云南省农村老年人五种常见慢性病及共病的流行现状及与社会经济地位的关系
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摘要
目的分析云南省农村老年人高血压、糖尿病、脑卒中、冠心病、慢性阻塞性肺疾病(chronic obstructive pneumonia diseases,COPD)及共病的流行现状及与社会经济地位的关系。方法采用多阶段分层随机抽样的方法抽取云南省4 833名60岁及以上农村老年人进行问卷调查和体格检查,采用主成分分析法构建社会经济地位。结果云南农村老年人高血压、糖尿病、脑卒中、冠心病、COPD和共病的患病率分别为50.6%、10.2%、6.4%、5.5%、5.4%和16.1%。女性高血压和糖尿病的患病率均高于男性(均有P<0.05),而男性COPD的患病率高于女性(χ~2=5.499,P=0.019);高血压、冠心病、脑卒中、COPD和共病的患病率均随年龄的增长而增加(均有P<0.05);少数民族高血压、冠心病、COPD和共病的患病率均高于汉族(均有P<0.05)。多因素Logistic回归分析结果显示,社会经济地位越低的老年人,其患高血压、冠心病、脑卒中、COPD和共病的风险越高(均有P<0.05)。结论云南省农村老年人五种慢性病及共病的患病存在明显的社会经济差异,低社会经济地位的老年人是慢性病防控的重点人群。
Objective To analyze the relationship between socioeconomic position and prevalence of hypertension, diabetes, coronary heart disease, stroke, chronic obstructive pulmonary diseases(COPD) and multi-morbidity among older adults in rural Yunnan Province. Methods A total of 4 833 older adults aged 60 years and over were selected by multi-stage stratified random sampling method in rural Yunnan Province. Information was acquired from questionnaire and health examination. Principal component analysis was used to construct the socioeconomic comprehensive score. Results The prevalence of hypertension, diabetes, stroke, coronary heart disease, COPD and multi-morbidity in target persons was 50.6%, 10.2%, 6.4%, 5.5%, 5.4% and 16.1% respectively. The prevalence of hypertension and diabetes was much higher in female compared with male(both P<0.05), in contrast the prevalence of COPD was much higher in male than female(χ~2=5.499, P=0.019)The prevalence of hypertension, stroke, coronary heart disease, COPD and multi-morbidity was increased with age(all P<0.05);Minority ethnic were more likely to develop hypertension, coronary heart disease, COPD and multi-morbidity than Han ethnic(all P<0.05). The results of multivariate logistic regression analysis showed that older adults with lower socioeconomic position had higher probability of suffering from hypertension, coronary heart disease, stroke, COPD and multi-morbidity(all P<0.05). Conclusions There are significant socioeconomic differences between socioeconomic position and prevalence of five major chronic diseases and multi-morbidity among older adults in rural Yunnan province. Older adults with low socioeconomic position should be key population for future prevention and control of chronic diseases.
Objective To analyze the relationship between socioeconomic position and prevalence of hypertension, diabetes, coronary heart disease, stroke, chronic obstructive pulmonary diseases(COPD) and multi-morbidity among older adults in rural Yunnan Province. Methods A total of 4 833 older adults aged 60 years and over were selected by multi-stage stratified random sampling method in rural Yunnan Province. Information was acquired from questionnaire and health examination. Principal component analysis was used to construct the socioeconomic comprehensive score. Results The prevalence of hypertension, diabetes, stroke, coronary heart disease, COPD and multi-morbidity in target persons was 50.6%, 10.2%, 6.4%, 5.5%, 5.4% and 16.1% respectively. The prevalence of hypertension and diabetes was much higher in female compared with male(both P<0.05), in contrast the prevalence of COPD was much higher in male than female(χ~2=5.499, P=0.019)The prevalence of hypertension, stroke, coronary heart disease, COPD and multi-morbidity was increased with age(all P<0.05);Minority ethnic were more likely to develop hypertension, coronary heart disease, COPD and multi-morbidity than Han ethnic(all P<0.05). The results of multivariate logistic regression analysis showed that older adults with lower socioeconomic position had higher probability of suffering from hypertension, coronary heart disease, stroke, COPD and multi-morbidity(all P<0.05). Conclusions There are significant socioeconomic differences between socioeconomic position and prevalence of five major chronic diseases and multi-morbidity among older adults in rural Yunnan province. Older adults with low socioeconomic position should be key population for future prevention and control of chronic diseases.
引文
[1] 卫生部统计信息中心.2013第五次国家卫生服务调查分析报告 [M].北京:协和医科大学,2013.Statistical Information Center of China Ministry of Health.Report on the fifth national health service survey and analysis in 2013 [M].Beijing:Peking Union Medical College,2013.
[2] 汤淑女,简伟研.社会经济地位与慢性病患病的关联——基于北京和上海工作群体的实证研究 [J].中国卫生政策研究,2012,5(1):51-55.DOI:10.3969 /j.issn.1674-2982.2012.01.010.Tang SN,Jian WY.The relationship between socio-economic status and prevalence of chronic disease:an empirical analysis based on working population in Beijing and Shanghai [J].Chinese Journal of Health Policy,2012,5(1):51-55.DOI:10.3969 /j.issn.1674-2982.2012.01.010.
[3] Mackenbach JP,Stirbu I,Roskam AJ,et al.Socioeconomic inequalities in health in 22 European countries [J].N Engl J Med,2008,358(23):2468-2481.DOI:10.1056/NEJMsa0707519.
[4] 李赪.云南统计年鉴 [M].中国统计出版社,2016.Li Z.Yunnan Statistical Yearbook [M] Beijing:China Statistics Press,2016.
[5] 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.Revision Committee of the Guidelines for the Prevention and Treatment of Hypertension in China.The Guidelines for the Prevention and Treatment of Hypertension in China (Revision 2016) [M] Beijing:People Public Health Publishing Company,2016.
[6] 徐永健,葛均波.内科学 [M].第8版.人民卫生出版社,2013.Xu YJ,Ge JB.Internal Medicine [M].8rd ed.People’s Health Publishing House,2013.
[7] Wu L,He Y,Jiang B,et al.Trends in prevalence,awareness,treatment and control of hypertension during 2001-2010 in an urban elderly population of China [J].PLoS One,2015,10(8):e132814.DOI:10.1371/journal.pone.0132814.
[8] Wang H,Zhang X,Zhang J,et al.Factors associated with prevalence,awareness,treatment and control of hypertension among adults in Southern China:a community-based,cross-sectional survey [J].PLoS One,2013,8(5):e62469.DOI :10.1371/journal.pone.0062469.
[9] Zhang S,Liu Z,Liu Y L,et al.Prevalence of stroke and associated risk factors among middle-aged and older farmers in western China [J].Environ Health Prev Med,2017,22(1):6.DOI :10.1186/s12199-017-0621-z.
[10] Tang X,Laskowitz DT,He L,et al.Neighborhood socioeconomic status and the prevalence of stroke and coronary heart disease in rural China:a population-based study [J].Int J Stroke,2015,10(3):388-395.DOI :10.1111/ijs.12343.
[11] Yin P,Zhang M,Li Y,et al.Prevalence of COPD and its association with socioeconomic status in China:findings from China chronic disease risk factor surveillance 2007 [J].BMC Public Health,2011,11(1):586.DOI:10.1186/1471-2458-11-586.
[12] Yang SH,Dou KF,Song WJ.Prevalence of diabetes among men and women in China [J].N Engl J Med,2010,362(25):2425-2426,2426.
[13] Hu X,Huang J,Lv Y,et al.Status of prevalence study on multimorbidity of chronic disease in China:systematic review[J].Geriatr Gerontol Int,2015,15(1):1-10.DOI:10.1111/ggi.12340
[14] 解晔,胡晓抒,钱晓勤.慢性非传染性疾病流行病学研究进展 [J].实用医学杂志,2009,25(10):1712-1714.Jie Y,Hu XS,Qian XQ.Research of epidemiology of chronic non-communicable diseases [J].The Journal of Practical Medicine,2009,25(10):1712-1714.
[15] 何利平,李晓梅,吴騻,等.云南省彝族居民卫生服务利用公平性研究 [J].卫生软科学,2017,31(4):21-24.DOI:10.3969/j.issn.1003-2800.2017.04.005.He LP,Li XM,Wu S,et al.Study on equity of health service utilization of Yi nationality residents in Yunnan Province [J] Soft Science of Health,2017,31(4):21-24.DOI:10.3969/j.issn.1003-2800.2017.04.005.
[16] 苏蓉,蔡乐,董峻,等.云南省4个独有少数民族糖尿病患病、知晓、治疗和控制现况及其与社会经济地位的相关性分析 [J].现代预防医学,2016,43(20):3733-3737.Su R,Cai L,Dong J,et al.The prevalence,awareness,treatment,control of diabetes and relationships with socioeconomic status among four unique ethnic minorities in Yunnan Province [J].Modern preventive medicine,2016,43(20):3733-3737.
[17] Park B,Ock M,Lee HA,et al.Multimorbidity and health-related quality of life in Koreans aged 50 or older using KNHANES 2013–2014 [J].Health Qual Life Outcomes,2018,16(1):186.DOI:10.1186/s12955-018-1016-6.
[18] 汤淑女,简伟研.中国就业人群慢性病的社会决定因素 [J].北京大学学报(医学版),2013,45(3):443-447.DOI:10.3969 /j.issn.1671-167X.2013.03.020 Tang SN,Jian WY.Social determinants of chronic disease in a working population in China [J].J Peking Univ (Health Sci),2013,45(3):443-447.DOI:10.3969/j.issn.1671-167X.2013.03.020
[19] Khan JA,Trujillo AJ,Ahmed S,et al.Distribution of chronic disease mortality and deterioration in household socioeconomic status in rural Bangladesh:an analysis over a 24-year period [J].Int J Epidemiol,2015,44(6):1917-1926.DOI:10.1093/ije/dyv197.
[2] 汤淑女,简伟研.社会经济地位与慢性病患病的关联——基于北京和上海工作群体的实证研究 [J].中国卫生政策研究,2012,5(1):51-55.DOI:10.3969 /j.issn.1674-2982.2012.01.010.Tang SN,Jian WY.The relationship between socio-economic status and prevalence of chronic disease:an empirical analysis based on working population in Beijing and Shanghai [J].Chinese Journal of Health Policy,2012,5(1):51-55.DOI:10.3969 /j.issn.1674-2982.2012.01.010.
[3] Mackenbach JP,Stirbu I,Roskam AJ,et al.Socioeconomic inequalities in health in 22 European countries [J].N Engl J Med,2008,358(23):2468-2481.DOI:10.1056/NEJMsa0707519.
[4] 李赪.云南统计年鉴 [M].中国统计出版社,2016.Li Z.Yunnan Statistical Yearbook [M] Beijing:China Statistics Press,2016.
[5] 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.Revision Committee of the Guidelines for the Prevention and Treatment of Hypertension in China.The Guidelines for the Prevention and Treatment of Hypertension in China (Revision 2016) [M] Beijing:People Public Health Publishing Company,2016.
[6] 徐永健,葛均波.内科学 [M].第8版.人民卫生出版社,2013.Xu YJ,Ge JB.Internal Medicine [M].8rd ed.People’s Health Publishing House,2013.
[7] Wu L,He Y,Jiang B,et al.Trends in prevalence,awareness,treatment and control of hypertension during 2001-2010 in an urban elderly population of China [J].PLoS One,2015,10(8):e132814.DOI:10.1371/journal.pone.0132814.
[8] Wang H,Zhang X,Zhang J,et al.Factors associated with prevalence,awareness,treatment and control of hypertension among adults in Southern China:a community-based,cross-sectional survey [J].PLoS One,2013,8(5):e62469.DOI :10.1371/journal.pone.0062469.
[9] Zhang S,Liu Z,Liu Y L,et al.Prevalence of stroke and associated risk factors among middle-aged and older farmers in western China [J].Environ Health Prev Med,2017,22(1):6.DOI :10.1186/s12199-017-0621-z.
[10] Tang X,Laskowitz DT,He L,et al.Neighborhood socioeconomic status and the prevalence of stroke and coronary heart disease in rural China:a population-based study [J].Int J Stroke,2015,10(3):388-395.DOI :10.1111/ijs.12343.
[11] Yin P,Zhang M,Li Y,et al.Prevalence of COPD and its association with socioeconomic status in China:findings from China chronic disease risk factor surveillance 2007 [J].BMC Public Health,2011,11(1):586.DOI:10.1186/1471-2458-11-586.
[12] Yang SH,Dou KF,Song WJ.Prevalence of diabetes among men and women in China [J].N Engl J Med,2010,362(25):2425-2426,2426.
[13] Hu X,Huang J,Lv Y,et al.Status of prevalence study on multimorbidity of chronic disease in China:systematic review[J].Geriatr Gerontol Int,2015,15(1):1-10.DOI:10.1111/ggi.12340
[14] 解晔,胡晓抒,钱晓勤.慢性非传染性疾病流行病学研究进展 [J].实用医学杂志,2009,25(10):1712-1714.Jie Y,Hu XS,Qian XQ.Research of epidemiology of chronic non-communicable diseases [J].The Journal of Practical Medicine,2009,25(10):1712-1714.
[15] 何利平,李晓梅,吴騻,等.云南省彝族居民卫生服务利用公平性研究 [J].卫生软科学,2017,31(4):21-24.DOI:10.3969/j.issn.1003-2800.2017.04.005.He LP,Li XM,Wu S,et al.Study on equity of health service utilization of Yi nationality residents in Yunnan Province [J] Soft Science of Health,2017,31(4):21-24.DOI:10.3969/j.issn.1003-2800.2017.04.005.
[16] 苏蓉,蔡乐,董峻,等.云南省4个独有少数民族糖尿病患病、知晓、治疗和控制现况及其与社会经济地位的相关性分析 [J].现代预防医学,2016,43(20):3733-3737.Su R,Cai L,Dong J,et al.The prevalence,awareness,treatment,control of diabetes and relationships with socioeconomic status among four unique ethnic minorities in Yunnan Province [J].Modern preventive medicine,2016,43(20):3733-3737.
[17] Park B,Ock M,Lee HA,et al.Multimorbidity and health-related quality of life in Koreans aged 50 or older using KNHANES 2013–2014 [J].Health Qual Life Outcomes,2018,16(1):186.DOI:10.1186/s12955-018-1016-6.
[18] 汤淑女,简伟研.中国就业人群慢性病的社会决定因素 [J].北京大学学报(医学版),2013,45(3):443-447.DOI:10.3969 /j.issn.1671-167X.2013.03.020 Tang SN,Jian WY.Social determinants of chronic disease in a working population in China [J].J Peking Univ (Health Sci),2013,45(3):443-447.DOI:10.3969/j.issn.1671-167X.2013.03.020
[19] Khan JA,Trujillo AJ,Ahmed S,et al.Distribution of chronic disease mortality and deterioration in household socioeconomic status in rural Bangladesh:an analysis over a 24-year period [J].Int J Epidemiol,2015,44(6):1917-1926.DOI:10.1093/ije/dyv197.