中国中老年人白内障手术发生率及影响因素的前瞻性队列研究

金鑫; 梁晨; 郭帅; 郑晓瑛

doi:10.16462/j.cnki.zhjbkz.2024.03.009

中国中老年人白内障手术发生率及影响因素的前瞻性队列研究

doi: 10.16462/j.cnki.zhjbkz.2024.03.009

金鑫^{1, 4},
梁晨²,
郭帅^{3, 4},
郑晓瑛^{3, 4, ,}

1.
北京大学人口研究所，北京 100871
2.
北京大学医院眼科，北京 100871
3.
中国医学科学院/北京协和医学院群医学及公共卫生学院，北京 100730
4.
北京大学亚太经合组织健康科学研究院，北京 100871

基金项目:

国家社会科学基金重大项目 21ZD107

国家科技重大专项 SQ2022YFC3600291

详细信息

通讯作者:
郑晓瑛，E-mail：zhengxiaoying@sph.pumc.edu.cn

中图分类号: R181.2
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- 被引次数: 0
出版历程
- 收稿日期: 2023-05-19
- 修回日期: 2024-01-09
- 网络出版日期: 2024-04-08
- 刊出日期: 2024-03-10

Cataract surgery incidence and influencing factors in middle-aged and elderly Chinese: a prospective cohort study

JIN Xin^{1, 4},
LIANG chen²,
GUO Shuai^{3, 4},
ZHENG Xiaoying^{3, 4
, ,}

1.
Institute of Population Research, Peking University, Beijing 100871, China
2.
Department of Ophthalmology, Peking University Hospital, Beijing 100871, China
3.
School of Population and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
4.
Peking University Asia Pacific Economic Cooperation Health Sciences Academy, Peking University, Beijing 100871, China

Funds:

Major Project of the National Social Science Fund of China 21ZD107

The National Key Research and Development Program SQ2022YFC3600291

More Information

Corresponding author: ZHENG Xiaoying, E-mail: zhengxiaoying@sph.pumc.edu.cn

摘要

摘要: 目的探讨我国中老年人(≥45岁)白内障手术发生率及影响因素。方法采用前瞻性队列研究设计，利用2011―2018年中国健康与养老追踪调查数据，跟踪12 522名中老年人队列白内障手术发生状况，采用logistic回归分析模型分析白内障手术发生率及其影响因素。结果共计12 522名中老年人参加2011―2018年的连续4轮随访，7年期间白内障手术发生率为2.89%，其中≥60岁老年人7年期间白内障手术发生率为5.34%，呈上升趋势。Logistic回归分析模型显示，年龄较大、女性、远视力或近视力较差、患有糖尿病、教育程度较低、家庭人均周支出较低均与白内障手术发生的增加显著关联(OR=1.072，95% CI: 1.071~1.074，P < 0.001；OR=1.141，95% CI: 1.108~1.176，P=0.030；OR=1.587，95% CI: 1.531~1.646，P < 0.001；OR=1.445，95% CI: 1.394~1.499，P < 0.001；OR=1.474，95% CI: 1.417~1.533，P < 0.001；OR=0.867，95% CI: 0.840~0.895，P=0.002；OR=0.982，95% CI: 0.966~0.997，P=0.019)，对风险人群如≥60岁和远视力状况较差的老年人分析中有相似的结果，但社会经济因素已不再是白内障手术发生的主要影响因素。结论个体的人口特征和慢性病患病情况明显影响白内障手术发生率，相关部门推广的眼保健项目有助于减少社会经济因素对接受白内障手术的影响提高老年人白内障手术可及性综合考虑健康状况和眼健康服务对白内障手术促进计划至关重要。
- 中老年人 /
- 白内障手术发生率 /
- 影响因 /
- 队列研究
Abstract: Objective The study aimed to explore the pattern of cataract surgery incidence and influencing factors among middle-aged and older people in China. Methods The study adopted a prospective cohort design. It was based on the tracking studies data of cataract surgery incidence in a cohort of 12 522 middle-aged and older people from the China Health and Retirement Longitudinal Study 2011-2018, and analysed the influencing factors of cataract surgery incidence using logistic regression. Results The 12 522 middle-aged and elderly Chinese population participated in four consecutive rounds of survey from 2011 to 2018, and the 7-year incidence of cataract surgery was 2.89%. The 7-year incidence of cataract surgery in the elderly population aged 60 years and older was 5.34%, which showed an increasing trend along with older age. Logistic regression results showed that the following factors were significantly associated with the increase of the incidence of cataract surgery: older age, being female, having poorer distant or near vision, having diabetes, having a lower level of education, and having a lower per capita weekly expenditure per household (OR=1.072, 95% CI: 1.071-1.074, P < 0.001; OR=1.141, 95% CI: 1.108-1.176, P=0.030; OR=1.587, 95% CI: 1.531-1.646, P < 0.001; OR=1.445, 95% CI: 1.394-1.499, P < 0.001; OR=1.474, 95% CI: 1.417-1.533, P < 0.001; OR=0.867, 95% CI: 0.840-0.895, P=0.002; OR=0.982, 95% CI: 0.966-0.997, P=0.019). A similar result was found in the analyses on the risk groups such as the population aged 60 years and older and the elderly with poor distant vision. However, socioeconomic factors were no longer the main influence on the occurrence of cataract surgery. Conclusions Individual demographic characteristics and the prevalence of chronic conditions significantly influence the incidence of cataract surgery. Health promotion programs aimed at eye care, advocated by relevant authorities, are instrumental in mitigating the impact of socio-economic factors on the accessibility of cataract surgery for the elderly. A holistic approach that considers both health status and eye health services is crucial for the effective implementation of programs designed to enhance the uptake of cataract surgery.
- Middle-aged and elderly /
- Cataract surgery incidence /
- Influencing factor /
- Cohort study

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图 1 样本筛选流程图

Figure 1. Flow chart of sample screening

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表 1 队列研究对象基本特征

Table 1. Characteristics of the study cohort

变量名称Variable	白内障手术 ^① Cataract surgery ^①		t/χ²值value	P值value
变量名称Variable	是Yes(n=363)	否No(n=12 159)	t/χ²值value	P值value
年龄/岁Age /years	64.72±8.53	57.51±8.60	-15.752	< 0.001
远视力状况Distance vision status			45.421	< 0.001
一般/不好Poor or fair	283(77.96)	7 350(60.45)
极好/很好/好Excellent, very good and good	80(22.04)	4 809(39.55)
近视力状况Near vision status			25.823	< 0.001
一般/不好Poor or fair	287(79.06)	8 062(66.30)
极好/很好/好Excellent, very good and good	76(20.94)	4 097(33.70)
高血压Hypertension			5.711	< 0.001
有Yes	182(50.14)	5 328(43.82)
无No	181(49.86)	6 831(56.18)
糖尿病Diabetes			8.252	< 0.001
有Yes	55(15.15)	1 270(10.44)
无No	308(84.85)	10 889(89.56)
性别Gender			4.737	0.030
男性Male	153(42.15)	5 829(47.94)
女性Female	210(57.85)	6 330(52.06)
文化状况Literacy			35.532	< 0.001
非文盲Literate	218(60.06)	9 003(74.04)
文盲Illiterate	145(39.94)	3 156(25.96)
抑郁得分Depression score	9.14±6.30	8.27±6.28	-2.524	0.012
户口类型Hukou			1.184	0.553
农业户口Rural	302(83.20)	9 845(80.98)
其他户口类型Non-rural	61(16.80)	2 312(19.02)
家庭人均周支出的对数Log household per capita expenditure	4.57±0.97	4.70±0.87	2.352	0.019
医疗保险Health insurance			0.983	0.912
仅有公立保险Public insurance	334(93.04)	11 035(91.97)
仅有私立保险Private insurance	2(0.56)	89(0.74)
既有公立保险又有私立保险Both public and private insurance	4(1.11)	195(1.62)
既没有公立保险又没有私立保险Neither public nor private Insurance	19(5.29)	680(5.67)
地区特征Geographical location			0.701	0.704
东部地区Eastern region	132(36.36)	4 165(34.25)
中部地区Central region	117(32.23)	4 029(33.14)
西部地区Western region	114(31.41)	3 965(32.61)
婚姻状态Marital status			3.709	0.054
已婚与同居Married and cohabiting	296(81.54)	10 906(89.69)
其他Not married	67(18.46)	1 253(10.31)
注：①以人数(占比/%)或x±s表示。 Note: ① Number of people (proportion/%) or x±s.

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表 2 2011―2018年中国中老年人(≥45岁)白内障手术发生影响因素logistic回归分析

Table 2. Logistic regression analysis of factors influencing the occurrence of cataract surgery among middle-aged and elderly people(≥45 years) in China, 2011-2018

基线特征Baseline characteristic	单变量模型Univariate model			多变量模型Multivariate model
基线特征Baseline characteristic	β值value	OR值value (95% CI)	P值value	β值value	OR值value (95% CI)	P值value
年龄/岁Age/years	0.082	1.086(1.074~1.098)	<0.001	0.070	1.072(1.071~1.074)	<0.001
远视力状况Distance vision status			<0.001			<0.001
一般/不好Poor or fair		1.000			1.000
极好/很好/好Excellent, very good and good	0.839	2.315(1.801~2.974)		0.462	1.587(1.531~1.646)
近视力状况Near vision status			<0.001			<0.001
一般/不好Poor or fair		1.000			1.000
极好/很好/好Excellent, very good and good	0.652	1.919(1.486~2.478)		0.368	1.445(1.394~1.499)
性别Gender			0.030			0.030
男性Male		1.000			1.000
女性Female	0.234	1.264(1.023~1.561)		0.132	1.141(1.108~1.176)
高血压Hypertension			<0.001			0.010
否No		1.000			1.000
是Yes	0.235	1.264(1.231~1.297)		-0.037	0.937(0.937~0.991)
糖尿病Diabetes			<0.001			<0.001
否No		1.000			1.000
是Yes	0.396	1.486(1.432~1.542)		0.388	1.474(1.417~1.533)
文化状况Literacy			<0.001			0.002
文盲Illiterate		1.000			1.000
非文盲Literate	-0.640	0.527(0.426~0.653)		-0.143	0.867(0.840~0.895)
抑郁量表平均得分Mean depression score	0.020	1.020(1.018~1.022)	<0.001	-0.001	0.999(0.997~1.002)	0.858
平均家庭人均支出对数Log household per capita expenditure	-0.206	0.814(0.723~0.916)	<0.001	-0.019	0.982(0.966~0.997)	0.019
注：高血压、是否患糖尿病和抑郁量表平均得分均根据年龄结构进行了调整。 Note: Hypertension, diabetes status, and the average depression score were adjusted for age structure.

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表 3 2011―2018年中国老年人(≥60岁且基线自报远视力一般/差)白内障手术发生影响因素logistic回归分析

Table 3. Logistic regression analysis of factors influencing the occurrence of cataract surgery in elderly (≥60 years and baseline self-reported fair/poor distance vision) in China, 2011-2018

基线特征Baseline characteristic	单变量模型Univariate model			多变量模型Multivariate model
基线特征Baseline characteristic	β值value	OR值value(95% CI)	P值value	β值value	OR值value(95% CI)	P值value
年龄/岁 Age/years	0.058	1.058(1.036~1.082)	<0.001	0.054	1.056(1.053~1.059)	<0.001
近视力状况Near vision status			0.350
一般/不好Poor or fair		1.000
极好/很好/好Excellent, very good and good	0.190	1.210(0.881~1.904)
性别Gender			0.055			<0.001
男性Male		1.000			1.000
女性Female	0.286	1.331(0.994~1.783)		0.236	1.266(1.218~1.315)
高血压Hypertension			<0.001			<0.001
否No		1.000			1.000
是Yes	0.083	1.087(1.050~1.125)		0.219	1.245(1.202~1.290)
糖尿病Diabetes			<0.001			<0.001
否No		1.000			1.000
是Yes	0.346	1.414(1.347~1.484)		0.452	1.571(1.496~1.651)
文化状况Literacy			0.013			<0.001
文盲Illiterate		1.000			1.000
非文盲Literate	-0.365	0.694(0.520~0.926)		-0.125	0.883(0.849~0.918)
抑郁量表平均得分Mean depression score	0.001	1.000(0.998~1.004)	0.474
平均家庭人均支出对数Log household per capita expenditure	-0.022	0.978(0.832~1.150)	0.790
注：高血压、是否患糖尿病和抑郁量表平均得分均根据年龄结构进行了调整。 Note: Hypertension, diabetes status, and the average depression score were adjusted for age structure.

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