安徽省马鞍山市中老年人群吸烟与高血压的剂量-反应关系研究

胡文蕾; 何家镠; 胡明军; 李国傲; 秦其荣; 朱振宇; 黄芬

doi:10.16462/j.cnki.zhjbkz.2023.01.007

安徽省马鞍山市中老年人群吸烟与高血压的剂量-反应关系研究

doi: 10.16462/j.cnki.zhjbkz.2023.01.007

1.
230032 合肥，安徽医科大学公共卫生学院流行病与卫生统计学系
2.
243000 马鞍山，马鞍山市疾病预防控制中心慢病防治与健康管理科

基金项目:

安徽省中央引导地方科技发展专项 202007d07050008

详细信息

通讯作者:
黄芬，E-mail: fenh@ahmu.edu.cn

中图分类号: R554.1;R181.1
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出版历程
- 收稿日期: 2021-12-21
- 修回日期: 2022-03-25
- 网络出版日期: 2023-02-09
- 刊出日期: 2023-01-10

Dose-response relationship between smoking and hypertension among middle-aged and elderly people in Ma'anshan City, Anhui Province

1.
Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, China
2.
Department of Chronic Disease Prevention and Health Management, Ma'anshan Center for Disease Control and Prevention, Ma 'anshan 243000, China

Funds:

The Central Government Guides the Local Science and Technology Development Special Project of Anhui Province 202007d07050008

More Information

Corresponding author: HUANG Fen, E-mail: fenh@ahmu.edu.cn

摘要

摘要: 目的探索安徽省马鞍山市吸烟与中老年(45岁以上)居民高血压的关系，为高血压防制提供针对性的理论依据。方法按照多阶段抽样的方法，于2020年8-11月选取了马鞍山市三个地区，共12 132名居民参与问卷调查和体格测量。采用二元logistic回归分析模型分析吸烟与高血压之间是否存在关联，限制性立方样条(restricted cubic spline, RCS)模型和广义线性模型分析二者之间的剂量-反应关系。结果本研究共纳入11 457名研究对象，其中高血压患者6 067名，占52.95%。以不吸烟人群作为参照，曾经吸烟人群患高血压风险的OR值在模型一、模型二、模型三中分别为1.37(95% CI: 1.20~1.56)、1.25(95% CI: 1.07~1.46)、1.18(95% CI: 1.00~1.39)。吸烟与高血压的RCS曲线呈现近似“J”型，当吸烟指数＞25包/年之后，随着吸烟指数的增加，高血压患病风险呈单调递增的趋势，亚组分析得到一样的结果。均有P_非线性＞0.05，P_整体＜0.001，表明吸烟与高血压存在线性剂量-反应关系。广义线性模型的结果显示，吸烟指数每增加1包/年，高血压的患病风险增加1.004倍。结论中老年人群中，吸烟与高血压存在剂量-反应关系。
- 吸烟 /
- 高血压 /
- 限制性立方样条模型 /
- 中老年人
Abstract: Objective To explore the relationship between smoking and hypertension among middle-aged and elderly residents in Ma'anshan city, Anhui Province, and provide theoretical basis of hypertension prevention and treatment. Methods According to the multi-stage sampling method, 12 132 residents were selected from August to November 2020 in three districts of Ma'anshan city, and participated in questionnaire survey and physical measurement. Binary logistic regression was used to analyze the association between smoking and hypertension, and the dose-response relationship for smoking and hypertension was analyzed using the restricted cubic spline (RCS) model and the generalize linear model. Results There were 11 457 subjects in this study, including 6 067 patients with hypertension(52.95%). Taking non-smokers as the reference, the OR value of the risk of hypertension in former smokers was 1.37(95% CI: 1.20-1.56), 1.25(95% CI: 1.07-1.46) and 1.18(95% CI: 1.00-1.39) in Model 1, Model 2 and Model 3, respectively. The RCS curve of smoking and hypertension presents an approximate "J" shape. When the smoking index was greater than 25 pack-years, the risk of hypertension increased monotonically with the increase of smoking index, and the subgroup analysis showed the same results. P_non-linear was greater than 0.05 and P_total was less than 0.001, indicating a linear dose-response relationship between smoking and hypertension. The results of the generalize linear model showed that for every 1-pack-year increased in the smoking index, the risk of hypertension increased 1.004-fold. Conclusion There is a significant dose-response relationship between smoking and hypertension in middle-aged and elderly people.
- Smoking /
- Hypertension /
- Restricted cubic spline model /
- Middle-aged and elderly people

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图 1 吸烟与高血压的剂量-反应关系

注：A是总人群吸烟与高血压的RCS曲线(调整了性别、年龄、BMI、文化程度、婚姻状况、家庭年收入、高血压家族史、职业、近一年的饮酒频率、是否参加规律性体育锻炼)，吸烟指数取3个节点(7.5包/年、27.0包/年、52.0包/年)；B是男性人群吸烟与高血压的RCS曲线(调整了年龄、BMI、文化程度、家庭年收入、高血压家族史、职业、近一年的饮酒频率、是否参加规律性体育锻炼)，吸烟指数取3个节点(7.7包/年、28.0包/年、54.4包/年)；C是中年人群吸烟与高血压的RCS曲线(调整了性别、BMI、职业、高血压家族史、近一年的饮酒频率)，吸烟指数取3个节点(7.5包/年、26.0包/年、51.0包/年)；D是老年人群吸烟与高血压的RCS曲线(调整了性别、BMI、文化程度、高血压家族史)，吸烟指数取3个节点(7.5包/年、30.0包/年、57.8包/年)。

Figure 1. Dose-response relationship between smoking and hypertension

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表 1 研究对象根据是否患有高血压的基本人口学特征[n(%)]

Table 1. Basic characteristics of study participants with hypertension [n(%)]

变量	高血压组(n=6 067)	非高血压组(n=5 390)	χ²/Z值	P值	变量	高血压组(n=6 067)	非高血压组(n=5 390)	χ²/Z值	P值
性别			8.90	0.003	职业			62.32	＜0.001
男	2 663(43.89)	2 217(41.13)			职员	568(9.36)	743(13.78)
女	3 404(56.11)	3 173(58.87)			离退休人员	3 443(56.75)	2 792(51.80)
年龄(岁)			160.72	< 0.001	其他	945(15.58)	834(15.47)
0~ < 60	2 107(34.73)	2 499(46.36)			高血压家族史			14.01	< 0.001
≥60	3 960(65.27)	2 891(53.64)			是	2 519(41.52)	2 053(38.09)
BMI(kg/m²)			-9.92 ^a	< 0.001	否	3 548(58.48)	3 337(61.91)
< 18.5	118(1.94)	111(2.06)			饮酒频率			-2.88 ^a	0.004
18.5~＜24.0	2 782(45.85)	2 909(53.97)			每天	779(12.84)	544(10.09)
24.0~＜28.0	2 414(39.79)	1 970(36.55)			3~6 d/周	214(3.53)	191(3.54)
≥28.0	753(12.41)	400(7.42)			1~2 d/周	273(4.50)	238(4.42)
文化程度			-6.14 ^a	< 0.001	1~3 d/月	226(3.73)	256(4.75)
未正式上过学	1 025(16.89)	776(14.40)			少于1 d/月	4 575(75.41)	4 161(77.20)
小学	1 398(23.04)	1 102(20.45)			睡眠时间(h)			-0.38 ^a	0.701
初中	2 021(33.31)	1 861(34.53)			< 7	1 088(17.93)	872(16.18)
高中/中专/技校	1 157(19.07)	1 131(20.98)			7~ < 9	3 970(65.44)	3 695(68.55)
大专及以上	466(7.68)	520(9.65)			≥9	1 009(16.63)	823(15.27)
婚姻状况			16.69	< 0.001	参与规律性体育锻炼			6.06	0.014
已婚	5 350(88.18)	4 834(89.68)			是	3 400(56.04)	2 897(53.75)
离异	168(2.77)	175(3.25)			否	2 667(43.96)	2 493(46.25)
丧偶与其他	549(9.05)	381(7.07)			吸烟状况			-3.90 ^a	< 0.001
家庭平均年收入(万元)			-2.61 ^a	0.009	从不吸烟	4 183(68.95)	3 875(71.89)
< 1	152(2.51)	120(2.23)			目前吸烟	1 283(21.15)	1 107(20.54)
1~ < 3	797(13.14)	689(12.78)			曾经吸烟	601(9.91)	408(7.57)
3~ < 10	4 198(69.19)	3 652(67.76)			被动吸烟			-0.47 ^a	0.642
≥10	920(15.16)	929(17.24)			每天	1 699(28.00)	1 533(28.44)
职业			62.32	< 0.001	4~6 d/周	955(15.74)	842(15.62)
工人	446(7.35)	405(7.51)			1~3 d/周	440(7.25)	393(7.29)
农民	665(10.96)	616(11.43)			没有	2 973(49.00)	2 622(48.65)
注：^a为单向有序类型变量，采用Mann-Whitney U检验。

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表 2 吸烟与高血压关系的二元logistic回归分析

Table 2. Binary logistic regression analysis on the relationship between smoking and hypertension

吸烟状况	模型一^a		模型二^b		模型三^c
吸烟状况	OR(95% CI)值	P值	OR(95% CI)值	P值	OR(95% CI)值	P值
从不吸烟	1.00		1.00		1.00
目前吸烟	1.07(0.98~1.18)	0.128	1.10(0.98~1.25)	0.120	1.05(0.93~1.19)	0.446
曾经吸烟	1.37(1.20~1.56)	< 0.001	1.25(1.07~1.46)	0.006	1.18(1.00~1.39)	0.044
0包/年	1.00		1.00		1.00
< 15包/年	1.06(0.92~1.23)	0.419	1.09(0.92~1.28)	0.328	1.06(0.89~1.25)	0.513
15包/年~ < 30包/年	1.10(0.97~1.26)	0.136	1.11(0.95~1.30)	0.173	1.06(0.91~1.25)	0.456
≥30包/年	1.24(1.11~1.38)	< 0.001	1.20(1.04~1.37)	0.011	1.13(0.98~1.30)	0.104
注：^a模型一为单因素分析; ^b模型二调整了性别与年龄; ^c模型三在模型二的基础上调整了BMI、文化程度、职业、婚姻状况、家庭年收入、高血压家族史、近一年的平均饮酒频率、是否参加规律性的体育锻炼。

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表 3 吸烟指数对高血压患病影响的广义线性回归分析

Table 3. Generalize linear regression analysis of the influence of smoking index on hypertension

影响因素	β值	s_x值	P值	OR(95% CI)值	影响因素	β值	s_x值	P值	OR(95% CI)值
吸烟指数	0.004	0.001	0.008	1.00(1.00~1.01)	家庭年收入	0.011	0.032	0.735	1.01(0.95~1.08)
性别	-0.048	0.052	0.350	0.95(0.86~1.05)	职业	0.019	0.014	0.180	1.02(0.99~1.05)
年龄	0.428	0.043	< 0.001	1.53(1.41~1.67)	高血压家族史	0.198	0.040	< 0.001	1.22(1.13~1.32)
BMI	0.258	0.028	< 0.001	1.29(1.23~1.37)	近一年的饮酒频率	-0.026	0.013	0.041	0.97(0.95~0.99)
文化程度	-0.056	0.018	0.002	0.95(0.91~0.98)	是否参与规律性的体育锻炼	0.056	0.039	0.146	1.06(0.98~1.14)
婚姻状况	0.060	0.036	0.094	1.06(0.99~1.14)
注：性别、年龄、BMI、文化程度、婚姻状况、家庭年收入、高血压家族史、职业、近一年的饮酒频率、是否参加规律性体育锻炼均为协变量。

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