An epidemiological features and risk factors study of osteoporosis among residents aged 40 and over in four counties of Hunan, 2018
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摘要:
目的 了解湖南省2018年4个县区≥40岁人群中骨质疏松症及骨量低下的检出率与分布特征及骨质疏松症患病危险因素，为防控以及相应卫生资源配置提供数据支持。 方法 采用多阶段分层随机抽样方法进行抽样，对研究对象进行问卷调查并对骨密度、身高、体重和腰围进行测量。采用率、构成比、均数等指标进行统计描述，率的比较采用Rao-Scott χ2检验。采用SAS 9.4软件的多因素Survey logistic回归分析模型进行危险因素分析。 结果 共调查≥40岁人群1 597人，其中男性704人(44.08%)，女性893人(55.92%)。骨质疏松症患病率为15.37%(95% CI：12.08~18.65)，女性(26.95%)高于男性(4.55%)(Rao-Scott χ2 =54.34，P < 0.001)。患病率随年龄增长而增加(Rao-Scott χ2 =131.00，P < 0.001)。骨量低下检出率为53.33%(95% CI：49.61~57.04, P < 0.001)，男、女性骨量低下检出率分别为54.28%和52.01%，性别差异无统计学意义(Rao-Scott χ2 =0.63，P=0.420)。多因素Survey logistic回归分析模型分析提示，与男性患骨质疏松相关的因素有BMI < 18.5 kg/m2(OR=6.52，95% CI：1.51~28.12, P=0.010)，与女性患骨质疏松相关的因素有在45岁前停经(OR=2.47，95% CI：1.53~3.90, P < 0.001)、骨折病史(OR=2.76，95% CI：1.62~4.65，P < 0.001)、BMI < 18.5 kg/m2 (OR=17.67，95% CI：2.54~122.87，P=0.004)、≥60岁(OR=11.35，95% CI：3.62~35.56，P < 0.001)。 结论 湖南省≥40岁人群中骨质疏松症患病水平较高，女性患病风险高于男性。潜在发病的骨量低下人群较大，男女性并重。 Abstract:Objective This research focuses on understanding the epidemiology, prevalence, and associated risks of osteoporosis and low bone mass among individuals aged 40 and over in four counties of Hunan Province. It aims to bolster the efforts in bone health management and osteoporosis prevention in the region. Methods A multi-stage stratified random sampling was conducted for this epidemiological study, encompassing questionnaire survey, bone mass measurement and physical measurement such as body weight and height measurements. Rate, constituent ratio and mean were used for statistical despcrition of the data. Rao-Scott χ2 test was conducted for rate comparisons, and Survey logistic regression model was used for risk factors analysis. All the statistic procedures mentioned above were conducted by SAS 9.4 software. Results A total of 1 597 subjects were finally investigated, including 704 males (44.08%) and 893 females (55.92%). The overall prevalence of osteoporosis in the cohort was 15.37% (95% CI: 12.08-18.65), increasing with age (Rao-Scott χ2 =131.00, P < 0.001)and higher in females than males (26.95%∶4.55%, Rao-Scott χ2 =54.34, P < 0.001). Low bone mass was prevalent in 53.33% of the population (95% CI: 49.61-57.04, P < 0.001), while low bone mass was 54.28% prevalent in the studied males and 52.01% in females, and no statistically significant gender differences was found (Rao-Scott χ2 =0.63, P=0.420). Risk factors for osteoporosis in males included a BMI < 18.5 kg/m2 (OR=6.52, 95% CI: 1.51-28.12, P=0.010). While in females, they risk factors included menopause before 45 (OR=2.47, 95% CI: 1.53-3.90, P < 0.001), history of fracture (OR=2.76, 95% CI: 1.62-4.65, P < 0.001), BMI < 18.5 kg/m2 (OR=17.67, 95% CI: 2.54-122.87, P=0.004), and being aged ≥60 years (OR=11.35, 95% CI: 3.62-35.56, P < 0.001). Conclusions Osteoporosis prevalence is notably high in Hunan Province, particularly among females. The study underscores the significant potential risk for osteoporosis in both genders. -
Key words:
- Osteoporosis /
- Low bone mass /
- Prevalence /
- Epidemiology
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表 1 Survey logistic回归分析变量赋值
Table 1. Definition of study factors in Survey logistic analysis
变量Variable 赋值Assignment OP患病情况Diagnosed with OP or not 0=否，1=是0=No，1=Yes 有骨折史Had history of bone fracture 1=否，2=是1=No，2=Yes 40岁后身高降低≥3 cm Height loss ≥3 cm after 40 years old 1=否，2=是1=No，2=Yes 过去1年补充钙剂Had calcium supplement or not during the past year 1=否，2=是1=No，2=Yes 过去1年饮用咖啡Drank coffee or not during the past year 1=否，2=是1=No，2=Yes 现在或曾经有吸烟史Smoke now or used to smoke 1=否，2=是1=No，2=Yes 每天户外暴露时长＞45 min Had outdoor activity＞45 min per day 1=否，2=是1=No，2=Yes 每周至少1次进行中高强度体育锻炼活动≥10 min Had ≥10 minutes of mid-high intensity of physical exercise at least once a week 1=否，2=是1=No，2=Yes 男性：有过阳痿或者缺乏性欲情况Males: Diagnosed with erectile dysfunction or lack of libido 1=否，2=是1=No，2=Yes 女性：在45岁前停经Females: Had menopause before 45 years old 1=否，2=是1=No，2=Yes 患有慢性病等变量Diagnosed with non-communicable diseases or not 1=否，2=是1=No，2=Yes BMI < 18.5 /(kg·m-2) 1=否，2=是1=No，2=Yes 年龄组/岁Age group/years 1=40~ < 50，2=50~ < 60，3=≥60 注：OP, 骨质疏松症；高等强度活动指活动要求付出的体力很大或者能够引起呼吸或心率显著增加的活动；中等强度活动指活动要求付出的体力中等或者引起呼吸或心率轻度增加的活动; 慢性病指的非传染性的慢性疾病，如高血压、糖尿病等。
Note: OP, osteoporosis; High-intensity activity is refers activity requires a lot of physical effort or can cause a significant increase in breathing or heart rate; Moderate-intensity activity refers to an activity that requires moderate physical strength or causes a slight increase in breathing or heart rate; Chronic diseases refers to non-communicable chronic diseases, such as hypertension, diabetes, etc.
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表 2 湖南省2018年4个县区不同特征的≥40岁人群OP患病比较
Table 2. Comparisons among OP in population ≥40 with different features in four counties, Hunan, 2018
特征Feature 调查人数Number of subjects 患病人数Number of patients 患病率-加权后/% Weighted prevalence/% Rao-Scott χ2值value P值value 性别Gender 54.34 < 0.001 男Male 704 20 4.55 女Female 893 200 26.95 年龄组/岁Age group/years 131.00 < 0.001 40~＜50 521 13 3.93 50~＜60 490 49 11.53 ≥60 584 158 33.36 地区Region 2.18 0.130 城区Urban 800 109 12.83 农村Rural 797 111 17.20 骨折史Had history of bone fracture 26.45 < 0.001 是Yes 229 52 29.03 否No 1 360 166 13.01 过去1年补充钙剂Got calcium supplement or not during the past year 6.40 0.010 是Yes 418 70 4.83 否No 1 177 150 10.64 患慢性病Diagnosed with non-communicable diseases or not 16.85 < 0.001 是Yes 553 102 7.42 否No 1 015 114 7.94 40岁后身高降低≥3 cm Height loss ≥3 cm after 40 years old 4.80 0.030 是Yes 348 72 4.25 否No 1247 148 11.12 过去1年饮用咖啡Drank coffee or not during the past year 10.70 0.001 是Yes 160 15 11.73 否No 1 434 205 14.83 吸烟史Smoke now or used to smoke 22.82 < 0.001 是Yes 569 26 2.54 否No 1 026 194 12.83 每天户外暴露时间≥45 min Had outdoor activity ≥45 min per day 0.08 0.770 是Yes 1 054 208 14.65 否No 91 12 0.72 每周至少进行1次中高强度体育锻炼活动≥10 min Had ≥10 min of mid-high intensity of physical exercise at least once a week 1.48 0.220 是Yes 384 45 4.73 否No 1 211 175 10.64 男性：有过阳痿或者缺乏性欲情况Male: diagnosed with erectile dysfunction or lack of libido 5.35 0.020 是Yes 140 7 2.59 否No 562 13 1.96 女性：在45岁前停经Female: had menopause before 45 years old 8.45 0.003 是Yes 129 60 16.03 否No 439 117 24.58 BMI < 18.5 /(kg·m-2) 14.81 < 0.001 是Yes 1 557 206 13.84 否No 38 14 1.52 注：OP, 骨质疏松症。
各分组合计数如低于调查总数1 597(男性低于704，女性低于893)，则有缺失情况。
Note: OP, osteoporosis.
There were some missing values when the total numbers were < 1 597(males < 704, females < 893) in different groups.
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表 3 湖南省2018年4个县区不同特征的≥40岁人群OP患病比较
Table 3. Comparisons among OP in population ≥40 with different features in four counties, Hunan, 2018
变量及分组Variables and group 年龄组/岁Age group/years [%, (95% CI)] 合计Total [%, (95% CI)] Rao-Scott χ2值value P值value 40~＜50 50~＜60 ≥60 OP患病率Prevalence rate of OP 性别Gender 男Male 1.92(0.00~4.24) 3.13(0.46~5.80) 9.01(0.00~19.10) 4.55(0.97~8.13) 8.65 0.010 女Female 6.02(0.67~11.39) 20.45(14.04~26.87) 60.42(51.39~69.43) 26.95(21.78~32.11) 1 514.29 < 0.001 Rao-Scott χ2值value 5.29 95.31 56.51 54.34 P值value 0.020 < 0.001 < 0.001 < 0.001 地区Region 城市Urban 2.45(0.00~5.23) 11.25(6.07~16.44) 29.69(18.73~40.59) 12.82(8.62~17.03) 41.88 < 0.001 农村Rural 5.12(0.39~9.85) 11.72(6.78~16.68) 35.66(24.47~46.85) 17.20(12.44~21.96) 89.23 < 0.001 Rao-Scott χ2值value 2.06 0.01 0.80 2.19 P值value 0.150 0.970 0.370 0.140 合计Total 3.93(1.02~6.84) 11.53(7.93~15.12) 33.36(25.35~41.37) 15.37(12.08~18.65) 131.00 < 0.001 骨量低下检出率Prevalence rate of low bone mess 性别Gender 男Male 45.76(37.50~54.01) 49.55(41.02~58.08) 69.94(61.84~78.04) 54.28(48.96~59.60) 21.29 < 0.001 女Female 31.24(24.49~38.00) 68.65(61.53~75.77) 88.64(82.74~94.53) 52.00(47.14~56.87) 445.53 < 0.001 Rao-Scott χ2值value 13.91 22.1 43.35 0.63 P值value < 0.001 < 0.001 < 0.001 0.420 骨量低下检出率Prevalence rate of low bone mess 城乡Urban rural 城市Urban 37.35(30.11~44.61) 51.65(42.22~61.08) 66.97(58.86~75.05) 48.29(43.23~53.25) 18.45 < 0.001 农村Rural 40.02(32.10~47.94) 62.37(55.17~69.57) 80.86(73.89~87.85) 57.16(51.95~62.37) 445.53 < 0.001 Rao-Scott χ2值value 0.27 2.90 8.50 8.19 P值value 0.600 0.090 0.010 0.004 合计Total 38.81(33.39~44.24) 57.88(52.03~63.71) 75.20(69.54~80.86) 53.33(49.61~57.04) 80.15 < 0.001 注：OP, 骨质疏松症。
Note: OP, osteoporosis.
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表 4 不同性别的多因素与骨质疏松症的Survey logistic回归分析
Table 4. Survey logistic analysis of multiple factors and osteoporosis in different genders
因素Factors β值value sx Wald χ2值value OR值value (95% CI) P值value 男性Male BMI < 18.5 /(kg·m-2) 1.87 0.75 6.33 6.52(1.51~28.12) 0.010 女性Female 在45岁前停经Had menopause before 45 years old 0.90 0.25 13.62 2.47(1.53~3.90) < 0.001 骨折病史History of bone fracture 1.02 0.27 14.65 2.76(1.62~4.65) < 0.001 BMI < 18.5 /(kg·m-2) 3.02 1.00 8.42 17.67(2.54~122.87) 0.004 ≥60岁∶40~＜60岁≥60 years old∶40~＜60 years old 2.42 0.58 17.40 11.35(3.62~35.56) < 0.001
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