怒族老年高血压患者知晓、治疗和控制现状及影响因素

王秀清; 毛勇; 龙欣甜; 陈洁; 周佳; 孙承欢; 赖纯米; 张倩; 楚天舒

doi:10.16462/j.cnki.zhjbkz.2021.01.016

怒族老年高血压患者知晓、治疗和控制现状及影响因素

doi: 10.16462/j.cnki.zhjbkz.2021.01.016

1.
650500 昆明，昆明医科大学公共卫生学院
2.
650500 昆明昆明医科大学第二附属医院心血管内科

基金项目:

云南省科学技术厅-昆明医科大学应用基础研究联合专项基金资助项目 2013FB115

云南省创新团队培育计划 202005AE160002

详细信息

通讯作者:
毛勇，E-mail：maoyong@kmmu.edu.cn

中图分类号: R544.1
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出版历程
- 收稿日期: 2020-07-20
- 修回日期: 2020-10-20
- 刊出日期: 2021-01-10

Awareness, treatment and control of high blood pressure and its determinants in the aged patients with hypertension of Nu ethnic group: a multilevel model analysis

1.
School of Public Health, Kunming Medical University, Kunming 650500, China
2.
Department of Cardiology, The Second Affiliated Hospital, Kunming Medical University, Kunming 650500, China

Funds:

Joint Special Project for Applied Basic Research Support by Yunnan Provincial Science and Technology Department and Kunming Medical University 2013FB115

Cultivation Plan for Yunnan Innovation Team 202005AE160002

More Information

Corresponding author: MAO Yong, E-mail: maoyong@kmmu.edu.cn

摘要

摘要: 目的了解怒族老年高血压人群的高血压知晓、治疗和控制现状，探讨其影响因素。方法采用多阶段抽样方法随机抽取1 080名怒族老年人，采用问卷调查和体格检查方法进行现况调查。结果 1 080名调查对象中检出高血压患者319例，其高血压知晓率、治疗率和控制率分别为38.6%、25.7%和10.3%。其中，男性分别为44.4%、30.0%和15.0%，女性分别为32.7%、21.4%和5.7%；经济发展水平中等地区分别为48.9%、33.2%和14.2%，经济发展水平较低地区分别为23.3%、14.7%和4.7%。与对照组比较，经济发展水平中等地区和中度医疗负担老年高血压人群的知晓率(48.9%vs.23.3%, 42.9%vs.27.1%)、治疗率(33.2%vs.14.7%, 30.0%vs.12.9%)和控制率(14.2%vs.4.7%, 12.9%vs.2.9%)较高；男性老年高血压人群知晓率和控制率(44.4%vs.32.7%, 15.6%vs.5.0%)较高；血脂异常老年高血压人群的知晓率和治疗率(100.0%vs.36.4%, 54.6%vs.24.7%)较高。控制协变量的多层Logistic回归分析模型结果显示，经济发展水平与男性对知晓率、治疗率和控制率有跨层交互作用(均有P＜0.05)，个体水平协变量血脂异常对知晓率(OR=5.191, 95% CI: 3.141~8.578, P=0.042)、治疗率(OR=6.101, 95% CI: 3.120~11.930, P=0.043)和控制率(OR=6.699, 95% CI: 4.625~9.702, P=0.047)均有正效应，而低盐饮食(OR=0.329, 95% CI: 0.134~0.810, P=0.019)对知晓率有负效应。结论怒族老年高血压患者知晓率、治疗率和控制率低于全国水平，主要影响因素为男性、经济发展水平、血脂异常和低盐饮食等。
- 怒族 /
- 高血压 /
- 知晓率 /
- 治疗率 /
- 控制率 /
- 多水平模型
Abstract: Objective To identify the status of awareness, treatment and control of high blood pressure in the aged patients with hypertension of Nu ethnic group, and to determine the associated determinants. Methods A sample of 1 080 persons, which was sampled by the multiple-stage sampling method from the aged population of Nu ethnic group, was investigated and examined cross-sectionally. Results There were 319 patients with hypertension in the 1 080 participants. The rate of awareness, treatment and control of high blood pressure in the whole patients was 38.6%, 25.7% and 10.3%; that in male patients was 44.4%, 30.0% and 15.0%; that in female patients was 32.7%, 21.4% and 5.7%; that in the middle-economic level area was 48.9%, 33.2% and 14.2%; and that in the low-economic level area was 23.3%, 14.7% and 4.7%, respectively. Comparison to the control groups, the aged patients with hypertension resided in the middle-economic area and those with middle medical burden had a higher awareness rate (48.9% vs. 23.3%, 42.9% vs.27.1%), treatment rate (33.2% vs.14.7%, 30.0% vs.12.9%) and control rate (14.2% vs. 4.7%, 12.9% vs.2.9%); the male patients with hypertension had a greater awareness rate and control rate (44.4% vs.32.7%, 15.6% vs.15.0%); the patients with dyslipidemia and hypertension had a larger awareness rate and treatment rate (100.0% vs.36.4%, 54.6% vs.24.70%). The results of covariate-adjusted multilevel logistic regression model indicated that there was cross-level interaction, which was between economic level and male, on the rates of awareness, treatment and control (all P < 0.05). Dyslipidemia, which was an individual covariate, had a positive effect on the rate of awareness (OR=5.191, 95% CI: 3.141-8.578, P=0.042), treatment (OR=6.101, 95% CI: 3.120-11.930, P=0.043) and control (OR=6.699, 95% CI: 4.625-9.702, P=0.047), respectively. Low salt diet, however, had a negative effect on the rate of awareness (OR=0.329, 95% CI: 0.134-0.810, P=0.019). Conclusions The rates of awareness, treatment and control of high blood pressure in the aged patients with hypertension of Nu ethnic group were lower than those of national population. The dominant determinants were male, economic level, dyslipidemia and low salt diet, etc.
- Nu ethnic group /
- Hypertension /
- Awareness rate /
- Treatment rate /
- Control rate /
- Multilevel model

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表 1 不同特征怒族老年高血压人群的知晓率比较[n(%)]

Table 1. Comparison of the awareness rate among the elderly hypertension population of Nu ethnic with different characteristics[n(%)]

变量	调查人数	知晓情况	χ²值	P值
性别			4.585	0.032
男	160	71(44.4)
女	159	52(32.7)
医疗负担			8.637	0.013
轻度	70	19(27.1)
中度	240	103(42.9)
重度	1	1(11.1)
血脂异常			21.597	< 0.001
是	11	11(100.0)
否	308	112(36.4)
经济发展水平中等			21.407	< 0.001
是	190	93(48.9)
否	129	30(23.3)

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表 2 不同特征怒族老年高血压人群的治疗率比较[n(%)]

Table 2. Comparison of the treatment rate among the elderly hypertension population of Nu ethnic with different characteristics[n(%)]

变量	调查人数	知晓情况	χ²值	P值
性别			3.100	0.078
男	160	48(30.0)
女	159	34(21.4)
医疗负担			9.372	0.009
轻度	70	9(12.9)
中度	240	72(30.0)
重度	1	1(11.1)
血脂异常			4.962	0.026
是	11	6(54.5)
否	308	76(24.7)
经济发展水平中等			13.664	< 0.001
是	190	63(33.2)
否	129	19(14.7)

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表 3 不同特征怒族老年高血压人群的控制率比较[n(%)]

Table 3. Comparison of the control rate among the elderly hypertension population of Nu ethnic with different characteristics[n(%)]

变量	调查人数	知晓情况	χ²值	P值
性别			9.650	0.002
男	160	25(15.6)
女	159	8(5.0)
医疗负担			6.982	0.031
轻度	70	2(2.9)
中度	240	31(12.9)
重度	1	0(0.0)
经济发展水平中等			7.570	0.006
是	190	27(14.2)
否	129	6(4.7)

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表 4 高血压知晓率与影响因素关系的多层Logistic回归分析模型

Table 4. Logistic regression model of hypertension awareness rate and influencing factors

参数	β值	s_x	t值	P值	OR(95% CI)值
截距	-2.750 7	1.174 5	-2.34	0.035	0.064(0.005, 0.793)
经济发展水平	1.019 4	0.256 1	1.35	0.199	2.772(1.600, 4.801)
男性	0.009 7	0.482 0	0.02	0.984	1.010(0.359, 2.839)
经济发展水平×男性	1.449 1	0.201 3	2.41	0.030	4.259(2.766, 6.559)
饮酒	0.978 6	0.558 0	1.75	0.101	2.661(0.804, 8.806)
血脂异常	1.646 9	0.234 2	2.24	0.042	5.191(3.141, 8.578)
年龄组	0.124 1	0.126 0	0.99	0.341	1.132(0.864, 1.484)
有配偶	-0.026 9	0.329 1	-0.08	0.936	0.973(0.481, 1.972)
医疗负担	-0.009 2	0.357 3	-0.03	0.980	0.991(0.460, 2.132)
家庭经济状况	0.511 3	0.375 5	1.36	0.195	1.667(0.745, 3.731)
糖尿病	0.935 1	0.250 6	1.44	0.173	2.547(1.488, 4.361)
低盐饮食	-1.111 8	0.419 8	-2.65	0.019	0.329(0.134, 0.810)
注：变量：经济发展水平(较低=0，中等=1)，医疗负担(轻度=1，中度=2，重度=3)，年龄组(60~岁=1、65~岁=2、70~岁=3、75~岁=4、80~岁=5)，家庭经济状况(差=1，中=2，好=3)，血脂异常、男性、饮酒、有配偶、糖尿病和低盐饮食(否=0，是=1)。年龄组、医疗负担、家庭经济状况等有序多分类变量经“相邻两个等级总体OR齐性检验”，差异均无统计学意义(均有P＞0.05)，即相邻两级总体OR相同，满足线性假设，均可直接引入模型。

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表 5 高血压治疗率与影响因素关系的多层Logistic回归分析模型

Table 5. Logistic regression model of hypertension treatment rate and influencing factors

参数	β值	s_x	t值	P值	OR(95% CI)值
截距	-3.407 8	1.368 1	-2.49	0.026	0.033(0.002, 0.623)
经济发展水平	0.730 3	0.301 6	0.91	0.378	2.076(1.087, 3.964)
男性	-0.452 5	0.563 7	-0.80	0.436	0.636(0.190, 2.131)
经济发展水平×男性	1.506 2	0.278 4	2.22	0.043	4.510(2.482, 8.194)
饮酒	0.946 4	0.576 8	1.64	0.123	2.576(0.748, 8.878)
血脂异常	1.808 5	0.312 6	2.23	0.043	6.101(3.120, 11.930)
年龄组	-0.081 3	0.140 2	-0.58	0.571	0.922(0.682, 1.245)
有配偶	-0.081 7	0.361 8	-0.23	0.825	0.922(0.424, 2.002)
医疗负担	-0.088 7	0.407 1	-0.22	0.831	0.915(0.382, 2.191)
家庭经济状况	0.373 1	0.402 8	0.93	0.370	1.452(0.612, 3.446)
糖尿病	0.338 0	0.750 3	0.45	0.659	1.402(0.280, 7.010)
BMI等级	0.122 9	0.216 8	0.57	0.580	1.131(0.710, 1.800)
低盐饮食	0.009 7	0.463 8	0.02	0.984	1.010(0.373, 2.731)
注：变量：经济发展水平(较低=0，中等=1)，医疗负担(轻度=1，中度=2，重度=3)，年龄组(60~岁=1、65~岁=2、70~岁=3、75~岁=4、80~岁=5)，家庭经济状况(差=1，中=2，好=3)，BMI等级(体重过低=1，体重正常=2，超重=3，肥胖=4)，血脂异常、男性、饮酒、有配偶、糖尿病和低盐饮食(否=0，是=1)。注：医疗负担、家庭经济状况、BMI等级等有序多分类变量经“相邻两个等级总体OR齐性检验”，差异均无统计学意义(均有P＞0.05)，即相邻两级总体OR相同，满足线性假设，均可直接引入模型。

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表 6 高血压控制率与影响因素关系的多层Logistic回归分析模型

Table 6. Logistic regression model of hypertension control rate and influencing factors

参数	β值	s_x	t值	P值	OR(95% CI)值
截距	-3.985 2	1.742 7	-2.29	0.038	-
经济发展水平	-0.113 2	0.542 7	-0.08	0.934	0.893(0.279, 2.860)
男性	-1.161 3	1.549 9	-0.93	0.369	0.313(0.021, 4.570)
经济发展水平×男性	3.898 7	0.039 3	2.71	0.017	49.338(45.350, 53.678)
年龄组	-0.055 4	0.205 2	-0.27	0.791	0.946(0.609, 1.469)
血脂异常	1.901 9	0.172 7	2.18	0.047	6.699(4.625, 9.702)
有配偶	-0.534 5	0.534 7	-1.00	0.334	0.586(0.186, 1.844)
家庭经济状况	0.050 8	0.584 7	0.09	0.932	1.052(0.300, 3.687)
BMI等级	0.088 0	0.363 3	0.24	0.812	1.092(0.501, 2.380)
低盐饮食	0.074 8	0.868 5	0.09	0.933	1.078(0.167, 6.942)
变量：经济发展水平(较低=0，中等=1)，家庭经济状况(差=1，中=2，好=3)，年龄组(60~岁=1、65~岁=2、70~岁=3、75~岁=4、80~岁=5)，BMI等级(体重过低=1，体重正常=2，超重=3，肥胖=4)，血脂异常、男性、有配偶和低盐饮食(否=0，是=1)。年龄组、家庭经济状况、BMI等级等有序多分类变量经“相邻两个等级总体OR齐性检验”，差异均无统计学意义(均有P＞0.05)，即相邻两级总体OR相同，满足线性假设，均可直接引入模型。

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