农村地区老年女性高血压患者生育史和生活方式与心血管病的关联

焦筱雨; 吴建; 冯宜飞; 齐雯哲; 张东杰; 李广樱; 苗豫东; 叶贝珠

doi:10.16462/j.cnki.zhjbkz.2025.06.008

农村地区老年女性高血压患者生育史和生活方式与心血管病的关联

doi: 10.16462/j.cnki.zhjbkz.2025.06.008

郑州大学公共卫生学院社会医学与卫生事业管理学系，郑州 450001

基金项目:

教育部人文社科规划基金 24YJAZH174

郑州大学研究生自主创新项目 20250432

详细信息

通讯作者:
叶贝珠，E-mail: yebeizhu@zzu.edu.cn

中图分类号: R169.49
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出版历程
- 收稿日期: 2024-12-23
- 修回日期: 2025-03-16
- 网络出版日期: 2025-07-07
- 刊出日期: 2025-06-10

Association between reproductive history, healthy lifestyle and cardiovascular disease in rural elder women with hypertension

Department of Social Medicine and Health Management, School of Public Health, Zhengzhou University, Zhengzhou 450001, China

Funds:

Humanities and Social Science Planning Fund Project of Ministry of Education 24YJAZH174

The Graduate Independent Innovation Project of Zhengzhou University 20250432

More Information

Corresponding author: YE Beizhu, E-mail: yebeizhu@zzu.edu.cn

摘要

摘要: 目的探究≥65岁农村地区女性高血压患者生育史、生活方式与患心血管病(cardiovascular disease, CVD)风险的关系，并进一步探讨二者的联合作用。方法采用整群抽样方法，于2023年7―8月对河南省某县老年女性高血压患者进行问卷调查和体格检查。生育史包括怀孕次数、活产婴儿数和流产史，生活方式包括睡眠、饮食、体力活动、被动吸烟和BMI。采用logistic回归分析生育史、生活方式以及二者的联合作用对农村地区老年女性患CVD风险的影响。结果纳入分析的研究对象共9 837人，CVD患者3 980人。Logistic回归分析结果显示，怀孕≥5次、有流产史者患CVD的风险分别增加19.8%(OR=1.198, 95% CI: 1.057~1.359)、26.1%(OR=1.261, 95% CI: 1.151~1.381)，生活方式得分为4~5分者患CVD的风险下降28.4%(OR=0.716, 95% CI: 0.592~0.866)。怀孕次数、流产史与生活方式对患CVD的风险存在联合作用，怀孕≥5次时，生活方式得分与患CVD的风险呈负相关。无论是否流产，生活方式得分与患CVD的风险均呈负相关。结论农村地区老年女性高血压患者中，怀孕次数较多、有流产史且健康生活方式较少是CVD防控的重点人群，应加强并提升生活方式教育，促进第一级预防的实施。
- 农村 /
- 生育史 /
- 生活方式 /
- 心血管病
Abstract: Objective We aimed to explore the relationship between reproductive factors, lifestyle factors, and the risk of cardiovascular disease (CVD) among rural hypertensive women aged 65 and older, with a particular focus on their joint effects. Methods A cluster sampling method was used to conduct face-to-face interviews and physical examinations among elderly female hypertensive patients in a county, Henan Province between July and August 2023. Reproductive factors included the number of pregnancies, live births, and history of miscarriage. Lifestyle factors included sleep, diet, physical activity, passive smoking, and BMI. Logistic regression analysis was employed to assess the impact of reproductive and lifestyle factors, both individually and jointly, on the risk of CVD. Results A total of 9 837 participants were included in the analysis, of whom 3 980 were diagnosed with CVD. Logistic regression analysis revealed that women with ≥5 pregnancies OR a history of miscarriage had a 19.8% (OR=1.198, 95% CI: 1.057-1.359) and 26.1% (OR=1.261, 95% CI: 1.151-1.381) increased risk of developing CVD, respectively. In contrast, those with a lifestyle score of 4-5 had a 28.4% (OR=0.716, 95% CI: 0.592-0.866) reduced risk of developing CVD. A joint effect was observed between the number of pregnancies, history of miscarriage, and lifestyle on the risk of CVD. Specifically, among women with ≥5 pregnancies, a higher lifestyle score was negatively associated with the risk of CVD. Regardless of miscarriage history, a higher lifestyle score was consistently associated with a lower risk of CVD. Conclusions Elderly hypertensive women with a higher number of pregnancies, a history of miscarriage, and unhealthy lifestyles represent a high-risk population for CVD prevention and control. Enhancing health education on healthy lifestyles and promoting primary prevention strategies are essential in reducing the burden of CVD in this vulnerable group.
- Rural areas /
- Reproductive history /
- Lifestyle /
- Cardiovascular diseases

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图 1 怀孕次数与生活方式得分联合作用对患CVD风险的森林图

CVD：心血管病。

Figure 1. Forest plot of the combined effect of number of pregnancies and lifestyle score on the risk of CVD

CVD: cardiovascular disease.

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图 2 流产史与生活方式得分联合作用对患CVD风险的森林图

CVD：心血管病。

Figure 2. Forest map of the combined effect of history of miscarriage and lifestyle score on CVD risk

CVD: cardiovascular disease.

下载: 全尺寸图片幻灯片

表 1 CVD患病率在不同特征组间的比较

Table 1. Comparison of CVD prevalence among different characteristic groups

基本特征Basic characteristics	例数Number of cases^①	CVD^①		χ²值value	P值value
基本特征Basic characteristics	例数Number of cases^①	无No	有Yes	χ²值value	P值value
年龄组/岁Age group/years				1.911	0.168
< 72	4 972(50.5)	2 994(51.1)	1 978(49.7)
≥72	4 865(49.5)	2 863(48.9)	2 002(51.3)
民族Nation				6.103	0.014
汉族Han nationality	9 718(98.8)	5 773(98.6)	3 945(99.1)
其他民族Other nationalities	119(1.2)	84(1.4)	35(0.9)
婚姻状况Marital status				0.763	0.683
已婚Married	6 690(68.0)	4 003(68.3)	2 687(67.5)
丧偶Windowed	3 034(30.8)	1 787(30.5)	1 247(31.3)
其他Others	113(1.2)	67(1.2)	46(1.2)
受教育水平Education level				9.166	0.010
未上学Illiteracy	6 019(61.2)	3 549(60.6)	2 470(62.1)
小学Elementary school	2 782(28.3)	1 646(28.1)	1 136(28.5)
初中及以上Junior high school or above	1 036(10.5)	662(11.3)	374(9.4)
家庭年收入/元Average yearly income /yuan				0.629	0.432
≤30 000	9 188(93.4)	5 467(93.2)	3 727(93.6)
＞30 000	649(6.6)	396(6.8)	253(6.4)
高血压病程/年Hypertension duration/year				174.066	< 0.001
≤5	2 928(29.8)	2 037(34.8)	891(22.4)
＞5	6 909(70.2)	3 820(65.2)	3 089(77.6)
血压控制Blood pressure control				0.203	0.663
差Poor	4 254(43.2)	2 522(43.1)	1 732(43.5)
良好Well	5 583(56.8)	3 335(56.9)	2 248(56.5)
怀孕次数/次Number of pregnancies/times				10.019	0.007
0~2	2 573(26.2)	1 588(27.1)	985(24.8)
3~4	5 115(52.0)	3 040(51.9)	2 075(52.1)
≥5	2 149(21.8)	1 229(21.0)	920(23.1)
活产婴儿数/个Number of live births/piece				5.148	0.076
0~1	374(3.8)	233(4.0)	141(3.5)
2~3	6 231(63.3)	3 748(64.0)	2 483(62.4)
≥4	3 232(32.9)	1 876(32.0)	1 356(34.1)
流产史History of miscarriage				21.195	< 0.001
无No	7 138(72.6)	4 350(74.3)	2 788(70.1)
有Yes	2 699(27.4)	1 507(25.7)	1 192(29.9)
睡眠充足Adequate sleep duration				41.403	< 0.001
否No	3 941(40.1)	2 193(37.4)	1 748(43.9)
是Yes	5 896(59.9)	3 664(62.6)	2 232(56.1)
体力活动充足Adequate physical activity				17.836	< 0.001
否No	1 484(15.1)	810(13.8)	674(16.9)
是Yes	8 353(84.9)	5 047(86.2)	3 306(83.1)
健康饮食Healthy diet				6.008	0.014
否No	9 459(96.2)	5 609(95.8)	3 850(96.7)
是Yes	378(3.8)	248(4.2)	130(3.3)
被动吸烟Passive smoking				6.815	0.010
是No	1 597(16.2)	904(15.4)	693(17.4)
否Yes	8 240(83.8)	4 953(84.6)	3 287(82.6)
BMI/(kg·m^-2)				9.936	0.019
< 18.5	3 714(37.8)	200(3.4)	126(3.2)
18.5~＜24.0	326(3.3)	2 275(38.8)	1 439(36.2)
24.0~＜28.0	3 835(39.0)	2 259(38.6)	1 576(39.6)
≥28.0	1 962(19.9)	1 123(19.2)	839(21.0)
生活方式得分/分Lifestyle score/score				20.049	< 0.001
0~＜2	524(5.3)	284(4.8)	240(6.0)
2~＜4	6 502(66.1)	3 811(65.1)	2 691(67.6)
4~5	2 811(28.6)	1 762(30.1)	1 049(26.4)
注：CVD，心血管病。①以人数(占比/%)表示。 Note: CVD, cardiovascular disease.① Number of people(proportion/%).

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表 2 生育史、生活方式得分与患CVD风险的关联分析

Table 2. Analysis of the association between reproductive factors, lifestyle score and the risk of CVD

变量Variable	模型1 Model 1^①		模型2 Model 2^②
变量Variable	OR值value (95% CI)	P值value	OR值value (95% CI)	P值value
怀孕次数Number of pregnancies
0~2	1.000		1.000
3~4	1.100(0.999~1.213)	0.053	1.094(0.989~1.210)	0.080
≥5	1.207(1.074~1.356)	0.002	1.198(1.057~1.359)	0.005
活产婴儿数/个Number of live births/piece
0~1	1.000		1.000
2~3	1.095(0.883~1.358)	0.410	1.080(0.869~1.342)	0.488
≥4	1.194(0.958~1.489)	0.114	1.159(0.924~1.454)	0.202
流产史History of miscarriage
无No	1.000		1.000
有Yes	1.234(1.128~1.350)	< 0.001	1.261(1.151~1.381)	< 0.001
生活方式得分/分Lifestyle score/score
0~＜2	1.000		1.000
2~＜4	0.836(0.699~0.999)	0.049	0.849(0.709~1.018)	0.077
4~5	0.704(0.584~0.850)	< 0.001	0.716(0.592~0.866)	0.001
注: CVD，心血管病。 ①模型1，未校正模型; ②模型2，在模型1的基础上进一步校正年龄、民族、婚姻状况、受教育水平、家庭年收入、高血压病程、血压控制情况。 Note: CVD, cardiovascular disease. ① Model 1, unadjusted model; ② Model 2, based on model 1, further adjusted for potential confounding factors, including age, nation, marital status, education level, average yearly income, hypertension duration, blood pressure control.

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