云南省农村老年人糖尿病患病现状和基于结构方程模型的影响因素

李潇; 申静蓉; 刘颖楠; 崔文龙; 左春梅; 何莲菊; 蔡乐

doi:10.16462/j.cnki.zhjbkz.2023.05.009

云南省农村老年人糖尿病患病现状和基于结构方程模型的影响因素

doi: 10.16462/j.cnki.zhjbkz.2023.05.009

李潇^{1, 2},
申静蓉²,
刘颖楠²,
崔文龙²,
左春梅²,
何莲菊²,
蔡乐^2, ,

1.
671000 大理，大理大学第一附属医院肾内科
2.
650500 昆明，昆明医科大学公共卫生学院

基金项目:

国家自然科学基金 71663035

云南省创新团队培育计划 202005AE160002

云南省高校科技创新团队支持计划 (2018)134

详细信息

通讯作者:
蔡乐，E-mail: caile002@hotmail.com

中图分类号: R181
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- 被引次数: 0
出版历程
- 收稿日期: 2022-01-05
- 修回日期: 2022-10-11
- 刊出日期: 2023-05-10

Analysis of diabetes prevalence and related factors among older adults in rural Yunnan Province: a structure equation modelling approach

1.
Department of Nephrology, First Affiliated Hospital of Dali University, Dali 671000, China
2.
School of Public Health, Kunming Medical University, Kunming 650500, China

Funds:

National Natural Science Fund of China 71663035

Program for Innovation Team Cultivation Plan in University of Yunnan Province 202005AE160002

Program for Innovative Research Team in University of Yunnan Province (2018)134

More Information

Corresponding author: CAI Le，E-mail: caile002@hotmail.com

摘要

摘要: 目的采用结构方程模型(structural equation model, SEM)分析云南省农村老年人糖尿病患病的现状及其影响因素。方法在云南农村地区抽取4 833名≥60岁的老年人，采用多阶段分层随机抽样的方法进行问卷调查和体格检查，糖尿病老年人患病的影响因素采用SEM进行分析。结果云南农村老年人糖尿病患病率为10.2%，其中男性为203人，占9.2%，女性为291人，占11.0%。SEM的分析结果显示，体型(包括肥胖和中心性肥胖)和缺乏体力活动对糖尿病患病起到直接和间接作用，其路径系数分别为0.134和0.041；高血压和糖尿病家族史对糖尿病患病起到直接作用，其路径系数分别为0.054和0.097；性别、吸烟、居住模式和社会经济地位(socioeconomic status, SES)对糖尿病患病起到间接作用，其路径系数分别为0.045、0.005、-0.007和-0.049。结论体型、缺乏体力活动、高血压、糖尿病家族史和吸烟是糖尿病患病的主要影响因素。加强糖尿病的健康教育对SES低的老年人的糖尿病的预防与控制有效。
- 农村 /
- 糖尿病 /
- 老年人 /
- 结构方程模型
Abstract: Objective This study aims to analyze the prevalence of diabetes and its associated influencing factors among older adults in rural Yunnan Province. Methods A stratified randomized method was used to select 4 833 older adults aged ≥60 years in rural Yunnan Province. Each participant underwent a questionnaire survey and health examination. The associated influencing factors were analyzed using structural equation modelling (SEM). Results The prevalence of diabetes among older adults in rural Yunnan Province was 10.2%. The results of SEM indicated that body fat distribution (obesity and central obesity) and physical inactivity had both direct and indirect effect on diabetes, with the path coefficients of 0.134 and 0.041, respectively. Hypertension and family history of diabetes had direct effect on diabetes, with path coefficient of 0.054 and 0.097, respectively. Gender, smoking, residential pattern and socioeconomic status (SES) had only indirect effect on diabetes, with path coefficients of 0.045, 0.005, -0.007 and -0.049, respectively. Conclusions The main factors influencing diabetes prevalence include body fat distribution, physical inactivity, hypertension, family history of diabetes, and smoking. Promoting healthy lifestyle education among older adults with low SEP is beneficial for diabetes prevention and control.
- Rural area /
- Diabetes /
- Older adults /
- Structural equation model

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图 1 基础SEM：假设SES和人口学特征影响糖尿病患病

Figure 1. The basic SEM: hypothesis that SES and demographic characteristics affect the prevalence of diabetes

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图 2 最终模型D：SES和人口学特征等影响糖尿病患病

Figure 2. Final model D: SES and demographic characteristics affect the prevalence of diabetes

下载: 全尺寸图片幻灯片

表 1 不同特征人群的糖尿病患病情况

Table 1. The prevalence of diabetes in different characteristic populations

特征	[n(%)]	95% CI	$\chi$²值	P值	特征	[n(%)]	95% CI	$\chi$²值	P值
性别			4.269	0.039	医疗服务可及性			9.125	0.003
男	203(9.2)	7.9~10.5			好	362(9.5)	8.6~10.5
女	291(11.0)	9.8~12.3			差	132(12.7)	10.7~14.9
年龄组(岁)			2.096	0.553	吸烟			5.874	0.015
60~ < 65	129(9.7)	8.2~11.4			是	410(10.8)	9.8~11.8
65~ < 70	137(10.7)	9.0~12.4			否	84(8.2)	6.5~9.9
70~ < 75	116(11.1)	9.0~13.0			缺乏体力活动			10.023	0.002
≥75	112(9.5)	7.8~11.2			是	286(11.6)	10.3~13.0
民族			0.682	0.409	否	208(8.8)	7.6~9.9
汉族	418(10.4)	9.4~11.4			肥胖			30.982	＜0.001
少数民族	76(9.4)	7.5~11.5			是	62(19.3)	15.0~23.6
居住模式			0.029	0.865	否	432(9.6)	8.7~10.4
和配偶居住	346(10.3)	9.2~11.3			中心性肥胖			47.229	＜0.001
未和配偶居住	148(10.1)	8.6~11.6			是	333(13.1)	11.7~14.2
受教育程度			0.417	0.518	否	161(7.1)	6.0~8.1
文盲	295(10.0)	8.9~11.0			糖尿病家族史			60.860	＜0.001
小学及以上	199(10.6)	9.2~11.9			是	66(24.1)	9.5~29.8
家庭财产			3.603	0.058	否	428(9.4)	8.6~10.2
好	371(8.9)	7.4~10.4			高血压			41.576	＜0.001
差	123(10.7)	9.7~11.8			是	318(13.0)	11.7~14.4
					否	176(7.4)	6.4~8.5
					合计	494(10.2)

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表 2 基础模型和修正模型

Table 2. Basic model and modified model

模型	$\chi$²/υ	RMSEA	GFI	CFI	TLI	RMR	P值
基础模型	16.148	0.056	0.976	0.845	0.723	0.011	< 0.001
模型A	14.123	0.052	0.976	0.844	0.760	0.011	< 0.001
模型B	9.337	0.042	0.984	0.905	0.858	0.011	< 0.001
模型C	8.180	0.039	0.987	0.908	0.869	0.006	< 0.001
模型D	4.662	0.028	0.993	0.957	0.933	0.004	< 0.001

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参考文献(11)

[1]	Ogurtsova K, Da RF J, Huang Y, et al. IDF diabetes atlas: Global estimates for the prevalence of diabetes for 2015 and 2040 [J]. Diabetes Res Clin Pract, 2017, 128: 40-50. DOI: 10.1016/j.diabres.2017.03.024.
[2]	Yang L, Shao J, Bian Y, et al. Prevalence of type 2 diabetes mellitus among inland residents in China (2000-2014): a meta-analysis [J]. J Diabetes Investig, 2016, 7(6): 845-852. DOI: 10.1111/jdi.12514.
[3]	苏蓉. 云南省四个独有少数民族糖尿病患病、管理和控制现状及社会经济影响研究[D]. 昆明: 昆明医科大学, 2017. Su R. The prevalence, managment and control of diabetes and relationships with socioeconomic status among four unique ethnic minorities in Yunnan Province [D]. Kunming: Kunming medical University, 2017.
[4]	中国高血压防治指南修订委员会. 中国高血压防治指南(2016年修订版) [M]. 北京: 人民卫生出版社, 2016: 770-771. China hypertension guidelines revision committee. China hypertension guidelines (revised in 2016) [M]. Beijing: People's Medical Publishing House, 2016: 770-771.
[5]	World Health Organization. The asia-pacific perspective: redefining obesity and its treatment [M]. Sydney: Health Communications, 2000: 20-21.
[6]	Wang Z, Li X, Chen M. Socioeconomic factors and inequality in the prevalence and treatment of diabetes among middle-aged and elderly adults in China [J]. J Diabetes Res, 2018, 2018: 1-12. DOI: 10.1155/2018/1471808.
[7]	Salas A, Acosta D, Ferri CP, et al. The prevalence, correlates, detection and control of diabetes among older people in low and middle income countries. A 10/66 dementia research group population-based survey [J]. PLoS One, 2016, 11(2): e149616. DOI: 10.1371/journal.pone.0149616.
[8]	Tripathy JP, Thakur JS, Jeet G, et al. Structural equation modeling to identify the risk factors of diabetes in the adult population of North India [J]. Trop Med Health, 2018, 46(1). DOI: 10.1186/s41182-018-0104-y.
[9]	Gatimu SM, Milimo BW, Sebastian MS. Prevalence and determinants of diabetes among older adults in Ghana [J]. BMC Public Health, 2016, 16(1). DOI: 10.1186/s12889-016-3845-8.
[10]	Ustulin M, Rhee SY, Chon S, et al. Importance of family history of diabetes in computing a diabetes risk score in Korean prediabetic population [J]. Sci Rep, 2018, 8(1): 15958. DOI: 10.1038/s41598-018-34411-w.
[11]	Sliwińska-Mossoń M, Milnerowicz H. The impact of smoking on the development of diabetes and its complications [J]. Diab Vasc Dis Res, 2017, 14(4): 265-276. DOI: 10.1177/1479164117701876.