Study on the prevalence of hypertension and diabetes mellitus and risk factors of comorbidities in the disabled persons over 50 years old in Shanghai
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摘要:
目的 探索上海市50岁以上残疾人群高血压及糖尿病的患病率，共病情况及风险因素。 方法 采用整群抽样方法对上海市某残疾人定点健康保健医院，2018年2月-2018年12月的6 195例50岁以上残疾人的健康体检信息进行回顾性调查分析，内容包含研究对象一般人口学信息、残疾类型、残疾等级、高血压和糖尿病患病情况及血液生化检测指标。研究对象按高血压和糖尿病患病人数分为三级，采用有序多分类Logistic回归分析模型对研究对象高血压和糖尿病共病的风险因素进行分析。 结果 6 195例残疾人的年龄为(63.9±6.9)岁，男性3 313人，占比53.5%；肢体残疾3 735人，占比60.3%。高血压标准化患病率为48.0%，糖尿病标准化患病率为13.4%。高血压及糖尿病共病者565人，占比9.12%。按共病分类比较，性别、年龄、文化程度、残疾类型、BMI、TG、胆固醇、尿酸及肌酐水平差异有统计学意义(均有P < 0.05)。有序多分类Logistic回归分析结果显示，男性、高龄、肢体残疾、超重或肥胖、TG超标、尿酸及肌酐水平异常是残疾人高血压及糖尿病共病的风险因素。 结论 残疾人群高血压及糖尿病共病患病率较高，尤其是肢体残疾的患者。应关注体重、脂代谢、尿酸等指标的变化，针对不同残疾类型制定精准的防控策略。 Abstract:Objective To explore the prevalence, comorbidity characteristics and risk factors of hypertension and diabetes among disabled population over 50 years old in Shanghai. Methods A cluster sampling method was used to retrospectively investigate and analyze the health examination information of 6 195 cases of disabled persons over the age of 50 from a designated health care hospital for the disabled in Shanghai from February to December 2018. The subjects' general demographic information, disability type, disability grade, prevalence of hypertension and diabetes mellitus, and blood biochemical indicators were investigated. Subjects were divided into three levels according to the prevalence of hypertension and diabetes. The risk factors of the morbidity of hypertension and diabetes mellitus were analyzed by using the ordered multi-classification Logistic regression model. Results The age of the 6 195 disabled peoples was (63.9±6.9) years. Among them, 3 313 (53.5%) were males and 3 735 (60.3%) were physical disabilities. The standardized prevalence rate of hypertension was 48.0%, and the standardized prevalence rate of diabetes was 13.4%. There were 565 (9.12%) patients with hypertension and diabetes comorbid. According to the classification of comorbidities, the differences in gender, age, education level, disability type, BMI, triglyceride, cholesterol, uric acid and creatinine levels were statistically significant (all P < 0.05). The results of multi-class Logistic regression analysis showed that male, elderly, physical disability, overweight or obesity, excessive triglycerides, abnormal uric acid and creatinine levels, were risk factors for hypertension and diabetes comorbidities. Conclusions The prevalence of comorbidities of hypertension and diabetes is higher among the disabled, especially those with physical disabilities. Attention should be paid to the changes in indicators such as body weight, lipid metabolism, and uric acid, and precise prevention and control strategies should be formulated for different types of disabilities. -
Key words:
- Disabled persons /
- Hypertension /
- Diabetes mellitus /
- Prevalence of disease /
- Comorbidities
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表 1 研究对象基本信息[n(%)]
Table 1. Basic information of research objects [n(%)]
变量 总人数
(N=6 195)未患高血压
和糖尿病(n=2 917)患高血压或糖尿病(n=2 713) 同时患有高血压和糖尿病(n=565) χ2/F/
H值P值 性别 男 3 313(53.5) 1 425(23.0) 1 558(25.1) 330(5.3) 47.6 < 0.001 年龄(x±s, 岁) 63.9±6.9 62.4±6.7 65.1±6.9 65.4±6.6 120.1 < 0.001 文化程度 21.3 < 0.001 小学 1 222(19.7) 524(8.5) 600(9.7) 98(1.6) 初中/中专 3 396(54.8) 1 603(25.9) 1 465(23.6) 328(5.3) 高中及以上 1 577(25.5) 790(12.8) 648(10.5) 139(2.2) 残疾类型 38.8 < 0.001 肢体残疾 3 735(60.3) 1 674(27.0) 1 682(27.2) 379(6.1) 智力/精神残疾 515(8.3) 281(4.5) 195(3.1) 39(0.6) 视力残疾 1 445(23.3) 696(11.2) 627(10.1) 122(2.0) 听力/言语残疾 430(6.9) 235(3.8) 174(2.8) 21(0.3) 多重残疾 70(1.1) 31(0.5) 35(0.6) 4(0.1) 残疾等级 6.0 0.423 1级残疾 418(6.7) 203(3.3) 174(2.8) 41(0.7) 2级残疾 805(13.0) 398(6.4) 327(5.3) 80(1.3) 3级残疾 2 020(32.6) 931(15.0) 913(14.7) 176(2.8) 4级残疾 2 952(47.7) 1 385(22.4) 1 299(21.0) 268(4.3) BMI(x±s, kg/m2) 24.4±3.4 23.5±3.17 25.0±3.3 25.8±3.4 210.1 < 0.001 SBP(x±s, mm Hg) 128.2±16.1 120.2±12.0 135.0±15.8 136.2±16.7 851.9 < 0.001 DBP(x±s, mm Hg) 73.3±7.6 79.0±8.4 78.9±8.8 76.3±8.6 387.8 < 0.001 FPG(x±s, mmol/L) 5.7±1.7 5.2±0.9 5.8±1.5 8.0±2.9 848.1 < 0.001 TG(x±s, mmol/L) 1.7±1.3 1.6±1.1 1.8±1.3 2.1±1.9 50.3 < 0.001 TC(x±s, mmol/L) 5.1±1.0 5.2±1.0 5.1±1.0 4.9±1.1 23.6 < 0.001 血清尿酸[M(P25, P75), μmol/L] 316.5(265.9, 373.0) 305.5(257.7, 357.5) 327.2(275.1, 386.3) 332.1(273.5, 385.5) 55.8 < 0.001 血清肌酐(x±s, μmoI/L) 61.5(51.1, 73.0) 60.2(51.0, 70.3) 63.0(52.0, 75.0) 63.0(52.0, 75.3) 30.0 < 0.001 血小板(x±s, 109/L) 221.4±59.6 220.9±59.4 224.1±58.9 221.0±63.2 5.3 0.078 血红蛋白(x±s, g/L) 141.5±14.4 140.5±14.2 142.5±14.5 141.2±15.0 13.5 0.065 
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表 2 共病类型影响因素的有序多分类Logistic回归分析模型分析
Table 2. Analysis of influencing factors of comorbidity types by ordinal multi-classification Logistic regression model
变量 β值 sx值 Wald χ2值 OR(95% CI)值 P值 变量 β值 sx值 Wald χ2值 OR(95% CI)值 P值 性别 BMI(kg/m2) 男性 1.00 18.5~ < 24 1.00 女性 -0.21 0.05 16.88 0.81(0.73~0.89) < 0.001 ≥24 0.690 0.050 73.850 2.00(1.81~2.22) < 0.001 文化程度 < 18.5 -0.770 0.190 16.280 0.56(0.42~0.87) < 0.001 高中/大专或以上 1.00 TG(mmol/L) 小学或以下 0.07 0.08 0.96 1.08(0.93~1.26) 0.330 < 2.3 1.00 初中/中专 0.05 0.06 0.60 1.05(0.93~1.18) 0.430 ≥2.3 0.380 0.060 32.660 1.46(1.28~1.67) < 0.001 残疾类型 TC(mmol/L) 肢体残疾 1.00 < 6.2 1.00 非肢体残疾 -0.23 0.05 19.42 0.79(0.72~0.88) < 0.001 ≥6.2 -0.140 0.070 3.180 0.87(0.75~1.01) 0.070 年龄(岁) 血清尿酸(mol/L) 50~ < 60 1.00 < 360 1.00 ≥80 0.89 0.19 20.65 2.44(1.66~3.59) < 0.001 ≥360 0.230 0.070 10.760 1.25(1.09~1.43) 0.001 70~ < 80 0.88 0.08 29.30 2.42(2.08~2.83) < 0.001 血清肌酐(μmoI/L) 60~ < 70 0.47 0.06 62.31 1.61(1.43~1.81) < 0.001 < 70 1.00 ≥70 1.320 0.260 25.430 3.76(2.25~5.30) < 0.001
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