Comorbidities and their risk factors among hypertension patients from Jinchang Cohort
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摘要:
目的 了解金昌队列高血压患者合并症发病情况及其影响因素,为高血压患者的预后控制提供参考依据。 方法 收集金昌队列2011年6月 — 2015年12月完成基线调查和随访调查的4551例原发性高血压患者的相关数据,进行高血压患者合并症发病情况及其影响因素分析。 结果 金昌队列4551例基线高血压患者中,随访期间共325例患者发生不同程度的高血压合并症,总观察人年数为10174.90人年,发病密度为31.94/千人年;其中,299例(92.00 %)高血压患者仅出现1种合并症,26例(8.00 %)高血压患者出现 ≥ 2种合并症,3种高发合并症依次为脑卒中(12.87/千人年)、冠心病(10.91/千人年)和糖尿病(10.61/千人年)。多因素非条件logistic回归分析结果显示,年龄 ≥ 45岁是金昌队列高血压患者合并脑卒中的危险因素,文化程度大专及以上是金昌队列高血压患者合并脑卒中的保护因素;年龄 ≥ 45岁是金昌队列高血压患者合并冠心病的危险因素;年龄 ≥ 65岁、肥胖、总胆固醇(TC)异常和甘油三酯(TG)异常是金昌队列高血压患者合并糖尿病的危险因素。 结论 脑卒中、冠心病和糖尿病是金昌队列高血压患者的高发合并症且具有不同的发病风险,年龄较大是高血压患者合并脑卒中、冠心病和糖尿病的共同危险因素。 Abstract:Objective To investigate the incidence and influencing factors of comorbidities among hypertension patients in a cohort established among workers in an enterprise – Jinchang Cohort, and to provide references for prevention and management of comorbidities in hypertension patients. Methods The data on 4 551 primary hypertension patients were collected in a baseline survey and subsequent follow-ups were carried out during the period from June 2011 to December 2015 among the participants of Jinchang Cohort with on-the-job and retired workers in a large nonferrous metals and chemical enterprise located in Northwestern China. The incidence of comorbidities in the hypertension patients and their influencing factors were analyzed. Results Among the 4 551 hypertension patients, 325 developed comorbidities during the follow-up of 10 174.90 person-years and the comorbidity incidence density was 31.94/1 000 person years. Of the hypertension patients with comorbidities, 92.00% (299) and 8.00% (26) were detected with only one and two or more hypertension comorbidites. The top three comorbidities of the hypertension patients were stroke, coronary heart disease and diabetes, with the incidence densities of 12.87/1 000 person years, 10.91/1 000 person years and 10.61/1 000 person years, respectively. The results of unconditional multivariate logistic regression analysis demonstrated that aged ≥ 45 years was a risk factor for comorbidities of stroke and coronary heart disease, while with the education of college and above was a protective factor against stroke; aged ≥ 65 years, obesity, abnormal total cholesterol and abnormal triglyceride were risk factors for concurrent diabetes. Conclusion Stroke, coronary heart disease and diabetes are high-risk comorbidities of hypertension and older age is a common risk factor for the three comorbidities among the hypertension patients in the workers of Jinchang Cohort. -
Key words:
- hypertension patients /
- complication /
- incidence /
- influencing factor /
- Jinchang Cohort
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表 1 金昌队列不同特征高血压患者3种高发合并症发病情况比较
特征 高血压患者数 脑卒中 冠心病 糖尿病 n 发病密度
(1/千人年)n 发病密度
(1/千人年)n 发病密度
(1/千人年)性别 男性 3 070 90 13.18 74 10.83 71 10.40 女性 1 481 41 12.28 37 11.08 37 11.07 年龄(岁) < 45 1 141 4 1.69 10 4.23 16 6.77 45~64 2 472 69 12.44 60 10.82 65 11.72 ≥ 65 938 58 25.67 c 41 18.12 c 27 11.95 a 文化程度 初中及以下 2 419 101 17.87 73 12.91 68 12.03 高中/中专 1 247 22 8.02 24 8.75 24 8.75 大专及以上 885 8 4.51 c 14 7.90 a 16 9.03 职业 干部 580 12 9.64 15 12.06 16 12.88 技术人员 151 4 13.03 3 9.77 3 9.77 工人 3 442 100 12.87 85 10.94 81 10.42 内勤服务人员 378 15 17.72 8 9.44 8 9.44 家庭人均月收入(元) < 2 000 2 430 77 14.05 53 9.67 55 10.04 ≥ 2 000 2 121 54 11.52 58 12.37 53 11.30 吸烟情况 从不吸烟 2 210 56 11.33 49 9.91 57 11.54 目前仍吸烟 1 740 47 12.46 45 11.93 35 9.28 现已戒烟 601 28 19.23 a 17 11.69 16 10.99 饮酒情况 从不饮酒 3 088 96 13.79 80 11.49 80 11.49 目前仍饮酒 1 164 21 8.38 25 9.98 22 8.78 现已戒酒 299 14 19.91 a 6 8.53 6 8.55 体育锻炼情况 从不体育锻炼 558 19 16.35 10 8.60 18 15.48 偶尔体育锻炼 1 535 31 9.41 32 9.71 25 7.59 经常体育锻炼 2 458 81 14.18 a 69 12.08 65 11.38 a 高血压家族史 无 2 461 93 16.45 66 11.66 60 10.61 有 2 090 38 8.42 c 45 9.97 48 10.64 高血压病程(年) < 5 2 298 47 9.40 47 9.39 55 11.00 5~9 974 32 14.51 28 12.71 19 8.62 10~14 617 25 17.82 15 10.69 13 9.28 ≥ 15 662 27 17.31 b 21 13.46 21 13.45 体检血压分期 正常血压 1 338 40 13.54 36 12.19 24 8.12 I期高血压 1 665 34 9.19 34 9.19 38 10.27 II期高血压 1 055 35 14.64 25 10.46 33 13.81 III期高血压 493 22 19.54 a 16 14.21 13 11.57 BMI 正常体重 1 456 46 14.01 40 12.18 25 7.61 超重 2 204 59 11.95 51 10.33 45 9.12 肥胖 891 26 13.36 20 10.28 38 19.52 c TC 正常 4 111 120 13.01 100 10.84 88 9.54 异常 440 11 11.63 11 11.63 20 21.14 b TG 正常 2 843 87 13.48 69 10.69 45 6.97 异常 1 708 44 11.84 42 11.30 63 16.96 c HDL-C 正常 3 804 110 12.96 92 10.84 83 9.78 异常 747 21 12.50 19 11.30 25 14.87 LDL-C 正常 4 078 118 12.93 97 10.63 94 10.30 异常 473 13 12.45 14 13.43 14 13.41 UA 正常 3 492 97 12.49 84 10.82 81 10.43 异常 1 059 34 14.14 27 11.23 27 11.23 注:各组内比较,a P < 0.05;b P < 0.01;c P < 0.001。 表 2 金昌队列高血压患者3种高发合并症发病影响因素多因素非条件logistic回归分析
高发并发症 参照组 β $S_{\bar x}$ Wald χ2 值 P 值 OR 值 95 % CI 脑卒中 年龄(岁) 45~64 < 45 1.641 0.526 9.733 0.002 5.162 1.841~14.475 ≥ 65 2.353 0.538 19.130 < 0.001 10.514 3.664~30.173 文化程度 高中/中专 初中及以下 – 0.449 0.259 3.018 0.082 0.638 0.384~1.059 大专及以上 – 1.206 0.473 6.500 0.011 0.299 0.118~0.757 冠心病 年龄(岁) 45~64 < 45 0.904 0.348 6.760 0.009 2.470 1.249~4.883 ≥ 65 1.526 0.363 17.711 < 0.001 4.601 2.260~9.366 糖尿病 年龄(岁) 45~64 < 45 0.520 0.291 3.185 0.074 1.682 0.950~2.977 ≥ 65 0.927 0.335 7.629 0.006 2.526 1.309~4.875 BMI 超重 正常体重 0.012 0.279 0.002 0.965 1.012 0.586~1.747 肥胖 0.849 0.287 8.739 0.003 2.337 1.331~4.104 TC 异常 正常 0.657 0.274 5.726 0.017 1.929 1.126~3.303 TG 异常 正常 0.951 0.226 17.669 < 0.001 2.587 1.661~4.030 -
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