中国九省(区)农民心血管代谢性危险因素的流行特征及人口经济因素的影响
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摘要
目的:分析我国九省18岁及以上农民心血管代谢性危险因素的流行特征及聚集性,探讨人口经济因素对其的影响。方法:利用2009年"中国健康与营养调查"中的血样检测数据、人口经济因素和体格测量数据,选择18岁及以上农民共2 001人作为研究对象。采用国际糖尿病联盟(IDF)于2005年发布的定义判定心血管代谢性危险因素,具有2个及以上危险因素(≥2RFs)为危险因素聚集。采用多因素Logistic回归模型分析社会经济因素与各代谢性危险因素之间的关联性。结果:2009年我国九省(区)农民中,中心型肥胖、血压升高、血糖升高、血脂升高和高密度脂蛋白胆固醇降低的人群比例分别为39. 8%、36. 8%、21. 8%、22. 1%和27. 8%。多因素Logistic回归分析显示,女性血压升高[OR=0. 74,95%CI (0. 60,0. 90)]、血糖升高[OR=0. 68,95%CI (0. 54,0. 85)]和甘油三酯升高[OR=0. 77,95%CI (0. 62,0. 96)]的危险性低于男性,中心型肥胖[OR=6. 25,95%CI (4. 74,8. 24)]和HDL-C降低[OR=4. 49,95%CI (3. 45,5. 84)]的危险性高于男性;年龄与代谢性危险因素及聚集性均呈显著的正相关(P-trend <0. 05)。南部地区的农民患血压升高的危险性明显低于北部地区农民,但血糖升高的危险性高于北部地区农民。未发现农民收入水平、受教育程度及社区城市化水平与代谢性危险因素存在显著关联。结论:我国九省中约有2/3的农民至少有1种心血管代谢性危险因素,约有一半的农民存在危险因素聚集性。从公共卫生防控的角度,应根据农民各代谢性危险因素的性别、年龄及区域性流行特征,发现相应的高危人群,优先采取精准化的一级预防营养干预措施,重视控制体重,降低心血管疾病的发病风险和疾病负担。
Objective To analyze the epidemiological characteristics and clustering of cardiovascular risk factors in peasants 18 years old and above,and explore the influence of population economic factors on them. Method Totally 2 001 peasants aged 18 years and older identified by their occupations as farmer,fisherman or hunter were selected as peasants in this study from the database of China Health and Nutrition Survey in 2009. Basic information(age,gender),anthropometric data(height,weight and waist size),blood biochemical data and socioeconomic data(occupation,income,education level,urbanization level and geographic location) were included. According to the definition of the metabolic syndrome released by the International Diabetes Federation(IDF) in 2005,there were five cardiometabolic risk factors including central obesity,raised triglycerides,reduced HDL-cholesterol,raised blood pressure and raised plasma glucose. Existing of 2 or more risk factors in a person at the same time was recognized as a risk factor clustering. Multivariate logistic regression model was used to analyze the relationship between socioeconomic factors and metabolic risk factors. Result In 2 001 peasants of 9 provinces(regions) of China,the prevalence of central obesity,raised blood pressure,raised plasma glucose,raised triglycerides and reduced HDL-cholesterol were 39. 8%,36. 8%,21. 8%,22. 1% and 27. 8% respectively. Multivariate logistic regression analysis showed there were less possibilities of raised blood pressure [OR = 0. 74,95% CI(0. 60,0. 90) ],raised blood glucose [OR = 0. 68,95% CI(0. 54,0. 85) ] and raised triglyceride [OR = 0. 77,95% CI(0. 62,0. 96) ] in women than those in men and more possibilities of central obesity [OR = 6. 25,95% CI(4. 74,8. 24) ] and reduced HDL-cholesterol [OR = 4. 49,95% CI(3. 45,5. 84) ] in women than those in men,and there were significantly higher risk of central obesity,raised blood pressure and raised blood glucose in the group of 60 years old and above than those in the 18 ～ 44 group. Peasants in the southern region were significantly less likely to suffer from raised blood pressure than those in the northern region,but the likelihood of increased blood sugar was higher than that in the northern region. Age were positively correlated with metabolic risk factors. No significant correlation was found between income level,education level,urbanization level and metabolic risk factors.Conclusion In China there are about 2/3 of peasants suffering from at least a kinds of cardiometabolic risk factors,and about half of them have risking clustering factors. Based on the epidemiological characteristics above and in the view of public health prevention and control,priorities should be given to primary prevention accurately. We should manage to identify the high-risk population accordingly,pay attention to control weight,reduce the incidence of cardiometabolic diseases and corresponding burdens.
Objective To analyze the epidemiological characteristics and clustering of cardiovascular risk factors in peasants 18 years old and above,and explore the influence of population economic factors on them. Method Totally 2 001 peasants aged 18 years and older identified by their occupations as farmer,fisherman or hunter were selected as peasants in this study from the database of China Health and Nutrition Survey in 2009. Basic information(age,gender),anthropometric data(height,weight and waist size),blood biochemical data and socioeconomic data(occupation,income,education level,urbanization level and geographic location) were included. According to the definition of the metabolic syndrome released by the International Diabetes Federation(IDF) in 2005,there were five cardiometabolic risk factors including central obesity,raised triglycerides,reduced HDL-cholesterol,raised blood pressure and raised plasma glucose. Existing of 2 or more risk factors in a person at the same time was recognized as a risk factor clustering. Multivariate logistic regression model was used to analyze the relationship between socioeconomic factors and metabolic risk factors. Result In 2 001 peasants of 9 provinces(regions) of China,the prevalence of central obesity,raised blood pressure,raised plasma glucose,raised triglycerides and reduced HDL-cholesterol were 39. 8%,36. 8%,21. 8%,22. 1% and 27. 8% respectively. Multivariate logistic regression analysis showed there were less possibilities of raised blood pressure [OR = 0. 74,95% CI(0. 60,0. 90) ],raised blood glucose [OR = 0. 68,95% CI(0. 54,0. 85) ] and raised triglyceride [OR = 0. 77,95% CI(0. 62,0. 96) ] in women than those in men and more possibilities of central obesity [OR = 6. 25,95% CI(4. 74,8. 24) ] and reduced HDL-cholesterol [OR = 4. 49,95% CI(3. 45,5. 84) ] in women than those in men,and there were significantly higher risk of central obesity,raised blood pressure and raised blood glucose in the group of 60 years old and above than those in the 18 ～ 44 group. Peasants in the southern region were significantly less likely to suffer from raised blood pressure than those in the northern region,but the likelihood of increased blood sugar was higher than that in the northern region. Age were positively correlated with metabolic risk factors. No significant correlation was found between income level,education level,urbanization level and metabolic risk factors.Conclusion In China there are about 2/3 of peasants suffering from at least a kinds of cardiometabolic risk factors,and about half of them have risking clustering factors. Based on the epidemiological characteristics above and in the view of public health prevention and control,priorities should be given to primary prevention accurately. We should manage to identify the high-risk population accordingly,pay attention to control weight,reduce the incidence of cardiometabolic diseases and corresponding burdens.
引文
[1]中国居民营养与慢性病状况报告[R]. 2015.
[2]陈伟伟,高润霖,刘力生,等.《中国心血管病报告2015》概要[J].中国循环杂志,2016,31(6):617-622.
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[5] Zimmet P,AlbertI K G,Serrano R M. A new international diabetes federation(IDF)worldwide definition of the metabolic syndrome:the rationale and the results[J]. Revista Espa1ola De Cardiología,2005,58(12):1371-1375.
[6]姜勇,张梅,李镒冲,等.中国老年人中心型肥胖流行特征及其与心血管代谢性危险因素聚集的关系[J].中华预防医学杂志,2013,47(9):816-820.
[7]李小花,齐建国.我国农民健康状况、健康知识态度与行为现状调查[J].现代预防医学,2015,42(3):479-484.
[8]项目组中国健康与营养调查. 1989—2009年中国九省区居民膳食营养素摄入状况及变化趋势(一)健康与营养调查项目总体方案[J].营养学报,2011,33(3):234-236.
[9] Popkin B M,Du S,Zhai F,et al. Cohort profile:the china health and Nutrition Survey--monitoring and understanding socioeconomic and health change in China,1989-2011[J]. International Journal of Epidemiology,2010,39(6):1435-1440.
[10] Zhang B,Zhai F Y,Du S F,et al. The China Health and Nutrition Survey,1989-2011[J]. Obesity Reviews an Official Journal of the International Association for the Study of Obesity,2014,15 Suppl 1(S1):2.
[11] Jones-Smith J C,Popkin B M. Understanding community context and adult health changes in China:development of an urbanicity scale[J]. Social Science&Medicine,2010,71(8):1436-1446.
[12]杜文雯,王惠君,王志宏,等.我国9省/区农村居民膳食结构变化及地区差异性分析[J].中国食物与营养,2016,22(7):74-77.
[13]乔玉成,王卫军.全球人口体力活动不足的概况及特征[J].体育科学,2015(8):8-15.
[14] Chol K M. Sarcopenia and sarcopenic obesity[J]. Endocrinology&Metabolism,2013,28(2):86.
[15]贺媛,曾强,赵小兰.中国成人肥胖、中心性肥胖与高血压和糖尿病的相关性研究[J].解放军医学杂志,2015,40(10):803-808.
[16]邓武权,陈兵.性激素与心血管疾病[J].中国实用内科杂志,2011(4):266-268.
[17]戚常春,吴海涛,李俊娟,等.开滦不同年龄、性别人群心血管健康行为和因素的流行差异[J].中华高血压杂志,2013(9):865-870.
[18]何明月,丁凌玉,武晓岩,等.我国北方居民膳食模式与高血压患病关系[J].中国公共卫生,2017.
[19]刘晓田,李玉倩,张路宁,等.农村老年人群代谢性危险因素与2型糖尿病的关系[J].中华疾病控制杂志,2014,18(9):812-815.
[20]王重建.农村老年人群代谢性危险因素与2型糖尿病的关系:营养与糖尿病并发症——达能营养中心第十六届学术会议[C].中国湖北武汉,2013.
[21]王历,张春芳,夏昆,等.代谢性危险因素及生活方式对北京社区居民新发高血压的影响[J].中华高血压杂志,2016,43(6):600.
[22]王志宏,郭春雷,王柳森,等.中国九省(区)农民心血管代谢性危险因素的流行特征及社会经济因素的影响[C].中国营养学会第十三届全国营养科学大会暨全球华人营养科学家大会论文,2017.
[23]王志宏,姜红如,王惠君,等.中国九省(区)成年女性心血管代谢性危险因素的流行特征及社会经济因素的影响[C].中国营养学会第十三届全国营养科学大会暨全球华人营养科学家大会论文,2017.
[2]陈伟伟,高润霖,刘力生,等.《中国心血管病报告2015》概要[J].中国循环杂志,2016,31(6):617-622.
[3]米杰,梁亚军.我国代谢综合征的流行现状和防治对策[J].中华预防医学杂志,2008,42(s1):90-92.
[4]胡大一.转变理念做实我国心血管疾病的预防:全国心力衰竭学术会议[C]. 2008.
[5] Zimmet P,AlbertI K G,Serrano R M. A new international diabetes federation(IDF)worldwide definition of the metabolic syndrome:the rationale and the results[J]. Revista Espa1ola De Cardiología,2005,58(12):1371-1375.
[6]姜勇,张梅,李镒冲,等.中国老年人中心型肥胖流行特征及其与心血管代谢性危险因素聚集的关系[J].中华预防医学杂志,2013,47(9):816-820.
[7]李小花,齐建国.我国农民健康状况、健康知识态度与行为现状调查[J].现代预防医学,2015,42(3):479-484.
[8]项目组中国健康与营养调查. 1989—2009年中国九省区居民膳食营养素摄入状况及变化趋势(一)健康与营养调查项目总体方案[J].营养学报,2011,33(3):234-236.
[9] Popkin B M,Du S,Zhai F,et al. Cohort profile:the china health and Nutrition Survey--monitoring and understanding socioeconomic and health change in China,1989-2011[J]. International Journal of Epidemiology,2010,39(6):1435-1440.
[10] Zhang B,Zhai F Y,Du S F,et al. The China Health and Nutrition Survey,1989-2011[J]. Obesity Reviews an Official Journal of the International Association for the Study of Obesity,2014,15 Suppl 1(S1):2.
[11] Jones-Smith J C,Popkin B M. Understanding community context and adult health changes in China:development of an urbanicity scale[J]. Social Science&Medicine,2010,71(8):1436-1446.
[12]杜文雯,王惠君,王志宏,等.我国9省/区农村居民膳食结构变化及地区差异性分析[J].中国食物与营养,2016,22(7):74-77.
[13]乔玉成,王卫军.全球人口体力活动不足的概况及特征[J].体育科学,2015(8):8-15.
[14] Chol K M. Sarcopenia and sarcopenic obesity[J]. Endocrinology&Metabolism,2013,28(2):86.
[15]贺媛,曾强,赵小兰.中国成人肥胖、中心性肥胖与高血压和糖尿病的相关性研究[J].解放军医学杂志,2015,40(10):803-808.
[16]邓武权,陈兵.性激素与心血管疾病[J].中国实用内科杂志,2011(4):266-268.
[17]戚常春,吴海涛,李俊娟,等.开滦不同年龄、性别人群心血管健康行为和因素的流行差异[J].中华高血压杂志,2013(9):865-870.
[18]何明月,丁凌玉,武晓岩,等.我国北方居民膳食模式与高血压患病关系[J].中国公共卫生,2017.
[19]刘晓田,李玉倩,张路宁,等.农村老年人群代谢性危险因素与2型糖尿病的关系[J].中华疾病控制杂志,2014,18(9):812-815.
[20]王重建.农村老年人群代谢性危险因素与2型糖尿病的关系:营养与糖尿病并发症——达能营养中心第十六届学术会议[C].中国湖北武汉,2013.
[21]王历,张春芳,夏昆,等.代谢性危险因素及生活方式对北京社区居民新发高血压的影响[J].中华高血压杂志,2016,43(6):600.
[22]王志宏,郭春雷,王柳森,等.中国九省(区)农民心血管代谢性危险因素的流行特征及社会经济因素的影响[C].中国营养学会第十三届全国营养科学大会暨全球华人营养科学家大会论文,2017.
[23]王志宏,姜红如,王惠君,等.中国九省(区)成年女性心血管代谢性危险因素的流行特征及社会经济因素的影响[C].中国营养学会第十三届全国营养科学大会暨全球华人营养科学家大会论文,2017.