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中国老年人不同严重程度跌倒风险与慢性病和睡眠的关联研究

林进龙 魏玥 陈功 裴丽君

林进龙, 魏玥, 陈功, 裴丽君. 中国老年人不同严重程度跌倒风险与慢性病和睡眠的关联研究[J]. 中华疾病控制杂志, 2021, 25(1): 25-31. doi: 10.16462/j.cnki.zhjbkz.2021.01.006
引用本文: 林进龙, 魏玥, 陈功, 裴丽君. 中国老年人不同严重程度跌倒风险与慢性病和睡眠的关联研究[J]. 中华疾病控制杂志, 2021, 25(1): 25-31. doi: 10.16462/j.cnki.zhjbkz.2021.01.006
LIN Jin-long, WEI Yue, CHEN Gong, PEI Li-jun. Chronic diseases and sleep duration in association with falls of different severity among the Chinese elderly[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2021, 25(1): 25-31. doi: 10.16462/j.cnki.zhjbkz.2021.01.006
Citation: LIN Jin-long, WEI Yue, CHEN Gong, PEI Li-jun. Chronic diseases and sleep duration in association with falls of different severity among the Chinese elderly[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2021, 25(1): 25-31. doi: 10.16462/j.cnki.zhjbkz.2021.01.006

中国老年人不同严重程度跌倒风险与慢性病和睡眠的关联研究

doi: 10.16462/j.cnki.zhjbkz.2021.01.006
基金项目: 

国家自然科学基金 41871360

国家重点研发计划 2018YFC2000603

详细信息
    通讯作者:

    裴丽君,E-mail: peilj@pku.edu.cn

  • 中图分类号: R181

Chronic diseases and sleep duration in association with falls of different severity among the Chinese elderly

Funds: 

National Natural Science Fund 41871360

National Key Research and Development Project 2018YFC2000603

More Information
  • 摘要:   目的  探索老年人慢性疾病和睡眠状况与不同严重程度跌倒风险之间的关联,为老年人跌倒所致伤害的预防和干预提供线索。  方法  采用病例对照研究发生风险,以“中国健康与养老追踪调查项目”数据为基础,利用2011-2015年抽样调查数据,运用多因素Logistic回归分析模型分析慢性疾病和睡眠的暴露与中国老年人普通跌倒和跌倒就医发生风险的关联。  结果  11 912例老年人两年内普通跌倒报告率和跌倒就医报告率分别为7.82%和17.09%;多因素Logistic回归分析模型结果显示,听力退化、身体疼痛、有抑郁症状、肾脏病、关节炎和日常生活自理能力(activities of daily living, ADL)受损与老年人普通跌倒和跌倒就医发生风险存在关联(均有P < 0.05);患高血糖与普通跌倒发生风险存在关联(OR=1.43, 95% CI: 1.13~1.81, P=0.002),患脑卒中与跌倒就医发生风险存在关联(OR=1.34, 95% CI: 1.03~1.75, P=0.031);睡眠时长5~ h和≥7 h与老年人两类跌倒发生风险存在负关联(均有P < 0.05)。  结论  老年人退行性疾病及慢性疾病可能是跌倒发生的共同危险因素,充足的睡眠可能是两类跌倒的共同保护因素,应当针对高危老年人群体和暴露因素开展跌倒的预防和干预。
  • 表  1  老年人两年内跌倒伤害报告率[n(%)]

    Table  1.   The report rate of fall among elderly people in two years [n(%)]

    特征 调查(例) 普通跌倒(例) 跌倒就医(例) 普通跌倒报告率
    (95% CI)值
    跌倒就医报告率
    (95% CI)值
    跌倒报告率
    (95% CI)值
    总人群 11 912 932 2 036 7.82(7.34~8.31) 17.09(16.42~17.77) 24.92(24.14~25.69)
    性别a
      男 5 922(49.73) 411(44.10) 772(37.92) 6.94(6.29~7.59) 13.04(12.18~13.89) 19.98(18.96~20.99)
      女 5 987(50.27) 521(55.90) 1 264(62.08) 8.70(7.99~9.42) 20.08(18.15~22.17) 29.81(28.66~30.97)
    年龄(岁)
      60~ 8 312(69.78) 624(66.95) 1 202(59.04) 7.51(6.94~8.08) 14.46(13.71~15.22) 21.97(21.08~22.87)
      70~ 2 778(23.32) 243(26.07) 606(29.76) 8.75(7.70~9.80) 21.82(13.71~15.22) 30.56(28.85~32.27)
      ≥80 822(6.90) 65(26.14) 228(11.20) 7.91(6.06~9.75) 27.74(24.68~30.80) 35.64(32.37~38.92)
    注:a性别:性别变量剔除3例缺失值信息; 表格显示的跌倒伤害报告率为2011、2013和2015年三次调查数据的计算结果; 性别、年龄在普通跌倒和跌倒就医病例与对照之间差异均有统计意义(均有P < 0.05)。
    下载: 导出CSV

    表  2  老年人不同严重程度跌倒的病例对照暴露因素[n(%)]

    Table  2.   Exposure factors for falls of different severity in the elderly between case and control [n(%)]

    特征 对照组(n=8 018) 普通跌倒(n=803) 跌倒就医(n=1 782)
    例数 χ2 P 例数 χ2 P
    年龄(岁) 8.289 0.016 104.355 < 0.001
      60~ 5 894(73.51) 554(68.99) 1 101(61.78)
      70~ 1 704(21.25) 205(25.53) 519(29.12)
      ≥80 420(5.24) 44(5.48) 162(9.09)
    性别 23.359 < 0.001 133.132 < 0.001
      男 4 271(53.27) 356(44.33) 680(38.16)
      女 3 747(46.73) 447(55.67) 1 102(61.84)
    教育程度 0.004 66.660 < 0.001
      文盲 2 618(32.65) 309(38.48) 11.250 715(40.12)
      小学 3 444(42.95) 318(39.60) 778(43.66)
      初中及以上 1 956(24.40) 176(21.92) 289(16.22)
    吸烟 5.174 0.075 68.952 < 0.001
      从未吸烟 4 455(55.56) 475(59.15) 1 154(64.76)
      过去吸烟 1 270(15.84) 106(13.20) 285(15.99)
      现在吸烟 2 293(28.60) 222(27.65) 343(19.25)
    饮酒 0.568 0.451 9.574 0.002
      不饮酒 5 407(67.44) 531(66.13) 1 269(71.21)
      饮酒 2 611(32.56) 272(33.87) 513(28.79)
    睡眠时长(h) 52.717 < 0.001 128.598 < 0.001
       < 5 1 479(18.45) 230(28.64) 536(30.08)
      5~ 2 812(35.07) 273(34.00) 592(33.22)
      ≥7 3 727(46.48) 300(37.36) 654(36.70)
    午休时长(min) 1.820 0.402 25.894 < 0.001
      无午休 3 537(44.11) 350(43.59) 894(50.17)
       < 30 1 227(15.30) 111(13.82) 212(11.90)
      ≥30 3 254(40.58) 342(42.59) 676(37.93)
    听力 58.561 < 0.001 84.352 < 0.001
      好 3 203(39.95) 210(26.15) 504(28.28)
      不好 4 815(60.05) 593(73.85) 1 278(71.72)
    近视力 19.673 < 0.001 33.575 < 0.001
      好 2 621(32.69) 201(25.03) 457(25.65)
      不好 5 397(67.31) 602(74.97) 1 325(74.35)
    远视力 36.483 < 0.001 82.255 < 0.001
      好 2 709(33.79) 187(23.29) 405(22.73)
      不好 5 309(66.21) 616(76.71) 1 377(77.27)
    身体疼痛 69.664 < 0.001 148.691 < 0.001
      无 6 257(78.04) 522(65.01) 1 146(64.31)
      有 1 761(21.96) 281(34.99) 636(35.69)
    抑郁症状 65.493 < 0.001 214.770 < 0.001
      无 5 509(68.71) 439(54.67) 899(50.45)
      有 2 509(31.29) 364(45.33) 883(49.55)
    高血糖 17.200 < 0.001 11.159 < 0.001
      无 7 396(92.24) 707(88.04) 1 601(89.84)
      有 662(7.76) 96(11.96) 181(10.16)
    脑卒中 4.674 0.031 25.772 < 0.001
      无 7 796(97.23) 770(95.89) 1 691(94.89)
      有 222(2.77) 33(4.11) 91(5.11)
    肾脏病 18.633 < 0.001 45.937 < 0.001
      无 7 556(94.24) 726(90.41) 1 601(89.84)
      有 462(5.76) 77(9.59) 181(10.16)
    关节炎 62.288 < 0.001 154.156 < 0.001
      无 5 384(67.15) 428(53.30) 919(51.57)
      有 2 634(32.85) 375(46.70) 863(48.43)
    ADL 99.927 < 0.001 324.843 < 0.001
      自理 7 082(88.33) 610(75.97) 1 276(71.60)
      失能 936(11.67) 193(24.03) 506(28.40)
    下载: 导出CSV

    表  3  老年人不同严重程度跌倒的暴露因素多因素分析

    Table  3.   Multivariate analysis of exposure factors for falls of different severity in the elderly

    特征 普通跌倒a 跌倒就医b
    OR(95% CI)值 Wald χ2 P OR(95% CI)值 Wald χ2 P
    睡眠时长(h)
      <5 1.00 1.00
      5~ 0.79(0.65~0.97) 5.378 0.020 0.83(0.72~0.96) 6.194 0.012
      ≥7 0.71(0.58~0.86) 12.184 < 0.001 0.74(0.64~0.85) 16.898 < 0.001
    午休时长(min)
      无午休 - - - 1.00
       < 30 - - - 0.67(0.57~0.80) 19.621 < 0.001
      ≥30 - - - 0.92(0.82~1.03) 1.963 0.161
    听力
      好 1.00 1.00
      不好 1.52(1.27~1.82) 21.047 < 0.001 1.28(1.13~1.45) 14.700 < 0.001
    近视力
      好 1.00 1.00
      不好 1.03(0.85~1.24) 0.074 0.785 0.97(0.85~1.11) 0.160 0.688
    远视力
      好 1.00 1.00
      不好 1.14(0.94~1.39) 1.674 0.196 1.17(1.01~1.35) 4.696 0.030
    身体疼痛
      无 1.00 1.00
      有 1.26(1.06~1.50) 6.822 0.009 1.21(1.07~1.37) 8.808 0.003
    抑郁症状
      无 1.00 1.00
      有 1.23(1.05~1.45) 6.330 0.011 1.41(1.26~1.60) 33.052 < 0.001
    高血糖
      无 1.00 1.00
      有 1.43(1.13~1.81) 8.855 0.002 1.18(0.99~1.43) 3.281 0.070
    脑卒中
      无 1.00 1.00
      有 1.09(0.74~1.61) 0.203 0.652 1.34(1.03~1.75) 4.624 0.031
    肾脏病
      无 1.00 1.00
      有 1.33(1.02~1.74) 4.558 0.032 1.50(1.24~1.82) 16.920 < 0.001
    关节炎
      无 1.00 1.00
      有 1.39(1.19~1.63) 17.309 < 0.001 1.42(1.27~1.59) 36.956 < 0.001
    ADL
      自理 1.00 1.00
      失能 1.63(1.34~1.99) 23.653 < 0.001 1.88(1.63~2.16) 77.094 < 0.001
    注:a普通跌倒:普通跌倒的多因素Logistic回归分析模型:调整了年龄、性别、教育程度。其中,午休时长变量在单因素检验中差异无统计学意义且尚无明确证据表明午休对普通跌倒存在重要影响,故不纳入模型; b跌倒就医跌倒就医的多因素Logistic回归分析模型:调整了年龄、性别、教育程度、吸烟、饮酒。
    下载: 导出CSV
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  • 收稿日期:  2020-06-16
  • 修回日期:  2020-10-19
  • 刊出日期:  2021-01-10

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