德清农村居民糖尿病和高血压共患病率及其危险因素

常睿; 董晓莲; 王玉琢; 陈跃; 张一鸣; 朱建福; 陈芸; 姜庆五; 付朝伟

doi:10.16462/j.cnki.zhjbkz.2019.06.005

德清农村居民糖尿病和高血压共患病率及其危险因素

doi: 10.16462/j.cnki.zhjbkz.2019.06.005

1.
200032 上海, 复旦大学公共卫生学院流行病学教研室
2.
313299 德清, 德清县疾病预防控制中心慢病科
3.
K1N 6N5 渥太华, 渥太华大学流行病学与公共卫生学院流行病学教研室

基金项目:

国家自然科学基金 81473038

上海市公共卫生重点学科建设计划 15GWZX0801

上海市公共卫生高端海外研修计划 GWTD2015S04

详细信息

通讯作者:
付朝伟, E-mail: fcw@fudan.edu.cn

中图分类号: R181
计量
- 文章访问数: 340
- HTML全文浏览量: 178
- PDF下载量: 39
- 被引次数: 0
出版历程
- 收稿日期: 2019-01-05
- 修回日期: 2019-04-20
- 刊出日期: 2019-06-10

The prevalence and risk factors of diabetes and hypertension in Deqing rural community

1.
Department of Epidemiology, School of Public Health, Fudan University, Shanghai 200032, China
2.
Deqing Municipal Center for Disease Prevention and Control, Zhejiang 313299, China
3.
School of Epidemiology and Public Health, University of Ottawa, Ottawa K1N 6N5, Canada

Funds:

National Natural Science Foundation of China 81473038

Construction Plan of Key Disciplines of Public Health in Shanghai 15GWZX0801

Shanghai Public Health High-end Overseas Research Program GWTD2015S04

More Information

Corresponding author: FU Chao-wei, E-mail: fcw@fudan.edu.cn

摘要

摘要: 目的了解德清农村居民糖尿病和高血压共患病情况并探究其危险因素。方法采用横断面研究，在浙江省德清县随机整群抽取8个乡镇作为研究现场，共调查29 306名成人居民。调查内容包括：人口学信息、社会经济学特征、行为和生活方式、慢性病家族史，进行血压、血糖的测量。结果在研究人群中，2型糖尿病患病率为3.34%，高血压患病率为28.72%，其中2.01%人群共患糖尿病和高血压，共患率在70~79岁均达到较高水平。无序多元Logistics回归结果显示：糖尿病家族史(OR=4.94，95%CI：3.24~7.54，P < 0.001)、拥有伴侣(OR=2.17，95%CI：1.18~4.00，P=0.013)是仅糖尿病患病的可能危险因素，体重指数(body mass index，BMI) < 24 kg/m²(OR=0.48，95%CI：0.39~0.59，P < 0.001)是糖尿病的可能保护因素；BMI < 24 kg/m²(OR=0.60，95%CI：0.56~0.64，P < 0.001)、完成义务教育(OR=0.54，95%CI：0.49~0.59，P < 0.001)、运动(OR=0.77，95%CI：0.69~0.86，P < 0.001)是高血压患病的保护因素，饮酒(OR=1.18，95%CI：1.08~1.29，P < 0.001)是仅高血压患病的可能危险因素；BMI < 24 kg/m²(OR=0.26，95%CI：0.21~0.31，P < 0.001)、完成义务教育(OR=0.50，95%CI：0.35~0.72，P < 0.001)、饮茶(OR=0.80，95%CI：0.64~0.99，P=0.045)是两病共患的保护因素，农民(OR=1.35，95%CI：1.04~1.76，P=0.024)、糖尿病家族史(OR=4.21，95%CI：2.71~6.57，P < 0.001)、高血压家族史(OR=1.86，95%CI：1.31~2.64，P=0.001)是两病共患的危险因素。结论德清地区农村居民糖尿病患病水平低于全国平均水平，高血压患病水平与全国平均水平接近，也有一定的共患病水平。女性、年龄>60岁、农民、糖尿病家族史、高血压家族史、超重或肥胖人群是可能的高危因素，需要进一步的干预和控制。
- 糖尿病 /
- 高血压 /
- 危险因素 /
- 农村社区
Abstract: Objective This study aimed to describe the prevalence of both type 2 diabetes (T2D) and hypertension, and to explore possible risk factors. Methods A Cross-sectional study was conducted in eight towns cluster-sampled randomly from Deqing County, Zhejiang Province. Totally. 29 306 subjects aged ≥ 18 years old were recruited into this survey. Information on general information, life styles, health status and family history of chronic diseases was collected. Physical examinations including height, weight, blood pressure, etc. were done. Fasting plasma glucose was also tested. Results The prevalence of only T2DM, only hypertension and both of them was 3.34%, 28.72%, and 2.01%, respectively. Such prevalence of both reached a peak at the age of 70-79 years old.Family history of diabetes mellitus(OR=4.94, 95% CI: 3.24-7.54, P < 0.001) and having a spouse(OR=2.17, 95% CI: 1.18-4.00, P=0.013) were possible risk factors of diabetes mellitus, body mass index(BMI) < 24 kg/m²(OR=0.48, 95% CI: 0.39-0.59, P < 0.001) was the possible protective factor of diabetes mellitus, BMI < 24 kg/m²(OR=0.60, 95% CI: 0.56-0.64, P < 0.001), completing compulsory education(OR=0.54, 95% CI: 0.49-0.59, P < 0.001) and exercise(OR=0.77, 95% CI: 0.69-0.86, P < 0.001) were protective factors of hypertension, drinking(OR=1.18, 95% CI: 1.08-1.29, P < 0.001) was the possible risk factor of hypertension. BMI < 24 kg/m²(OR=0.26, 95% CI: 0.21-0.31, P < 0.001), completing compulsory education(OR=0.50, 95% CI: 0.35-0.72, P < 0.001) and drinking tea(OR=0.80, 95% CI: 0.64-0.99, P=0.045) were protective factors of these two diseases. Farmers(OR=1.35, 95% CI: 1.04-1.76, P=0.024), family history of diabetes(OR=4.21, 95% CI: 2.71-6.57, P < 0.001) and family history of hypertension(OR=1.86, 95% CI: 1.31-2.64, P=0.001) were risk factors for the co occurrence of two diseases. Conclusions The prevalence of diabetes among adults in Deqing County was relatively lower than other places. The prevalence of hypertension was close to the level of other regions. Age, overweight, alcohol consumption, family history of diabetes and hypertension were the risk factors of diabetes and hypertension. Diabetes mellitus was a high-risk group of hypertension. Further means should be taken to strengthen the self-management and treatment of this group. Further intervention action should be taken to promote health and quality of life.
- Diabetes /
- Hypertension /
- Risk factor /
- Rural community

HTML全文

图 1 不同疾病患病率年龄分布

Figure 1. Age distribution of prevalence of different diseases

下载: 全尺寸图片幻灯片

表 1 高血压和糖尿病居民不同年龄性别共患情况[n(%)]

Table 1. Prevalence of hypertension and diabetes among different age groups[n(%)]

	年龄(岁)	男	女	合并	χ²值	P值
糖尿病	18~	1(0.18)	0(0.00)	1(0.08)	1.24	0.266
	30~	6(0.63)	5(0.39)	11(0.49)	0.67	0.415
	40~	37(1.51)	51(1.60)	88(1.56)	0.07	0.798
	50~	85(2.69)	172(3.98)	257(3.43)	9.16	0.002
	60~	126(3.98)	258(6.30)	384(5.29)	19.23	＜0.001
	70~	64(3.57)	122(6.36)	186(5.01)	15.17	＜0.001
	≥80	20(2.52)	31(3.36)	51(2.97)	1.05	0.305
高血压	18~	43(7.76)	33(4.81)	76(6.13)	4.64	0.031
	30~	105(11.10)	98(7.63)	203(9.01)	7.91	0.005
	40~	378(15.45)	516(16.17)	894(15.86)	0.53	0.466
	50~	774(24.47)	1 240(28.66)	2 014(26.89)	16.34	＜0.001
	60~	1 104(34.88)	1 657(40.49)	2 761(38.04)	23.85	＜0.001
	70~	783(43.65)	929(48.41)	1 712(46.11)	8.47	0.004
	≥80	356(44.84)	401(43.49)	757(44.11)	0.31	0.576
高血压人群中共患	18~	1(2.33)	0(0.00)	1(1.32)	0.78	0.378
	30~	0(0.00)	2(2.04)	2(0.99)	2.16	0.141
	40~	15(3.97)	13(2.52)	28(3.13)	1.51	0.219
	50~	39(5.04)	96(7.74)	135(6.70)	5.57	0.018
	60~	75(6.79)	171(10.32)	246(8.91)	10.15	0.001
	70~	49(6.26)	97(10.44)	146(8.53)	9.53	0.002
	≥80	15(4.21)	16(3.99)	31(4.10)	0.02	0.877
糖尿病人群共患	18~	1(100.00)	-	1(100.00)	-	-
	30~	0(0.00)	2(40.00)	2(18.18)	2.93	0.087
	40~	15(40.54)	13(25.49)	28(31.82)	2.24	0.135
	50~	39(45.88)	96(55.81)	135(52.53)	2.25	0.134
	60~	75(59.52)	171(66.28)	246(64.06)	1.68	0.195
	70~	49(76.56)	97(79.51)	146(78.49)	0.22	0.642
	≥80	15(75.00)	16(51.61)	31(60.78)	2.79	0.095

下载: 导出CSV

表 2 基本信息及疾病相关危险因素分析[n(%)]

Table 2. Basic information and risk factors for Disease[n(%)]

	合计	不患病人数	糖尿病					高血压					共患
	合计	不患病人数	人数	P值	OR(95% CI)值	调整后P值	调整后OR(95% CI)值	人数	P值	OR(95% CI)值	调整后P值	调整后OR(95% CI)值	人数	P值	OR(95% CI)值	调整后P值	调整后OR(95% CI)值
性别
男	12 862(43.89)	9 174(71.33)	145(1.13)	0.003	0.73(0.60~0.90)	0.028	0.71(0.53~0.96)	3 349(26.04)	0.002	0.92(0.87~0.97)	0.454	0.97(0.90~1.05)	194(1.51)	< 0.001	0.61(0.51~0.72)	0.030	0.77(0.61~0.97)
女	16 444(56.11)	11 303(68.74)	244(1.49)					4 479(27.28)					395(2.41)
年龄 > 60岁
是	12 687(43.29)	7 259(57.22)	198(1.56)	< 0.001	1.89(1.55~2.31)	< 0.001	1.95(1.53~2.48)	4 807(37.89)	< 0.001	2.90(2.75~3.06)	< 0.001	2.63(2.46~2.81)	423(3.33)	< 0.001	4.65(3.88~5.57)	< 0.001	3.98(3.21~4.93)
否	16 619(56.71)	13 241(79.67)	191(1.15)					3 021(18.18)					166(1.00)
伴侣
是	27 279(93.08)	18 535(67.95)	358(1.36)	0.054	1.67(0.99~2.80)	0.013	2.17(1.18~4.00)	6 915(26.27)	< 0.001	0.73(0.66~0.81)	0.287	0.94(0.84~1.05)	518(1.97)	0.001	0.62(0.47~0.82)	0.404	0.87(0.64~1.20)
否	2 027(6.92)	1 295(63.89)	15(0.74)					659(32.51)					58(2.86)
超重肥胖
是	9 107(31.08)	5 635(61.88)	171(1.88)	< 0.001	2.08(1.69~2.56)	< 0.001	2.33(1.85~2.94)	2 964(32.55)	< 0.001	1.61(1.52~1.69)	< 0.001	1.67(1.56~1.79)	337(3.70)	< 0.001	3.57(3.03~4.17)	< 0.001	3.85(3.23~4.76)
否	20 199(68.92)	14 865(73.59)	218(1.08)					4 864(24.08)					252(1.25)
义务教育
是	5 854(19.98)	4 950(84.56)	52(0.89)	< 0.001	0.49(0.36~0.65)	0.071	0.73(0.52~1.03)	812(13.87)	< 0.001	0.36(0.33~0.39)	< 0.001	0.54(0.49~0.59)	40(0.68)	< 0.001	0.23(0.16~0.31)	< 0.001	0.50(0.35~0.72)
否	23 452(80.02)	15 324(65.34)	330					(1.43)6 933(29.97)					546(2.36)
农民
是	7 807(26.64)	6 166(78.98)	89(1.14)	0.002	1.45(1.14~1.84)	0.124	1.26(0.94~1.68)	1 465(18.77)	< 0.001	1.87(1.75~1.99)	< 0.001	1.26(1.16~1.36)	502(2.33)	< 0.001	2.48(1.97~3.12)	0.024	1.35(1.04~1.76)
否	21 499(73.36)	14 334(66.67)	300(1.40)					6 363(29.60)					87(1.11)
低收入
是	4 296(14.66)	2 893(67.34)	63(1.47)	0.243	1.18(0.90~1.54)	0.327	1.16(0.86~1.57)	1 235(28.75)	< 0.001	1.14(1.061~.23)	0.433	1.03(0.95~1.12)	105(2.44)	0.011	1.32(1.07~1.64)	0.125	1.20(0.95~1.53)
否	25 010(85.34)	17 607(70.40)	326(1.30)					6 593(26.36)					484(1.94)
吸烟
是	6 588(22.48)	4 875(74.00)	80(1.21)	0.138	0.83(0.65~1.06)	0.328	1.20(0.83~1.72)	1 556(23.62)	< 0.001	0.79(0.740~.85)	< 0.001	0.84(0.76~0.91)	77(1.17)	< 0.001	0.48(0.38~0.61)	0.004	0.62(0.45~0.86)
否	22 718(77.52)	15 609(68.71)	309(1.36)					6 272(27.63)					512(2.26)
饮酒
是	5 424(18.51)	3 824(70.50)	50(0.92)	0.004	0.64(0.48~0.87)	0.125	0.75(0.51~1.08)	1 467(27.05)	0.889	1.00(0.94~1.07)	< 0.001	1.18(1.08~1.29)	83(1.53)	0.005	0.71(0.57~0.90)	0.172	1.23(0.91~1.65)
否	23 882(81.49)	16 660(69.76)	339(1.42)					6 361(26.65)					506(2.12)
运动
是	2 606(8.89)	1 961(75.25)	34(1.30)	0.865	0.97(0.68~1.39)	0.705	1.08(0.74~1.57)	565(21.68)	< 0.001	0.75(0.68~0.83)	< 0.001	0.77(0.69~0.86)	46(1.77)	0.290	0.85(0.62~1.15)	0.407	0.87(0.63~1.21)
否	26 700(91.11)	16 438(61.57)	294(1.25)					6 273(26.74)					455(1.94)
饮茶
是	11 125(37.96)	7 990(71.82)	124(1.11)	0.005	0.73(0.59~0.91)	0.400	0.90(0.70~1.16)	2 835(25.48)	< 0.001	0.89(0.84~0.94)	0.316	1.03(0.97~1.10)	176(1.58)	< 0.001	0.67(0.56~0.80)	0.045	0.80(0.64~0.99)
否	18 181(62.04)	12 510(68.81)	265(1.46)					4 993(27.46)					413(2.27)
糖尿病家族史
是	463(1.58)	281(60.69)	25(5.40)	< 0.001	4.94(3.24~7.54)	< 0.001	6.77(4.21~10.90)	120(25.92)	0.302	1.12(0.90~1.39)	0.025	0.74(0.57~0.96)	37(7.99)	< 0.001	4.82(3.39~6.87)	< 0.001	4.21(2.71~6.57)
否	28 843(98.42)	20 219(70.10)	364(1.26)					7 708(26.72)					552(1.91)
高血压家族史
是	2 125(7.25)	1 006(47.34)	13(0.61)	0.158	0.67(0.38~1.17)	0.035	0.50(0.27~0.95)	1 049(49.36)	< 0.001	3.00(2.74~3.28)	< 0.001	3.73(3.36~4.15)	532(1.96)	< 0.001	2.08(1.57~2.75)	0.001	1.86(1.31~2.64)
否	27 181(92.75)	19 494(71.72)	376(1.38)					6 779(24.94)					57(2.68)

下载: 导出CSV

参考文献(19)

[1]	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2013年版)[J]. 中华内分泌代谢杂志, 2014, 30(10): 893-942. DOI: 10.3760/cma.j.issn.1000-6699.2014.10.020. Chinese Diabetes Society. Guidelines for the prevention and treatment of Type 2 diabetes in China(2013version)[J]. Chin J Endocrinol Meta, 2014, 30(10): 893-942. DOI: 10.3760/cma.j.issn.1000-6699.2014.10.020.
[2]	Cho NH, Shaw JE, Karuranga S, et al. IDF diabetes atlas: global estimates of diabetes prevalence for 2017 and projections for 2045[J]. Diabetes Res Clin Pract, 2018, 138: 271-281. DOI: 10.1016/j.diabres.2013.11.002.
[3]	张毓辉, 万泉, 柴培培, 等. 我国糖尿病医疗费用及筹资负担研究[J]. 中国卫生经济, 2017, 36(4): 17-19. DOI: 10.7664/CHE20170404. Zhang YH, Wan Q, Chai PP, et al. Study on medical expense and financing burden of diabetes in China[J]. Chinese Health Economics, 2017, 36(4): 17-19. DOI: 10.7664/CHE20170404.
[4]	陈伟伟. 中国心血管病报告2015[J]. 中华医学信息导报, 2016, (12): 11. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGXH201606002.htm Chen WW. Report on cardiovascular diseases in China 2015[J]. China Medical News, 2016, (12): 11. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGXH201606002.htm
[5]	Nissinen A, Böthig S, Granroth H, et al. Hypertension in developing countries[J]. World Health Stat Q, 2014, 30(5): 527-533. DOI: 10.1016/j.cjca.2014.02.020.
[6]	付朝伟. 农村社区成人2型糖尿病(德清队列)研究[D]. 上海: 复旦大学, 2010. Fu CW. Study on adult type 2 diabetes mellitus (Deqing cohort) in rural community[D]. Shanghai: Fudan University, 2010.
[7]	中国营养学会. 中国居民膳食指南[M]. 北京: 人民卫生出版社, 2016. Chinese Nutrition Society. Dietary guidelines for Chinese residents[M]. Beijing: People's Medical Publishing House, 2016.
[8]	中华人民共和国卫生部疾病控制司. 中国成人超重和肥胖症预防控制指南[M]. 北京: 人民卫生出版社, 2006. Department of Disease Control, Ministry of health of the people's republic of China guidelines for prevention and control of overweight and obesity in Chinese adults[M]. Beijing: People's Medical Publishing House, 2006.
[9]	刘力生. 中国高血压防治指南2010[J]. 中华心血管病杂志, 2011, 3(7): 701-708. DOI: 10.3760/cma.j.issn.0253-3758.2011.07.002.Liu LS. Guidelines for the prevention and treatment of hypertension in China 2010[J]. Chinese Journal of Cardiology, 2011, 3(7): 701-708. DOI: 10.3760/cma.j.issn.0253-3758.2011.07.002.
[10]	颜穗珺, 李会芳. 中国糖尿病的患病概况[J]. 昆明医科大学学报, 2017, 88(3): 1-5. DOI: 10.3969/j.issn.1003-4706.2017.03.001. Yan SJ, Li HF. The prevalence of diabetes mellitus in China[J]. J Kunming Med Univ, 2017, 88(3): 1-5. DOI: 10.3969/j.issn.1003-4706.2017.03.001.
[11]	王丹, 郑代坤, 郑胜. 重庆市万州区2型糖尿病前期流行现状及其危险因素分析[J]. 现代预防医学, 2016, 43(10): 1735-1738. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201610003.htm Wang D, Zheng DK, Zheng S. Prevalence and risk factors of type 2 diabetes mellitus in Wanzhou district of Chongqing[J]. Modern Preventive Medicine, 2016, 43(10): 1735-1738. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201610003.htm
[12]	游弋, 卢春明, 潘磊磊, 等. 辽宁省成年人糖尿病患病现况及其影响因素分析[J]. 中华疾病控制杂志, 2018, 22(1): 19-22. DOI: 10.16462/j.cnki.zhjbkz.2018.01.005. You Y, Lu CM, Pan LL, et al. Analysis of prevalence and influencing factors of adult diabetes mellitus in Liaoning Province[J]. Chin J Dis Control Prev, 2018, 22(1): 19-22. DOI: 10.16462/j.cnki.zhjbkz.2018.01.005.
[13]	顾景范. 2012年全国营养与健康调查结果[C]. 全国中西医结合营养学术会议论文, 2015. Gu JF. Results of the national nutrition and health survey in 2012[C]. Papers of the National Symposium on Integrated Chinese and Western Medicine Nutrition, 2015.
[14]	林佳冰, 吴逸海, 林少炜, 等. 福建省部分地区居民的高血压病流行现状及其影响因素研究[J]. 福建医科大学学报, 2016, 50(1): 25-30. https://www.cnki.com.cn/Article/CJFDTOTAL-FJYD201601008.htm Lin JB, Wu YM, Lin SW, et al. Epidemiological status and influencing factors of hypertension among residents in some areas of Fujian Province[J]. J Fujian Med Univ, 2016, 50(1): 25-30. https://www.cnki.com.cn/Article/CJFDTOTAL-FJYD201601008.htm
[15]	何田静, 张岚, 张庆军, 等. 湖北省成人高血压患病率及高血压控制现况分析[J]. 中国公共卫生, 2017, 32(10): 1426-1430. DOI: 10.11847/zgggws2017-33-10-03. He TJ, Zhang L, Zhang QJ, et al. Prevalence and control of hypertension in adults in Hubei Province[J]. Chin J Public Health, 2017, 32(10): 1426-1430. DOI: 10.11847/zgggws2017-33-10-03.
[16]	孙中明, 潘恩春, 张芹, 等. 淮安市城区2型糖尿病人群高血压的患病率及其影响因素分析[J]. 现代预防医学, 2015, 42(9): 1642-1646. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201509035.htm Sun ZM, Pan EC, Zhang Q, et al. Prevalence and influencing factors of hypertension in type 2 diabetes mellitus population in Huaian City[J]. Modern Preventive Medicine, 2015, 42(9): 1642-1646. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF201509035.htm
[17]	Hariri S, Yoon PW, Qureshi N, et al. Family history of type 2 diabetes: a population-based screening tool for prevention?[J]. Genetics in Medicine, 2006, 8(2): 102-108. DOI: 10.1097/01.gim.0000200949.52795.df
[18]	Dagenais GR, Gerstein HC, Zhang X, et al. Variations in diabetes prevalence in low-, middle-, and high-income countries: results from the prospective urban and rural epidemiology study[J]. Diabetes Care, 2016, 39(5): 780-787. DOI: 10.2337/dc15-2338.
[19]	Valdez R, Yoon PW, Liu T, et al. Family history and prevalence of diabetes in the U.S. population: The 6-year results from the national health and nutrition examination survey (1999-2004)[J]. Diabetes, 2007, 30(10): 2517-2522. http://www.ncbi.nlm.nih.gov/pubmed/17666469