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基于多水平模型的四川省心血管疾病主要危险因素及聚集情况

查雨欣,  邓颖,  左明良,  王卓,  张岩,  许巍,  崔建兰,  何予晋,  何君

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文章导航 > 中华疾病控制杂志  > 2022 >  26(3): 331-336
查雨欣, 邓颖, 左明良, 王卓, 张岩, 许巍, 崔建兰, 何予晋, 何君. 基于多水平模型的四川省心血管疾病主要危险因素及聚集情况[J]. 中华疾病控制杂志, 2022, 26(3): 331-336. doi: 10.16462/j.cnki.zhjbkz.2022.03.015
引用本文: 查雨欣, 邓颖, 左明良, 王卓, 张岩, 许巍, 崔建兰, 何予晋, 何君. 基于多水平模型的四川省心血管疾病主要危险因素及聚集情况[J]. 中华疾病控制杂志, 2022, 26(3): 331-336. doi: 10.16462/j.cnki.zhjbkz.2022.03.015
shu
ZHA Yu-xin, DENG Ying, ZUO Ming-liang, WANG Zhuo, ZHANG Yan, XU Wei, CUI Jian-lan, HE Yu-jin, HE Jun. Main risk factors and clustering of cardiovascular diseases in Sichuan Province based on a multi-level model[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2022, 26(3): 331-336. doi: 10.16462/j.cnki.zhjbkz.2022.03.015
Citation: ZHA Yu-xin, DENG Ying, ZUO Ming-liang, WANG Zhuo, ZHANG Yan, XU Wei, CUI Jian-lan, HE Yu-jin, HE Jun. Main risk factors and clustering of cardiovascular diseases in Sichuan Province based on a multi-level model[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2022, 26(3): 331-336. doi: 10.16462/j.cnki.zhjbkz.2022.03.015
shu

基于多水平模型的四川省心血管疾病主要危险因素及聚集情况

doi: 10.16462/j.cnki.zhjbkz.2022.03.015
  • 1.

    610000 成都，四川省疾病预防控制中心慢性非传染性疾病预防控制研究所

  • 2.

    610000 成都，四川省医学科学院，四川省人民医院心血管超声及心功能科

  • 3.

    100000 北京，国家心血管病中心

基金项目: 

中央财政转移支付地方卫生计生服务项目: 心血管病高危人群早期筛查与综合干预项目 2014

详细信息
    通讯作者:

    何君，E-mail: 371134591@qq.com

  • 中图分类号: R181.1;R54

Main risk factors and clustering of cardiovascular diseases in Sichuan Province based on a multi-level model

  • 1.

    Sichuan Center For Disease Control and Prevention, Institute of Chronic Non-communicable Diseases, Chengdu 610000, China

  • 2.

    Department of Cardiovascular Ultrasound and Cardiac Function, Sichuan Provincial People's Hospital, Chengdu 610000, China

  • 3.

    The National Center for Cardiovascular Disease, Beijing 100000, China

Funds: 

Central Financial Transfer Payment local Health and Family Planning Service Project: Early Screening and Comprehensive Intervention Program for High-risk Population of Cardiovascular Disease 2014

More Information

    摘要
  • 摘要:   目的  探讨四川省不同地域居民心血管疾病(cardiovascular disease, CVD)主要危险因素的分布及高危类型聚集情况。  方法  采用多阶段整群抽样的方法，随机抽取四川省10个县(区)，于2015—2019年开展CVD高危人群筛查，共29 300名35~75岁常住居民纳入本次研究。采用多水平Logistic回归分析模型，对四川省不同地域CVD高危类型聚集情况进行分析。  结果  本调查人群中共检出CVD高危人群29 300例，标化检出率为17.64%，其中男性高于女性，农村高于城市，文化程度为高中教育及以上、家庭年收入≥5万元标化检出率较高，高危人群检出率川西地区最高，川南地区最低；标化检出率随年龄增长呈递增趋势。高危人群平均年龄(58.45±12.47)岁，分地域的基本特征、自报疾病史、危险因素情况及健康测量指标均有统计学差异(均有P<0.001)。不同地域对高危类型聚集风险的影响可忽略不计；男性≥2种高危类型聚集程度高于女性(P<0.001)，CVD高危类型聚集个数随年龄增长呈上升趋势；城市(OR=0.770, 95% CI: 0.717~0.828, P<0.001)为2种高危类型聚集程度的保护因素；高中程度及以下(OR=1.125, 95% CI: 1.011~1.252, P=0.030)、家庭年收入<5万元(OR=1.121, 95% CI: 1.008~1.247, P=0.036)为2种高危类型聚集程度的危险因素。  结论  四川省不同地域对高危类型聚集风险的影响可忽略不计，CVD高危类型聚集风险的防控应重点应关注和干预男性、高龄、文化程度高中以下、农村居民和家庭年收入<5万元人群，并针对不同地域的危险因素采取针对性措施，以取得更好的防控效果。
    Abstract:   Objective  To investigate the distribution and aggregation of high risk types of cardiovascular diseases (CVD) in different areas of Sichuan Province.  Methods  A total of 10 counties (districts) in Sichuan Province were randomly selected by multi-stage cluster sampling. A total of 29 300 permanent residents aged 35 to 75 years were included in this study during 2015 to 2019. Multi-level Logistic regression model was used to analyze the aggregation of CVD high-risk types in different regions of Sichuan Province.  Results  A total of 29 300 patients with high-risk of CVD were detected, and the standardized detection rate was 17.64%, among Patients the male was higher than the female, the rural was higher than the urban, high school education or above, and the family annual income ≥ 50 000 was higher. The detection rate of high-risk population was the highest in western Sichuan and the lowest in southern Sichuan. The standard detection rate increased with age. The average age of high-risk group was (58.45±12.47) years old, and there were statistical differences in basic characteristics, self-reported disease history, risk factors and health indicators by region (P<0.001). The influence of different regions on the aggregation risk of high-risk types could be ignored. The aggregation degree of ≥2 high-risk types in males was higher than that in females (P<0.001), and the concentration of high-risk types of CVD increased with age. Living in city (OR=0.770, 95% CI: 0.717-0.828, P<0.001) was the protective factor for the aggregation degree of two high-risk types. High school degree and below (OR=1.125, 95% CI: 1.011-1.252, P=0.030) and annual household income<50 000 (OR=1.121, 95% CI: 1.008-1.247, P=0.036) were the risk factors for aggregation degree of two high-risk types.  Conclusion  The influence of the different regions of Sichuan Province for high-risk type gathering risk negligible. The prevention and control of high-risk types of CVD aggregation risk should focus on the male, high school age, culture level, rural residents, family income,<50 000 people, and for risk factors of different areas in Sichuan Province to take targeted measures, in order to obtain better control effect.
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  • 表  1  四川省CVD高危人群整体、分地域的基本特征与危险因素情况[n (%)]

    Table  1.   Basic characteristics and risk factors of CVD high-risk population in Sichuan Province [n (%)]

    项目 整体
    (n=29 300)    		 川中地区
    (n=9 609)    		 川西地区
    (n=1 458)    		 川南地区
    (n=7 756)    		 川北地区
    (n=10 477)    		 F/χ2值 P值
    人口学与社会经济特征
        女性 17 316(59.10) 5 581(58.08) 816(55.97) 4 791(61.77) 6 128(58.49) 34.561 < 0.001 a
        年龄(岁, x±s) 60.78±9.06 61.03±8.73 55.61±8.60 60.86±9.13 61.22±9.16 171.569 b < 0.001 a
        农民 14 499(49.48) 4 695(48.86) 1 164(79.84) 2 327(30.00) 6 313(60.26) 2 202.683 < 0.001 a
        高中教育及以上 3 762(12.84) 1 357(14.12) 231(15.84) 1 319(17.01) 855(8.16) 351.149 < 0.001 a
        已婚 25 840(88.19) 8 361(87.01) 1 401(96.09) 6 618(85.33) 9 460(90.29) 205.701 < 0.001 a
        家庭年收入≥5万元 3 078(10.51) 1 001(10.42) 791(51.00) 891(11.49) 437(4.17) 3 045.124 < 0.001 a
        社会医疗保险 28 788(98.25) 9 420(98.03) 1 458(100.00) 7 656(98.71) 10 254(97.87) 46.967 < 0.001 a
    自报疾病史
        心肌梗死 751(2.56) 99(1.03) 7(0.48) 250(3.22) 395(3.77) 190.388 < 0.001 a
        卒中史 1 864(6.36) 252(2.62) 250(3.22) 250(3.22) 1 322(12.62) 1 074.231 < 0.001 a
        冠心病 1 006(3.43) 181(1.88) 27(1.85) 302(3.89) 496(4.05) 139.030 < 0.001 a
        糖尿病 2 786(9.51) 822(8.56) 162(11.11) 1 032(13.31) 770(7.35) 201.256 < 0.001 a
    危险因素
        血压≥ 140/90 (mm Hg) 24 837(84.77) 8 571(89.20) 1 114(76.41) 6 455(83.23) 8 697(83.01) 264.330 < 0.001 a
        GLU≥ 7.0 (mmol/L) 9 232(31.51) 2 779(28.92) 319(21.88) 2 738(35.30) 3 396(32.41) 148.149 < 0.001 a
        BMI≥ 24 (kg/m2) 17 659(60.27) 5 897(61.37) 939(64.40) 4 663(60.12) 6 160(58.80) 24.839 < 0.001 a
        TC≥ 5.0 (mmol/L) 12 458(42.52) 3 816(39.71) 676(46.36) 3 725(48.03) 4 241(40.48) 153.910 < 0.001 a
        中心性肥胖 10 807(36.88) 3 859(40.16) 666(45.68) 3 031(39.08) 3 251(31.03) 263.045 < 0.001 a
        吸烟 5 736(19.58) 1 742(18.13) 264(18.11) 1 559(20.10) 2 171(20.72) 24.869 < 0.001 a
        饮酒 3 949(13.48) 1 249(13.00) 122(8.37) 1 191(15.36) 1 387(13.24) 58.518 < 0.001 a
    健康测量指标
        SBP(mm Hg, x±s) 159.94±22.09 162.02±19.95 151.58±22.74 159.03±22.09 159.86±23.51 103.419 b < 0.001 a
        DBP(mm Hg, x±s) 89.03±13.16 90.79.±13.21 90.78±13.58 88.12±12.86 87.84±13.01 108.324 b < 0.001 a
        GLU(mmol/L, x±s) 6.88±2.25 6.77±2.13 6.65±2.44 7.06±2.42 6.89±2.20 39.621 b < 0.001 a
        BMI(kg/m2, x±s) 25.06±3.46 25.19±3.50 25.40±3.41 25.03±3.42 24.92±3.47 14.686 b < 0.001 a
        WC(cm, x±s) 83.51±9.64 84.41±9.53 86.31±9.85 83.98±9.51 81.94±9.58 171.049 b < 0.001 a
        TG(mmol/L, x±s) 1.71±0.41 1.61±0.25 2.24±0.32 1.79±0.34 1.66±0.23 173.414 b < 0.001 a
        TC(mmol/L, x±s) 4.97±1.36 4.87±1.29 4.98±1.29 5.16±1.41 4.86±1.03 72.788 b < 0.001 a
        HDL-C(mmol/L, x±s) 1.47±0.47 1.49±0.47 1.16±0.35 1.45±0.47 1.51±0.46 252.493 b < 0.001 a
        LDL-C(mmol/L, x±s) 2.74±0.54 2.62±0.39 2.98±0.38 2.87±0.23 2.71±0.48 84.283 b < 0.001 a
    注：a P<0.05，b F值。
    下载: 导出CSV

    表  2  四川省CVD高危人群检出率及四种高危类型聚集情况[n (%)]

    Table  2.   The detection rate of high risk population of CVD and the clustering of four high risk types in Sichuan Province [n (%)]

    变量 调查总人数 高危例数 标化后检出率 高危类型聚集 χ2/Z值 P值
    1个 2个 3个 4个
    地域 112.641 < 0.001 a
        川中地区 44 779 9 609 19.51 7 600(79.09) 1 855(19.31) 151(1.57) 3(0.03)
        川西地区 6 007 1 458 23.56 1 237(84.84) 201(13.79) 20(1.37) 0(0.00)
        川南地区 38 410 7 756 16.76 5 868(75.66) 1 729(22.29) 159(2.05) 0(0.00)
        川北地区 49 374 10 477 18.66 7 902(75.42) 2 304(21.99) 267(2.55) 4(0.04)
    地区 86.822 < 0.001 a
        农村 76 337 17 010 18.12 12 817(75.35) 3 850(22.63) 341(2.00) 2(0.02)
        城市 62 233 12 290 17.01 9 790(79.66) 2 239(18.22) 256(2.08) 3(0.02)
    性别 174.596 < 0.001 a
        男 52 487 11 984 20.59 8 780(73.26) 2 913(24.31) 287(2.39) 4(0.04)
        女 86 085 17 316 16.26 13 827(79.85) 3 176(18.34) 310(1.79) 3(0.02)
    年龄(岁) 38.391 < 0.001 a
        35~＜40 3 637 457 12.57 435(95.19) 21(4.60) 1(0.21) 0(0.00)
        40~＜50 25 014 3 478 13.51 3 174(91.26) 278(7.99) 26(0.75) 0(0.00)
        50~＜60 38 530 7 279 19.06 6 321(86.84) 861(11.83) 96(1.32) 1(0.01)
        60~＜70 53 466 12 818 23.80 9 098(70.98) 3 398(26.51) 318(2.48) 4(0.03)
        70~75 17 923 5 268 31.25 3 579(67.94) 1 531(29.06) 156(2.96) 2(0.04)
    文化程度 99.351 < 0.001 a
        高中教育以下 119 468 25 538 17.00 19 466(76.22) 5 529(21.65) 536(2.10) 7(0.03)
        高中教育及以上 19 104 3 762 18.99 3 141(83.49) 560(14.89) 61(1.62) 0(0.00)
    家庭年收入(万元) 44.517 < 0.001 a
        <5 123 572 26 222 17.41 20 086(76.60) 5 583(21.29) 546(2.08) 7(0.03)
        ≥5 15 000 3 078 18.76 2 521(81.90) 506(16.44) 51(1.66) 0(0.00)
    合计 138 572 29 300 17.64 22 607(77.16) 6 089(20.78) 597(2.04) 7(0.02)
    注：a P<0.05。
    下载: 导出CSV

    表  3  空模型的随机效应估计结果

    Table  3.   Results of the random effect estimates for the null model

    参数 估计值 标准误 Z值 P值
    截距方差(σμ02) 0.002 0.001 2.006 0.045
    残差方差(σ2) 0.228 0.002 121.016 < 0.001
    下载: 导出CSV

    表  4  不同血压水平人群相关影响因素的无序多分类Logistic回归分析

    Table  4.   Disordered multiple Logistic regression analysis of related factors in different blood pressure levels

    影响因素 高危类型聚集个数为2个 高危类型聚集个数≥3个
    OR 95% CI P OR 95% CI P
    性别(对照组=女性) 1.437 1.355~1.525 < 0.001 a 1.469 1.247~1.730 < 0.001 a
    地区(对照=农村) 0.770 0.717~0.828 < 0.001 a 1.012 0.717~1.235 0.911
    年龄(对照=70~75岁)
        60~＜70 0.888 0.828~0.955 < 0.001 a 0.820 0.675~0.996 0.046 a
        50~＜60 0.331 0.301~0.363 < 0.001 a 0.364 0.281~0.470 < 0.001 a
        40~＜50 0.209 0.182~0.239 < 0.001 a 0.191 0.125~0.291 < 0.001 a
        35~＜40 0.123 0.097~0.191 < 0.001 a 0.055 0.008~0.393 0.004 a
    文化程度(对照=高中程度及以上) 1.125 1.011~1.252 0.030 a 1.099 0.821~1.471 0.526
    家庭年收入(对照=年收入≥5万元) 1.121 1.008~1.247 0.036 a 1.176 0.870~1.590 0.293
    注：a P<0.05。
    下载: 导出CSV
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  • 收稿日期:  2021-05-25
  • 修回日期:  2021-09-14
  • 网络出版日期:  2022-03-17
  • 刊出日期:  2022-03-10

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