Effect of community public health comprehensive intervention on blood pressure control among people at different risk of cardiovascular disease in Anhui Province
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摘要:
目的 分析不同心血管疾病(cardiovascular disease, CVD)患病风险人群社区公共卫生综合干预血压控制效果。 方法 收集2016—2020年安徽省社区公共卫生综合干预资料(包括基线、3个月、12个月随访数据)，采用《中国心血管疾病风险评估和管理指南》推荐的10年CVD风险评估模型将研究对象分为心血管疾病高危和非高危人群，比较高危和非高危人群社区公共卫生综合干预血压控制效果。 结果 共随访3 755名研究对象，CVD高危人群645人，标化检出率10.9%。随访12个月与基线相比，高危人群SBP和DBP分别下降了16.47 mm Hg(95% CI：-18.09~-14.86)、2.66 mm Hg(95% CI：-3.63~-1.69)，非高危人群SBP和DBP分别下降了10.43 mm Hg(95% CI：-11.16~-9.70)、2.41 mm Hg(95% CI：-2.81~-2.01)；3个月与基线相比，高危人群SBP和DBP分别下降了12.27 mm Hg(95% CI：-13.88~-10.65)、3.66 mm Hg(95% CI：-4.54~-2.77)，非高危人群SBP和DBP分别下降了6.05 mm Hg(95% CI：-6.80~-5.30)、2.61 mm Hg(95% CI：-3.00~-2.23)。高危人群随访3个月后SBP下降水平、随访12个月后SBP和DBP下降水平明显高于非高危组(t=-5.100，t=-5.873，t=-2.729，均有P＜0.05)。 结论 社区公共卫生综合干预对CVD高危人群血压改善优于非高危人群。因此，未来的公共卫生工作应进一步关注非高危人群。 Abstract:Objective To analyze the effect of comprehensive community public health intervention on blood pressure control among people with different cardiovascular disease (CVD) risks. Methods Comprehensive intervention data of community public health in Anhui Province were collected from 2016 to 2020 (including baseline, 3-month, and 12-month follow-up data). The 10-year cardiovascular disease risk assessment model recommended by China's CVD risk assessment and management guidelines was utilized to divide subjects into high-risk and low-risk CVD. The effects of the comprehensive community public health intervention on blood pressure control between the groups were compared. Results A total of 3 755 subjects were followed up, 645 patients with a high risk of CVD were detected, and the standardized detection rate was 10.9%. At the 12-month follow-up compared to baseline, SBP and DBP decreased by 16.47 mm Hg (95% CI: -18.09--14.86) and 2.66 mm Hg (95% CI: -3.63--1.69) for the high-risk group, and by 10.43 mm Hg (95% CI: -11.16--9.70) and 2.41 mm Hg (95% CI: -2.81--2.01) respectively for the low-risk group. In addition, at the 3-month follow-up compared to baseline, SBP and DBP decreased by 12.27 mm Hg (95% CI: -13.88--10.65) and 3.66 mm Hg (95% CI: -4.54--2.77) for high-risk CVD group, and by 6.05 mm Hg (95% CI: -6.80--5.30) and 2.61 mm Hg (95% CI: -3.00--2.23) respectively for the low-risk group. At the same time, the decrease in SBP for the high-risk CVD group after 3 months of follow-up and for both types of blood pressure after 12 months of follow-up were significantly more significant than those of the low-risk group (t=-5.100, t=-5.873, t=-2.729; all P < 0.05). Conclusions The comprehensive community public health intervention was effective at improving the blood pressure in both CVD risk groups but more effective for the high-risk group. Therefore, paying more attention to low-risk CVD populations is vital in designing future public health interventions. -
Key words:
- Cardiovascular disease /
- Hypertension /
- Influencing factors /
- Comprehensive intervention
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图 1 CVD高危人群与非高危人群血压控制效果比较
注：sbp1：基线后12个月SBP－基线SBP；sbp2：基线后3个月SBP－基线SBP；dbp1：基线后12个月DBP－基线DBP；dbp2：基线后3个月DBP－基线DBP。
Figure 1. Comparison of blood pressure control effect between CVD high-risk group and non-high-risk group
表 1 10年CVD不同风险人群基线特征[n(%)]
Table 1. Baseline characteristics of different CVD risk groups in 10 years [n(%)]
组别 非高危人群(n=3 110) 高危人群(n=645) 合计(N=3 755) χ2值 P值 性别 359.896 ＜0.001 女 2 080(66.88) 172(26.67) 2 252(59.97) 男 1 030(33.12) 473(73.33) 1 503(40.03) 城乡 0.002 0.965 农村 1 946(62.57) 403(62.48) 2 349(62.56) 城市 1 164(37.47) 242(37.52) 1 406(37.44) 职业 68.494 ＜0.001 其他 1 331(42.80) 163(25.27) 1 494(39.79) 农民 1 779(57.20) 482(74.73) 2 261(60.21) 婚姻状况 0.530 0.467 未婚 373(11.99) 84(13.02) 457(12.17) 已婚 2 737(88.01) 561(86.98) 3 298(87.83) 地区 58.838 ＜0.001 南方 1 361(43.76) 177(27.44) 1 538(40.96) 北方 1 749(56.24) 468(72.56) 2 217(59.04) 饮酒情况 79.215 ＜0.001 否 2 608(83.86) 444(68.84) 3 052(81.28) 是 502(16.14) 201(31.16) 703(18.72) 吸烟情况 167.110 ＜0.001 否 2 629(84.53) 403(62.48) 3 032(80.75) 是 481(15.47) 242(37.52) 723(19.25) 年龄分组(岁) -14.339 a ＜0.001 35~ < 50 567(18.23) 27(4.19) 594(15.82) 50~ < 65 1 457(46.85) 205(31.78) 1 662(44.26) 65~75 1 086(34.92) 413(64.03) 1 499(39.92) BMI(kg/m2) -3.136 a 0.002 < 18.5 46(1.48) 13(2.02) 59(1.57) 18.5~ < 24.0 1 126(36.21) 266(41.24) 1 392(37.07) 24.0~ < 28.0 1 329(42.73) 270(41.86) 1 599(42.58) ≥28.0 609(19.58) 96(14.88) 705(18.77) 文化程度 -5.137 a ＜0.001 小学及以下 2 128(68.42) 504(78.14) 2 632(70.09) 初中 649(20.87) 104(16.12) 753(20.05) 高中 217(6.98) 29(4.50) 246(6.55) 大学及以上 116(3.73) 8(1.24) 124(3.30) 家庭年收入(元) -3.250 a 0.001 < 10 000 686(22.06) 179(27.75) 865(23.04) 10 000~ < 50 000 1 907(61.32) 378(58.60) 2 285(60.85) >50 000 517(16.62) 88(13.64) 605(16.11) 注：a使用Mann-Whitney U检验。 
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表 2 10年CVD不同风险人群血压各阶段差值的均数及95% CI
Table 2. Mean values and 95% CI of blood pressure differences at different stages in populations at different risk of CVD in 10 years
变量 高危人群(n=645) 非高危人群(n=3 110) x值 95% CI x值 95% CI sbp1 -16.47 -18.09~-14.86 -10.43 -11.16~-9.70 sbp2 -12.27 -13.88~-10.65 -6.05 -6.80~-5.30 dbp1 -2.66 -3.63~-1.69 -2.41 -2.81~-2.01 dbp2 -3.66 -4.54~-2.77 -2.61 -3.00~-2.23 注：sbp1：基线后12个月SBP－基线SBP；sbp2：基线后3个月SBP－基线SBP；dbp1：基线后12个月DBP－基线DBP；dbp2：基线后3个月DBP－基线DBP。
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表 3 血压控制效果影响因素的单因素分析结果[M(P25，P75)]
Table 3. Results of univariate analysis of influencing factors of blood pressure control effect [M(P25, P75)]
组别 sbp1 Z/H值 P值 sbp2 Z/H值 P值 dbp1 Z/H值 P值 dbp2 Z/H值 P值 性别 -1.883 0.060 -0.435 0.664 -3.019 0.003 -1.534 0.125 女 -11.0
(-12.0, -9.5)-5.5
(-6.5, -4.5)-2.0
(-2.5, -1.0)-2.0
(-2.0, -1.0)男 -9.5
(-10.5, -7.5)-6.0
(-7.5, -4.0)-3.0
(-3.5, -2.0)-2.5
(-3.0, -1.5)城乡 -1.927 0.054 -5.042 < 0.001 -7.105 < 0.001 -9.892 < 0.001 农村 -11.0
(-12.0, -9.5)-4.5
(-5.5, -3.0)-3.0
(-3.0, -2.5)-1.0
(-1.0, -0.5)城市 -9.5
(-10.5, -7.5)-8.5
(-9.5, -7.0)-0.5
(-1.0, 1.0)-4.5
(-5.0, -3.5)职业 -3.762 < 0.001 -1.744 0.081 -6.326 < 0.001 -4.134 < 0.001 其他 -8.0
(-9.5, -6.5)-4.5
(-5.5, -3.0)-3.5
(-4.0, -2.5)-3.0
(-3.5, -2.0)农民 -12.0
(-13.0, -10.5)-6.5
(-7.5, -5.0)-1.5
(-2.0, -0.5)-2.0
(-2.5, -1.5)婚姻状况 -0.484 0.629 -1.848 0.065 -2.369 0.018 -1.060 0.289 未婚 -11.0
(-14.0, -8.5)-7.5
(-10.0, -4.5)-1.5
(-2.5, -0.5)-2.0
(-3.0, -0.5)已婚 -10.5
(-11.0, -9.0)-5.5
(-6.0, -4.5)-2.5
(-2.5, -2.0)-2.5
(-2.5, -2.0)地区 -5.608 < 0.001 -1.805 0.071 -7.299 < 0.001 -3.797 < 0.001 南方 -8.0
(-9.0, -6.5)-5.0
(-6.5, -3.5)-3.5
(-4.0, -2.5)-3.0
(-3.5, -2.0)北方 -12.5
(-13.5, -11.0)-6.0
(-7.0, -5.0)-1.5
(-1.5, -0.5)-2.0
(-2.5, -1.5)饮酒情况 否 -10.0
(-10.5, -8.5)-0.499 0.618 -5.5
(-6.5, -4.5)-0.530 0.596 -2.0
(-2.0，-1.5)-3.375 0.001 -2.5
(-2.5, -2.0)-1.501 0.133 是 -11.5
(-13.0, -9.0)-7.5
(-9.0, -5.0)-3.5
(-4.0，-2.5)-2.5
(-3.0, -1.5)吸烟情况 -2.198 0.028 -1.553 0.120 -0.828 0.408 -0.378 0.705 否 -10.5
(-11.0, -9.0)-6.0
(-6.5, -5.0)-2.0
(-2.0，-1.0)-2.5
(-2.5, -2.0)是 -9.5
(-11.0, -7.0)-5.0
(-6.5, -3.5)-2.5
(-3.0, -1.5)-2.0
(-3.0, -1.0)年龄分组(岁) 62.356 < 0.001 38.666 < 0.001 9.234 0.010 4.183 0.124 35~ < 50 -4.8
(-6.5, -3.0)-1.5
(-3.0, 0.0)-2.5
(-3.0, -1.0)-1.0
(-1.5, 0.0)50~ < 65 -9.5
(-10.5, -8.0)-4.5
(-5.5, -3.5)-2.5
(-3.0, -1.5)-3.0
(-3.5, -2.0)65~75 -14.0
(-15.0, -12.5)-9.0
(-10.5, -7.5)-2.0
(-2.5, -1.0)-2.0
(-2.0, -1.0)BMI(kg/m2) 3.991 0.262 1.977 0.577 0.464 0.927 11.185 0.011 < 18.5 -13.0
(-20.5, -4.0)-4.0
(-11.0, 0.5)-2.0
(-6.5, 2.0)0.0
(-1.0, 4.0)18.5~ < 24.0 -9.0
(-10.5, -7.5)-5.5
(-6.5, -4.0)-2.3
(-3.0, -1.5)-2.0
(-2.5, -1.0)24.0~ < 28.0 -10.5
(-12.0, -8.5)-5.5
(-6.5, -4.5)-2.5
(-3.0, -1.5)-3.0
(-3.5, -2.0)≥28.0 -12.0
(-13.5, -10.0)-7.0
(-8.5, -5.0)-2.5
(-3.0, -1.5)-3.0
(-3.5, -1.5)文化程度 23.930 < 0.001 16.532 0.001 25.949 < 0.001 1.452 0.693 小学及以下 -12.0
(-13.0, -10.5)-6.5
(-7.0, -5.0)-2.0
(-2.5, -1.0)-2.5
(-3.0, -2.0)初中 -8.0
(-9.5, -6.5)-3.5
(-5.0, -1.5)-4.0
(-4.5, -2.5)-2.0
(-2.5, -1.0)高中 -6.0
(-7.0, -3.5)-3.5
(-6.0, -1.0)-2.0
(-3.0, 0.0)-2.0
(-3.5, -0.5)大学及以上 -7.5
(-11.0, -2.5)-7.0
(-9.0, -2.5)-4.0
(-6.0, -2.5)-3.0
(-4.5, -0.5)家庭年收入(元) 23.101 < 0.001 0.478 0.787 30.393 < 0.001 8.561 0.014 ＜10 000 -14.0
(-15.5, -11.5)-6.0
(-7.5, -4.5)-2.0
(-2.5, -1.0)-1.5
(-2.0, -0.5)10 000~ < 50 000 -9.5
(-10.5, -8.0)-6.0
(-7.0, -4.5)-1.5
(-2.0, -0.5)-3.0
(-3.5, -2.0)＞50 000 -9.5
(-11.0, -6.5)-5.0
(-6.5, -3.0)-4.5
(-5.5, -3.5)-2.0
(-2.5, -1.0)注：sbp1：基线后12个月SBP－基线SBP；sbp2：基线后3个月SBP－基线SBP；dbp1：基线后12个月DBP－基线DBP；dbp2：基线后3个月DBP－基线DBP。
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表 4 血压控制效果影响因素的多因素分析结果
Table 4. Results of multivariate analysis of influencing factors of blood pressure control effect
因变量 自变量 偏回归系数 标准误差 偏回归系数(标准化) t值 P值 sbp1 常量 -0.334 2.889 -0.116 0.908 地区 -4.075 0.736 -0.096 -5.538 ＜0.001 吸烟 1.712 0.867 0.032 1.976 0.048 年龄(岁) -3.324 0.519 -0.112 -6.411 ＜0.001 sbp2 常量 2.246 1.804 1.245 0.213 城乡 -3.506 0.720 -0.079 -4.871 ＜0.001 年龄(岁) -2.179 0.522 -0.072 -4.176 ＜0.001 dbp1 常量 -14.813 2.413 -6.140 ＜0.001 城乡 4.111 0.398 0.172 10.339 ＜0.001 职业 2.193 0.451 0.093 4.860 ＜0.001 地区 3.035 0.403 0.129 7.535 ＜0.001 性别 0.904 0.439 0.038 2.060 0.039 家庭年收入(元) -0.927 0.334 -0.050 -2.774 0.006 dbp2 常量 1.627 1.356 1.200 0.230 城乡 -3.142 0.382 -0.137 -8.218 ＜0.001 地区 0.846 0.390 0.038 2.168 0.030 BMI(kg/m2) -0.637 0.239 -0.044 -2.671 0.008 注：sbp1：基线后12个月SBP－基线SBP；sbp2：基线后3个月SBP－基线SBP；dbp1：基线后12个月DBP－基线DBP；dbp2：基线后3个月DBP－基线DBP。
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