in the group aged 60-69, and had higher annual income, the rate of dyslipidemia was lower.
  
  (4) The prevalence of hypertension was 73.88% in the 1049 elderly people who were effectively surveyed. Multi-factor analysis showed that, the risk of hypertension in the group with high WHR, dyslipidemia respectively was 2.17 and 1.48 times that of the group with normal WHR, normal lipid. The awareness rate of hypertension was 69.90%,treatment rate was 36.39% and control rate was 20.16%. The results of multi-factor analysis showed that, the awareness rate of hypertension was related to residence and WHR, the rural was lower than urban and the high WHR higher than the normal WHR.The treatment rate was related to residence, marital status and professional,among which, rural was lower than urban; compared with divorced/widowed, the treatment rate of married was lower; compared with agroforestry, the treatment rate of government institutions and other professions was higher. The rate of blood glucose control was related to residence, professional, annual income, diabetes, among them,rural were lower than urban; compared with agriculture, other occupations had higher blood pressure control rate, the risk of uncontrolled blood pressure increased with annual income, the blood pressure control rate of diabetic patients was higher than that of non-diabetic patients.
  
  (5) The prevalence of diabetes was 24.63% in 1011 subjects. The results of multi-factor analysis showed that, the prevalence of diabetes was related to gender,educational level and WHR, among them, female were higher than male, middle school and above were higher than primary school and below, and high WHR were higher than normal WHR. The awareness rate of diabetes was 60.08%, the treatment rate was 26.10%, and control rate was 22.27%. After adjusting for confounding factors, the awareness rate and treatment rate were all related to residence and BMI, and the awareness rate and treatment rate were all lower in rural than in urban, and overweight or obesity were lower than normal BMI. It had not been found that the included study factors had an impact on the blood glucose control rate.
  
  Conclusions The prevalence of hypertension, diabetes, overweight or obesity,abdominal obesity and dyslipidemia were high among the elderly people in Lu’an, the "three rate" of hypertension and diabetes were low. And the high prevalence rate and low "three rate" had different high-risk groups, so the prevention and control of chronic diseases should be targeted.
  
  Key words:  Elderly people / Chronic diseases / Prevalence rate / "three rate"。
  
  1 前言
  
  慢性病全称慢性非传染性疾病,是病因复杂、疾病负担较重的一类疾病,其中以高血压、糖尿病、超重/肥胖、腹型肥胖、血脂异常等最为常见,患者以老年人居多[1,2]。随着社会经济的发展,居民生活水平得到了极大改善,生活方式随之发生巨大变化,但不健康的生活方式尚未得到足够重视和有效控制,加之我国已步入老龄化社会[3],老年人口比重大,慢性病患病人数和负担急剧增加,我国慢性病死因比重已达 86.6%[1],在全球死因中慢性病也占据主导地位,2012 年全球因慢性病死亡的人数达 68%[4],慢性病已逐渐成为危害人类健康的“头号杀手”。有研究指出,通过有针对性的落实健康教育、筛查和干预、患者管理等措施,慢性病是可以预防和控制的[5],精准防控措施落实的前提是摸清本辖区主要慢性病患病、防控现状及影响因素,然而,六安市开展的此类调查较少,主要慢性病的综合性报道甚少,所辖县区此类报道也不多。老年人群是慢性病的“主力军”,六安是人口大市,且老龄化问题较严重[6],按照安徽省平均患病率推算,六安市拥有庞大的老年慢性病患病群体,研究本地区社区老年人慢性病现况及特征是老年慢性病防控的当务之急。本研究即是通过收集六安市两社区老年人基本情况、身体测量指标、实验室检测指标等信息,了解六安市老年人主要慢性病患病、高血压和糖尿病知晓率、治疗率、控制率(以下简称“三率”)及患病和“三率”的影响因素情况,为六安市主要慢性病精准防控提供依据和支持。
  
  高血压是最为常见慢性病,其疾病负担在全球占比最大[7]。调查显示,我国>15 岁人群 1958 年(5.1%)到 2002 年(17.6%)期间粗患病率不断攀升,10 年后,快速上升到 25.2%[8](其中≥60 岁老年人患病率最高,为 58.9%[1]);据安徽省 2013年监测数据显示[9],>18 岁人群患病率为 29.5%(≥60 岁为 62.2%),安徽省高于全国。可见,近 60 年的前 40 年里,高血压患病率增长相对缓慢,自 2002 年以来,高血压患病率增长迅猛,呈现男性高于女性、随年龄增长而增长的特点。虽然我国 1991-2012 年高血压“三率”逐步提高[10],但相对于高患病率,“三率”均与发达国家有差距[11];安徽省(50.8%、40.4%、12.1%)“三率”低于全国。高患病率和低“三率”是心脑血管事件高发的主要原因,致残、致死率高,严重缩短、降低了高血压患者健康寿命和生活质量。六安市高血压患病及“三率”情况暂时未知,但鉴于安徽省老年人的高患病率和六安市人口基数大且人口老龄化较为严重的情况,其高血压防控工作面临巨大挑战,了解该地区老年人高血压患病、“三率”及影响因素迫在眉睫。
  
  随着社会经济的发展[12]和生活水平的提高,居民不合理饮食、缺乏运动等不良生活方式问题较为普遍,糖尿病流行日趋严重,从近 40 年调查数据看,我国糖尿病患病率已从 0.67%上升到 9.7%[13],发病人数急剧增多,有研究显示,2015 年我国已拥有 1.09 亿患者,占全球总数的 26.3%[14]。国外研究也发现 1980-2012 年糖尿病的流行和发病率呈持续上升态势[15]。《指南》指出被诊断的患者仅为患者总数 40%[16],这说明尚有一大半患者未被发现,实际患病率可能会更高。患病率高而“三率”低是当前糖尿病防控的现状,低知晓率将会对治疗和控制产生负面影响,血糖控制不达标是糖尿病患者并发症发生和发展的重要原因,增加了心脑血管疾病的患病、致死风险,且影响其预后[17]。此外,糖尿病者无论是就医频次,还是住院时间和费用较非患者都成倍增加,患者、家庭和社会背负着沉重的精神和经济负担,其疾病负担日益加重[18]。有研究证实,通过积极干预,能有效降低糖尿病发病和患者心血管病死亡风险[19]。本次调查正是为了解和探索六安市社区老年人糖尿病患病及“三率”情况及影响因素,为积极采取有效防控措施,遏制糖尿病快速上升势头奠定基础。
  
  随着居民重体力劳动的逐渐减少,能量摄入过剩、身体活动缺乏等不健康的生活方式增加,超重/肥胖和腹型肥胖患病率逐渐升高。调查显示[20,21],近年来我国超重/肥胖和腹型肥胖患病率均增长了 1 倍左右,其中,腹型肥胖增长较超重/肥胖更快,到 2011 年,我国≥20 岁人群超重/肥胖和腹型肥胖分别为 42.3%、44.0%;加拿大的一项研究显示[22],其两个省超重/肥胖率分别为 57.1%、56.2%,国内外的超重/肥胖和腹型肥胖问题均日益严重。2012 年起,超重/肥胖和腹型肥胖被认为是一种慢性病[23],并于次年将腰围等指标纳入超重/肥胖的判定,使超重/肥胖的判定更具科学性。研究显示[24-26],超重/肥胖和腹型肥胖是诸多慢性病的重要危险因素。
  
  报道显示,心衰发病率随着 BMI 增加而按一定比例上升[27],糖尿病 34.2%的医疗费是超重和肥胖贡献的[28];另有研究显示,老年人超重/肥胖,与其血管内特殊的反应关系密切[29]。近年来,超重/肥胖问题虽已引起政府及社会各界的关注和重视,以多种形式开展了以“健康体重”为主题的宣传教育活动,但关注和重视的程度、宣传效果仍不理想,尚未将超重/肥胖、腹型肥胖患者纳入慢性病管理。纳入管理是有效防控手段之一,本研究旨在了解本地区社区老年人超重/肥胖及腹型肥胖的患病情况及其影响因素,为下一步防控工作的开展和防控效果的评价提供依据和基础数据。
  
  近年来,我国血脂异常患病率上升势头较迅猛[30],2012 年为 40.40%[1]。遗传、性别、年龄、饮食习惯等生活行为习惯不同程度影响着体内血脂水平。血脂异常是心血管疾病的危险因素,其中低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)异常升高分别是动脉粥样硬化性心血管疾病、冠心病和急性胰腺炎的首要危险因素,而高密度脂蛋白胆固醇(HDL-C)则对心血管具有一定的保护作用[31]。研究表明,总胆固醇(TC)水平癌症发生和转移有关[32,33],高 TG 和低 LDL-C 可能与肾结石发病密切相关[34],血脂异常的危害逐渐显现。研究证实[35-37],通过筛查或体检是发现血脂异常人群的有效途径,再按照《指南》进行危险分层,根据危险级别通过调整饮食结构、保持正常体质指数、规律的中等强度锻炼等生活方式干预、药物调脂治疗,可有效降低心血管病风险[31],同时,还可发挥中医药在调脂治疗中的作用[38]。老年人是血脂异常高危群体,本研究旨在了解本地区社区老年人 TC、TG、LDL-C、HDL-C 四项主要血脂指标异常患病及其影响因素情况,为干预和管理提供依据,为降低心血管疾病风险奠定基础。
  
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  2 对象与方法
  

  2.1 研究对象
  2.2 方法
  2.2.1 调查方法
  2.2.2 有关定义
  2.3 质量控制
  2.4 统计分析
  
  3 结果
  
  3.1 基本情况
  3.2 超重/肥胖情况
  3.3 腹型肥胖情况
  3.4 血脂异常情况
  3.5 高血压患病情况
  3.6 糖尿病患病情况
  3.7 高血压知晓、治疗、控制情况
  3.8 糖尿病知晓、治疗、控制情况
  3.9 超重/肥胖影响因素的多因素 logistic 回归分析
  3.10 腹型肥胖影响因素的多因素 logistic 回归分析
  3.11 血脂异常影响因素的多因素 logistic 回归分析
  3.12 高血压“三率”影响因素的多因素 logistic 回归分析
  3.13 糖尿病“三率”影响因素的多因素 logistic 回归分析
  
  4 讨论
  
  4.1 超重/肥胖情况分析
  4.2 腹型肥胖情况分析
  4.3 血脂异常情况分析
  4.4 高血压患病情况分析
  4.5 糖尿病患病情况分析
  4.6 高血压“三率”情况分析
  4.7 糖尿病“三率”情况分析
  4.8 防控对策建议

  结语

  综上,高血压患病与人口学特征、遗传因素有关,伴随着年龄的增长高血压的患病风险增加。健康状况与生活方式影响高血压的发生与发展,治疗基础疾病,通过戒烟、限酒、加强锻炼、改善睡眠等改变不健康生活方式,控制盐的摄入、按照膳食宝塔合理膳食,调节心理因素均能有效预防和控制高血压的发生及血压水平。老年高血压随着城镇化和人口老龄化进程加快而快速上升,而高血压的低控制率与高患病率是我们面临的严峻挑战。高血压的发生和发展出与上述因素有关之外,还与高尿酸血症、空巢老人的寂寞、是否合并心血管危险因素等因素有关,这些因素除独立或相互交互作用,协同影响血压水平。快速的生活和工作节奏及社会竞争压力,使心理因素和职业紧张在高血压发生发展中作用逐渐凸显。

  因此,研究和探讨老年高血压发病危险因素,有助于老年高血压的预防和控制,提高其晚年生活质量。

  参考文献

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