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贵州省不同社会经济地位成年居民健康生活方式对糖尿病发病影响

Impact of healthy lifestyle on diabetes incidence among adults of different socioeconomic status in Guizhou province: a prospective cohort study

  • 摘要:
    目的 了解贵州省不同社会经济地位(SES)成年居民健康生活方式对糖尿病发病的影响,为糖尿病的预防控制提供参考依据。
    方法 采用前瞻性队列研究方法,于2010年11月 — 2012年12月采用多阶段整群随机抽样方法在贵州省抽取9 280名 ≥ 18岁常住居民进行基线调查,并于2016年12月 — 2021年6月进行随访,排除基线有糖尿病病史和患病情况不明者以及失访和随访结局不明人群后最终纳入4747名成年居民,采用多因素Cox比例风险回归模型分析不同SES成年居民健康生活方式对糖尿病发病的影响。
    结果 贵州省4 747名成年居民随访0.10~9.52年,平均随访(6.98 ± 1.44)年,随访期间糖尿病发病560例,糖尿病发病率为11.80%,发病密度为168.90/1 000人年。多因素Cox比例风险回归模型分析结果显示,在调整了性别、年龄、民族、婚姻状况、居住地、有无糖尿病家族史和SES后,贵州具有3种、4种和 ≥ 5种健康生活方式成年居民糖尿病发病风险分别较具有 ≤ 2种健康生活方式成年居民分别降低34.5%(HR = 0.655,95%CI = 0.517~0.830)、38.1%(HR = 0.619,95%CI = 0.479~0.800)和70.8%(HR = 0.292,95%CI = 0.184~0.465);在调整了性别、年龄、民族、婚姻状况、居住地、有无糖尿病家族史和具有健康生活方式数量后,贵州省SES评分 ≥ 12分成年居民糖尿病发病风险较SES评分 ≤ 8分成年居民降低28.7%(HR = 0.713,95%CI = 0.541 ~ 0.940);在调整了性别、年龄、民族、婚姻状况、居住地和有无糖尿病家族史后,贵州省具有 ≥ 5种健康生活方式SES评分 ≤ 8分成年居民糖尿病发病风险较具有 ≤ 2种健康生活方式SES评分 ≤ 8分成年居民降低60.4%(HR = 0.396,95%CI = 0.198~0.788),具有3种、4种和 ≥ 5种健康生活方式SES评分9~11分成年居民糖尿病发病风险较具有 ≤ 2种健康生活方式SES评分9~11分成年居民分别降低42.0%(HR = 0.580,95%CI = 0.397~0.848)、36.6%(HR = 0.634,95%CI = 0.424~0.947)和78.0%(HR = 0.220,95%CI = 0.094~0.514),具有4种和 ≥ 5种健康生活方式SES评分 ≥ 12分成年居民糖尿病发病风险较具有 ≤ 2种健康生活方式SES评分 ≥ 12分成年居民分别降低50.4%(HR = 0.496,95%CI = 0.276~0.894)和71.4%(HR = 0.286,95%CI = 0.110~0.740)。
    结论 较高的SES或具备的健康生活方式较多均可降低贵州省成年居民糖尿病的发病风险,但处于低SES者需具有足够多的健康生活方式才能降低糖尿病的发病风险。

     

    Abstract:
    Objective To understand the impact of healthy lifestyle on diabetes incidence among adults with different socioeconomic status (SES) in Guizhou province and provide reference for diabetes prevention and control.
    Methods A total of 9 280 permanent residents aged ≥ 18 years in Guizhou Province were recruited using multistage cluster random sampling. Face-to-face interviews with a questionnaire developed by the Chinese Center for Disease Control and Prevention, physical examinations, and laboratory tests were conducted among the residents from November 2010 to December 2012 to collect baseline data, and follow-up surveys were conducted from December 2016 to June 2021. After excluding those with a history of diabetes at baseline, unclear diabetes status, loss to follow-up, and unclear follow-up outcomes, 4 747 adults were included in the final analysis. Multivariate Cox proportional hazards regression models were used to analyze the effect of healthy lifestyle on diabetes incidence among adults with different SES.
    Results The 4 747 adults were followed for 0.1 – 9.52 years, with a mean follow-up of 6.98 ± 1.44 years. During follow-up, 560 cases of diabetes were identified, with an incidence rate of 11.80% and an incidence density of 16.89/1 000 person-years. Multivariate Cox proportional hazards regression analysis showed that after adjustment for gender, age, ethnicity, marital status, place of residence, family history of diabetes, and SES score, adults with 3, 4, and ≥ 5 healthy lifestyle factors had 34. 5% (hazard ratio HR = 0.655, 95% confidence interval 95%CI: 0.517 – 0.830), 38.1% (HR = 0.619, 95%CI: 0.479 – 0.800), and 70.8% (HR = 0.292, 95%CI: 0.184 – 0.465) lower diabetes risk, respectively, compared with those with ≤ 2 healthy lifestyle factors. After adjustment for gender, age, ethnicity, marital status, place of residence, family history of diabetes, and number of healthy lifestyle factors, adults with an SES score of ≥ 12 had a 28.7% (HR = 0.713, 95%CI: 0.541 – 0.940) lower risk of diabetes compared with those with an SES score of ≤ 8. After adjustment for gender, age, ethnicity, marital status, place of residence, and family history of diabetes, among adults with an SES score of ≤ 8, those with 5 or more healthy lifestyle factors had a 60.4% (HR = 0.396, 95%CI: 0.198 – 0.788) lower risk of diabetes compared with those with 2 or fewer factors. Among adults with SES scores of 9 – 11, those with 3, 4, and ≥ 5 healthy lifestyle factors had 42.0% (HR = 0.580, 95%CI: 0.397 – 0.848), 36.6% (HR = 0.634, 95%CI: 0.424 – 0.947), and 78.0% (HR = 0.220, 95%CI: 0.094 – 0.514) lower diabetes risk, respectively. Among adults with an SES score of ≥ 12, those with 4 and 5 or more healthy lifestyle factors had 50.4% (HR = 0.496, 95%CI: 0.276 – 0.894) and 71.4% (HR = 0.286, 95%CI: 0.110 – 0.740) lower diabetes risk, respectively compared with those with 2 or fewer factors.
    Conclusions Both higher SES and more healthy lifestyle factors can reduce the risk of diabetes among adults in Guizhou province. However, those with low SES need to maintain a sufficient number of healthy lifestyle factors to reduce their diabetes risk.

     

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