Study on the status and correlation factors of multiple chronic conditions among health examination participants aged ≥45 years in a community in Taizhou City
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摘要:
目的 了解台州市≥45岁体检人群常见慢性健康问题及多病共存现状及相关因素。 方法 采用横断面研究，收集2021年1月至12月在台州市椒江区某街道卫生服务中心参加体检的≥45岁人群资料，采用χ2检验、t检验、方差分析了解其常见慢性健康问题及危险因素分布现状，利用有序logistic回归分析模型分析多病共存相关因素。 结果 共纳入13 020名研究对象，慢性健康问题总体检出率为93.07%，包括高血压(58.22%)、脂肪肝(41.31%)、肾功能异常(34.55%)、心电图异常(31.80%)、血脂异常(23.47%)、肝功能异常(20.60%)、糖尿病(13.45%)、贫血(10.43%), 研究对象5种健康危险因素为缺乏锻炼(77.26%)、饮食不均衡(71.27%)、中心性肥胖(55.98%)、吸烟(32.84%)和饮酒(32.28%)。71.87%的研究对象存在多病共存。高血压、脂肪肝、肾功能异常及血脂异常是多病共存主要组分。有序logistic回归分析模型分析结果提示年龄每增长1岁(aOR=1.010, 95% CI: 1.006~1.014, P＜0.001)、女性(aOR=1.396, 95% CI: 1.291~1.510, P＜0.001)、健康危险因素聚集2种(aOR=1.169, 95% CI: 1.054~1.295, P=0.003)、健康危险因素聚集3种(aOR=1.561, 95% CI: 1.409~1.730, P＜0.001)及健康危险因素聚集4种及以上(aOR=1.887, 95% CI: 1.668~2.134, P＜0.001)，均有可能导致多病共存风险增加。 结论 台州市≥45岁体检人群健康危险因素聚集情况普遍，多病共存居于较高水平。高龄、女性及多种健康危险因素可能增加多病共存风险，需要完善相关政策。 Abstract:Objective To investigate the distribution characteristics and risk factors of common chronic health conditions and multiple chronic conditions(MCCs) among the physical examination population aged ≥45 years in Taizhou City. Methods Based on a cross-sectional study, the health records of people aged ≥45 years who participated in routine health examination at a community health service center in a District of Taizhou city from January to December 2021 were collected. Chi-square test, t test and variance analysis were used to analyze the distribution of chronic health conditions and related health risk factors. Ordered logistic regression was used to analyze the co-existing factors of MCCs. Results A total of 13 020 subjects were included in the study. The overall detection rate of chronic health conditions was 93.07%, with the following rates: hypertension (58.22%), fatty liver (41.31%), abnormal renal function (34.55%), abnormal electrocardiogram (31.80%), dyslipidemia (23.47%), abnormal liver function (20.60%), diabetes (13.45%), and anemia (10.43%). The study identified five chronic disease-related risk factors among the subjects, including lack of exercise (77.26%), unbalanced diet (71.27%), central obesity (55.98%), smoking (32.84%) and alcohol consumption (32.28%). 71.87% of the subjects had MCCs, with hypertension, fatty liver, abnormal renal function, and dyslipidemia being the main components. The results of ordered logistic regression indicated that for each year of age increase (aOR=1.010, 95% CI: 1.006-1.014, P < 0.001), females (aOR=1.396, 95% CI: 1.291-1.510, P < 0.001) and the presence of 2 (aOR=1.169, 95% CI: 1.054-1.295, P=0.003), 3 (aOR=1.561, 95% CI: 1.409-1.730, P < 0.001) and 4 or more (aOR=1.887, 95% CI: 1.668-2.134, P < 0.001) health risk factors were associated with an increased risk of MCCs. Conclusions The aggregation of health risk factors is common in the physical examination population aged ≥45 years in Taizhou City, and the prevalence of multiple chronic conditions is notably high. Advanced age, female gender, and the presence of multiple risk health factors may significantly increase the risk of experiencing multiple chronic conditions, necessitating the enhancement of relevant policies. -
Key words:
- Chronic health conditions /
- Multiple chronic conditions /
- Epidemiology
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表 1 台州市≥45岁体检人群社会人口学特征
Table 1. Socio-demographic characteristics of the physical examination population aged ≥45 years in Taizhou City
变量 Variables 合计(占比/%)
Total (proportion/%) (n=13 020)男性人数(占比/%)
Number of male (proportion/%) (n=5 741)女性人数(占比/%)
Number of female (proportion/%) (n=7 279)χ2值
valueP值
value年龄组/岁 Age group/years 121.444 ＜0.001 45~ < 60 2 261(17.37) 809(14.09) 1 452(19.95) 60~ < 75 8 057(61.88) 3 544(61.73) 4 513(62.00) >75 2 702(20.75) 1 388(24.18) 1 314(18.05) 婚姻 Marriage 161.909 ＜0.001 已婚 Married 11 647(89.45) 5 357(93.31) 6 290(86.41) 非已婚 ① Unmarried ① 1 373(10.55) 384(6.69) 989(13.59) 职业 ② Occupation ② 908.704 ＜0.001 无业 Unemployed 3 353(25.75) 743(12.94) 2 610(35.86) 生产业 Production industry 8 766(67.33) 4 458(77.65) 4 308(59.18) 企事业 Enterprises and public institutions 901(6.92) 540(9.41) 361(4.96) 注：①非已婚包括未婚、离异或丧偶。②无业包括待业、失业或退休，生产业包括农、林、牧、渔、水利、运输业，企事业包括国家机关、党群组织等事业单位及商业、服务业等企业办事人员。
Note: ① "Unmarried" refers to individuals who are single, divorced, or widowed. ② "Unemployed" includes those who are jobless, unemployed, or retired. "Production industry" includes individuals engaged in agriculture, forestry, animal husbandry, fisheries, water management, and transportation. "Enterprise and public institutions" includes government agencies, party organizations, public institutions, as well as personnel working in commerce and the service sector.
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表 2 台州市≥45岁体检人群主要健康危险因素分析
Table 2. Analysis of main health risk factors of the physical examination population aged ≥45 years in Taizhou City
变量 Variables 健康危险因素聚集数
Cumulative health risk factor count缺乏锻炼 ①
Lack of physical activity ①饮食不均衡 ①
Unbalanced diet ①中心性肥胖 ①
Central obesity ①吸烟 ①
Smoking ①饮酒 ①
Alcohol consumption ①总计 Total 2.7±1.1 10 059(77.26) 9 279(71.27) 7 289(55.98) 4 276(32.84) 4 203(32.28) 性别 Gender 男 Male 3.3±1.1 4 450(77.51) 3 988(69.47) 2 648(46.12) 4 260(74.20) 3 733(65.02) 女 Female 2.2±0.8 5 609(77.06) 5 291(72.69) 4 641(63.76) 16(0.22) 470(6.46) t/χ2值 value 65.851 0.379 16.285 405.035 7 965.072 5 036.047 P值 value ＜0.001 0.538 ＜0.001 ＜0.001 ＜0.001 ＜0.001 年龄组/岁 Age group/years 45~ < 60 2.6±1.1 1 670(73.86) 1 578(69.79) 1 446(63.95) 582(25.74) 595(26.32) 60~ < 75 2.7±1.1 6 309(78.30) 5 756(71.44) 4 458(55.33) 2 732(33.91) 2 693(33.42) ≥75 2.7±1.1 2 080(76.98) 1 945(71.98) 1 385(51.26) 962(35.60) 915(33.86) F/χ2值 value 12.104 5.522 2.742 77.738 50.671 29.171 P值 value ＜0.001 0.019 0.098 ＜0.001 ＜0.001 ＜0.001 婚姻 Marriage 已婚 Married 2.7±1.1 9 003(77.30) 8 301(71.27) 6 464(55.50) 3 995(34.30) 3 892(33.42) 非已婚 ② Unmarried ② 2.5±1.0 1 056(76.91) 978(71.23) 825(60.09) 281(20.47) 311(22.65) t/χ2值 value 6.095 0.105 0.001 10.492 106.580 65.112 P值 value ＜0.001 0.746 0.975 0.001 ＜0.001 ＜0.001 职业 ③ Occupation ③ 无业 Unemployed 2.5±1.0 2 598(77.48) 2 479(73.93) 2 050(61.14) 525(15.66) 644(19.21) 生产业 Production industry 2.8±1.1 6 790(77.46) 6 198(70.70) 4 704(53.66) 3 339(38.09) 3 163(36.08) 企事业 Enterprises and public institutions 2.9±1.2 671(74.47) 602(66.81) 535(59.38) 412(45.73) 396(43.95) F/χ2值 value 102.518 4.275 21.720 59.558 626.224 376.274 P值 value ＜0.001 0.118 ＜0.001 ＜0.001 ＜0.001 ＜0.001 注：①以人数(占比/%)或x±s表示。②非已婚包括未婚、离异或丧偶。③无业包括待业、失业或退休，生产业包括农、林、牧、渔、水利、运输业，企事业包括国家机关、党群组织等事业单位及商业、服务业等企业办事人员。
Note: ① Number of people(proportion/%) or x±s. ② "Unmarried" refers to individuals who are single, divorced, or widowed. ③ "Unemployed" includes those who are jobless, unemployed, or retired. "Production industry" includes individuals engaged in agriculture, forestry, animal husbandry, fisheries, water management, and transportation. "Enterprise and public institutions" includes government agencies, party organizations, public institutions, as well as personnel working in commerce and the service sector.
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表 3 台州市≥45岁体检人群常见慢性健康问题检出率比较
Table 3. Comparison of detection rates of common chronic health conditions among the physical examination population aged ≥45 years in Taizhou City
变量 Variables 高血压 ①
Hypertension ①脂肪肝 ①
Fatty liver ①肾功能异常 ①
Renal dysfunction ①心电图异常 ①
Abnormal electrocardiogram ①血脂异常 ①
Dyslipidemia ①总计 Total 7 580(58.22) 5 378(41.31) 4 498(34.55) 4 141(31.80) 3 056(23.47) 性别 Gender 男 Male 3 262(56.82) 2 007(34.96) 1 822(31.74) 2 069(36.04) 1 134(19.75) 女 Female 4 318(59.32) 3 371(46.31) 2 676(36.76) 2 072(28.47) 1 922(26.40) χ2值 value 8.260 170.610 35.865 84.879 79.067 P值 value 0.004 ＜0.001 ＜0.001 ＜0.001 ＜0.001 年龄组/岁 Age group/years 45~ < 60 1 351(59.75) 1 245(55.06) 611(27.02) 490(21.67) 677(29.94) 60~ < 75 4 537(56.31) 3 343(41.49) 2 735(33.95) 2 473(30.69) 1 852(22.99) ≥75 1 692(62.62) 790(29.24) 1 152(42.64) 1 178(43.60) 527(19.50) χ2值 value 5.898 338.392 134.991 279.533 72.202 P值 value 0.015 ＜0.001 ＜0.001 ＜0.001 ＜0.001 婚姻 Marriage 已婚 Married 6 717(57.67) 4 849(41.63) 3 945(33.87) 3 696(31.73) 2 769(23.77) 非已婚 ② Unmarried ② 863(62.86) 529(38.53) 553(40.28) 445(32.41) 287(20.90) χ2值 value 13.567 4.882 22.286 0.260 5.637 P值 value ＜0.001 0.027 ＜0.001 0.610 0.018 职业 ③ Occupation ③ 无业 Unemployed 1 950(58.16) 1 539(45.90) 1 175(35.04) 954(28.45) 859(25.62) 生产业 Production industry 5 084(58.00) 3 434(39.17) 3 059(34.90) 2 912(33.22) 1 986(22.66) 企事业 Enterprises and public institutions 546(60.60) 405(44.95) 264(29.30) 275(30.52) 211(23.42) χ2值value 2.282 50.547 11.805 26.147 11.857 P值 value 0.320 ＜0.001 0.003 ＜0.001 0.003 变量 Variables 肝功能异常 ①
Liver dysfunction ①糖尿病 ①
Diabetes ①贫血 ①
Anemia ①多病共存 ①
Multiple chronic conditions ①总计 Total 2 682(20.60) 1 751(13.45) 1 358(10.43) 9 358(71.87) 性别 Gender 男 Male 1 398(24.35) 702(12.23) 797(13.88) 4 052(70.58) 女 Female 1 284(17.64) 1 049(14.41) 561(7.71) 5 306(72.89) χ2值 value 88.389 13.146 131.021 8.506 P值 value ＜0.001 ＜0.001 ＜0.001 0.004 年龄组/岁 Age group/years 45~ < 60 541(23.93) 420(18.58) 132(5.84) 1 655(73.20) 60~ < 75 1 632(20.26) 1 011(12.55) 645(8.01) 5 620(69.75) ≥75 509(18.84) 320(11.84) 581(21.50) 2 083(77.09) χ2值 value 18.645 44.061 351.316 12.325 P值 value ＜0.001 ＜0.001 ＜0.001 ＜0.001 婚姻 Marriage 已婚 Married 2 423(20.80) 1 546(13.27) 1 164(9.99) 8 329(71.51) 非已婚 ② Unmarried ② 259(18.86) 205(14.93) 194(14.13) 1 029(74.95) χ2值 value 2.826 2.897 22.486 7.162 P值 value 0.093 0.089 ＜0.001 0.007 职业 ③ Occupation ③ 无业 Unemployed 668(19.92) 470(14.02) 311(9.28) 2 442(72.83) 生产业 Production industry 1 814(20.69) 1 141(13.02) 969(11.05) 6 269(71.51) 企事业 Enterprises and public institutions 200(22.20) 140(15.54) 78(8.66) 647(71.81) χ2值 value 2.394 5.720 11.472 2.078 P值 value 0.302 0.057 0.003 0.354 注：①以人数(占比/%)或x±s表示。②非已婚包括未婚、离异或丧偶。③无业包括待业、失业或退休，生产业包括农、林、牧、渔、水利、运输业，企事业包括国家机关、党群组织等事业单位及商业、服务业等企业办事人员。
Note: ① Number of people(proportion/%) or x±s. ② "Unmarried" refers to individuals who are single, divorced, or widowed. ③ "Unemployed" includes those who are jobless, unemployed, or retired. "Production industry" includes individuals engaged in agriculture, forestry, animal husbandry, fisheries, water management, and transportation. “Enterprise and public institutions” includes government agencies, party organizations, public institutions, as well as personnel working in commerce and the service sector.
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表 4 台州市≥45岁体检人群多病共存情况的多因素分析
Table 4. Multivariate analysis of multiple chronic conditions in the physical examination population aged ≥45 years in Taizhou City
变量 Variables 慢性健康问题数量(占比/%) ① Number of chronic health conditions(proportion/%) ① ≤1(n=3 662) 2(n=3 783) 3(n=3 088) ≥4(n=2 487) 年龄/岁 Age/years，(x±s) 67.0±8.2 67.7±8.6 68.2±8.8 67.9±9.1 性别 Gender 男 Male 1 689(29.42) 1 672(29.12) 1 330(23.17) 1 050(18.29) 女 Female 1 973(27.11) 2 111(29.00) 1 758(24.15) 1 437(19.74) 婚姻 Marriage 已婚 Married 3 318(28.49) 3 389(29.10) 2 727(23.41) 2 213(19.00) 非已婚 Unmarried 344(25.05) 394(28.70) 361(26.29) 274(19.96) 职业 Occupation 无业 Unemployed 911(27.17) 973(29.02) 813(24.25) 656(19.56) 生产业 Production industry 2 497(28.49) 2 540(28.98) 2 082(23.75) 1 647(18.79) 企事业 Enterprises and public institutions 254(28.19) 270(29.97) 193(21.42) 184(20.42) 健康危险因素聚集数 Cumulative health risk factor count ≤1 564(33.65) 493(29.42) 370(22.08) 249(14.86) 2 1 214(30.49) 1 167(29.31) 915(22.98) 686(17.23) 3 1 156(25.60) 1 310(29.01) 1 095(24.25) 954(21.13) ≥4 728(25.57) 813(28.56) 708(24.87) 598(21.00) 变量 Variables 单因素分析 Univariate analysis 多因素分析 Multivariate analysis cOR值value(95% CI)② P值value aOR值value (95% CI) ③ P值value 年龄/岁 Age/years, (x±s) 1.009(1.005~1.012) ＜0.001 1.010(1.006~1.014) ＜0.001 性别 Gender 男 Male 1.000 1.000 女 Female 1.110(1.043~1.181) 0.001 1.396(1.291~1.510) ＜0.001 婚姻 Marriage 已婚 Married 1.000 1.000 非已婚 Unmarried 1.150(1.040~1.271) 0.006 1.062(0.957~1.188) 0.256 职业 Occupation 无业 Unemployed 1.000 1.000 生产业 Production industry 0.945(0.880~1.015) 0.122 0.973(0.904~1.047) 0.465 企事业 Enterprises and public institutions 0.961(0.842~1.096) 0.549 1.037(0.906~1.188) 0.595 健康危险因素聚集数 Cumulative health risk factor count ≤1 1.000 1.000 2 1.159(1.046~1.284) 0.005 1.169(1.054~1.295) 0.003 3 1.461(1.321~1.617) ＜0.001 1.561(1.409~1.730) ＜0.001 ≥4 1.472(1.320~1.641) ＜0.001 1.887(1.668~2.134) ＜0.001 注：①慢性健康问题检出数量(0=慢性健康问题检出≤1种，1=慢性健康问题检出2种，2=慢性健康问题检出3种，3=慢性健康问题检出≥4种)是有序logisitic回归模型的结局变量。②将单个变量分别纳入回归模型进行分析，计算cOR值。③将所有变量纳入模型进行分析，得到调整混杂因素后的aOR值。
Note: ① The number of detected chronic health conditions (0 = ≤1 chronic health condition detected, 1 = 2 chronic health conditions detected, 2 = 3 chronic health conditions detected, 3 = ≥4 chronic health conditions detected) serves as the outcome variable in an ordered logistic regression model; ② Individual variables were separately entered into the regression model for analysis, and crude odds ratios (cOR) were calculated; ③ All variables were included in the model for analysis, yielding adjusted odds ratios (aOR) after controlling for confounding factors.
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