The influence of blood pressure and overweight or obesity on diabetes mellitus among residents aged 40 years and above in Guangdong Province
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摘要:
目的 探讨高血压、超重/肥胖及二者相加交互作用对糖尿病的影响，为预防糖尿病提供依据。 方法 采用多阶段整群随机抽样方法，于2015年9-11月对8 991名居民进行问卷调查、医学体检及采集静脉血。基于复杂抽样构建Logistic回归分析模型及线性回归模型对数据进行统计分析，应用相加模型分析高血压及超重/肥胖对糖尿病患病的交互作用。 结果 Logistic回归分析模型结果显示高血压和超重/肥胖是40岁及以上居民糖尿病的危险因素。相加模型结果显示，高血压和超重/肥胖对糖尿病存在协同作用，OR值为4.45(95% CI: 2.75~7.20)。交互作用对FPG及糖化血红蛋白的影响也大于单独高血压或超重/肥胖人群。 结论 高血压、超重/肥胖是广东省40岁及以上人群糖尿病的独立危险因素，高血压伴有超重/肥胖对糖尿病患病存在相加交互作用。 Abstract:Objective To explore the influence of hypertension, overweight/obesity, and their interaction effects on diabetes, so as to provide reference for preventing the occurrence of diabetes. Methods A multi-stage cluster random sampling method was adopted in this study, and 8 991 residents from September to November 2015, were selected for questionnaire survey, medical examination and venous blood collection. Logistic regression model and linear regression model were constructed based on complex sampling to analyze the data, and the additive model was used to analyze the interaction effect of hypertension and overweight/obesity on the prevalence of diabetes. Results Logistic regression results showed that hypertension and overweight/obesity were risk factors for diabetes in people aged ≥40 years. The results of the additive model showed that hypertension and overweight/obesity had a synergistic effect on diabetes, with the OR value of 4.45 (95% CI: 2.75-7.20). The interaction effect on fasting blood glucose and glycosylated hemoglobin was also greater than that of individuals with hypertension or overweight/obese alone. Conclusions Hypertension and overweight/obesity were independent risk factors for diabetes in people aged 40 years and over in Guangdong Province. Hypertension and overweight/obesity had additive interaction effects on diabetes. -
Key words:
- Hypertension /
- Overweight/obesity /
- Diabetes /
- Interaction
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表 1 2015年广东省≥40岁人群糖尿病组与对照组一般人口学特征[n (%)]
Table 1. The general demographic characteristics of the diabete cases and the control group who aged ≥40 years in Guangdong Province in 2015 [n (%)]
变量 对照组(n=5 923) 糖尿病(n=652) χ2/t值 P值 变量 对照组(n=5 923) 糖尿病(n=652) χ2/t值 P值 性别 0.01 0.975 职业 13.47 0.001 男 2 676(45.18) 295(45.25) 体力劳动 2 565(43.31) 235(36.04) 女 3 247(54.82) 357(54.75) 脑力劳动 453(7.65) 50(7.67) 年龄组(岁) 35.13 < 0.001 退休/失业/学生 2 905(49.05) 367(56.29) 40~ < 55 2 665(44.99) 216(33.13) 糖尿病家族史 86.93 < 0.001 55~ < 65 1 784(30.12) 226(34.66) 否 5 615(94.80) 558(85.58) ≥65 1 474(24.89) 210(32.21) 是 308(5.20) 94(14.42) 城乡 13.09 < 0.001 吸烟 0.10 0.753 城镇 3 001(50.67) 379(58.13) 否 3 825(64.58) 417(63.96) 农村 2 922(49.33) 273(41.87) 是 2 098(35.42) 235(36.04) 文化程度 0.90 0.826 超重/肥胖 40.77 < 0.001 未接受教育 1 037(17.51) 123(18.87) 否 3 531(59.62) 304(46.63) 小学 2 426(40.96) 258(39.57) 是 2 392(40.38) 348(53.37) 中学 2 183(36.86) 240(36.81) 高血压 102.73 < 0.001 大专及以上 277(4.68) 31(4.75) 否 3 164(53.42) 212(32.52) 婚姻状态 3.39 0.183 是 2 759(46.58) 440(67.48) 未婚 62(1.05) 4(0.61) BMI(x±s, kg/m2) 23.41±3.36 24.65±3.67 -8.82 < 0.001 已婚/同居 5 498(92.82) 598(91.72) SBP(x±s, mm Hg) 137.70±22.81 145.90±23.10 -8.73 < 0.001 离婚/丧偶/分居 363(6.13) 50(7.67) DBP (x±s, mm Hg) 79.42±12.56 81.19±12.16 -3.58 < 0.001 FPG (x±s, mmol/L) 5.20±0.66 9.12±3.67 -72.18 < 0.001 HbA1c (x±s, %) 4.89±0.59 6.77±2.06 -52.71 < 0.001 
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表 2 2015年广东省≥40岁人群高血压及超重/肥胖与糖尿病患病状态的Logistic关联性分析
Table 2. Logistic regression analysis of hypertension, overweight/obesity and diabetes status in people aged ≥40 years in Guangdong Province in 2015
变量 调整前 调整后a OR (95% CI)值 P值 OR (95% CI)值 P值 高血压 否 1.00 1.00 是 4.00(2.82~5.68) < 0.001 3.79(2.49~5.76) < 0.001 超重/肥胖 否 1.00 1.00 是 1.44(0.99~2.08) 0.051 1.56(1.06~2.30) 0.023 注：a调整性别、年龄、城乡、职业及糖尿病家族史。
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表 3 2015年广东省≥40岁人群高血压、超重/肥胖交互作用对糖尿病的影响
Table 3. The interactive effects of hypertension and overweight/obesity on diabetes among people aged ≥40 years old in Guangdong Province in 2015
高血压 超重/肥胖 对照组(例) 糖尿病(例) OR (95% CI)值a RERI (95% CI)值b AP (95% CI)值b S (95% CI)值b 否 否 2 082 121 1.00 0.76(0.11~1.40) 0.22(0.05~0.40) 1.47(1.02~2.01) 是 否 1 082 91 3.32(1.92~5.72) 否 是 1 449 183 1.12(1.07~1.93) 是 是 1 310 257 4.45(2.75~7.20) 注：a调整性别、年龄、城乡、职业及糖尿病家族史; b P < 0.05; 交互作用归因比(attributable proportion, AP); 交互作用指数(synergyindex, S)。
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表 4 高血压及超重/肥胖与FPG及HbA1c之间的关系
Table 4. The relationship between hypertension or overweight/obesity and FBG or HbA1c
变量 FPG(mmol/L)a HbA1c(%)a β (95% CI)值 P值 β (95% CI)值 P值 高血压 否 1.00 1.00 是 0.39(0.30~0.48) < 0.001 0.17(0.12~0.23) < 0.001 超重/肥胖 否 1.00 1.00 是 0.35(0.26~0.44) < 0.001 0.23(0.18~0.28) < 0.001 高血压 超重/肥胖 否 否 1.00 1.00 是 否 0.32(0.21~0.43) < 0.001 0.07(0.00~0.13) 0.047 否 是 0.26(0.15~0.37) < 0.001 0.13(0.06~0.19) < 0.001 是 是 0.62(0.51~0.74) < 0.001 0.34(0.27~0.41) 0.003 注：a调整性别、年龄、城乡、职业及糖尿病家族史。
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