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河北省35~75岁居民4种健康生活方式与全因死亡和心血管病死亡关系

Relationship between four healthy lifestyle factors and all-cause and cardiovascular disease mortality among residents aged 35 – 75 years in Hebei province

  • 摘要:
    目的 了解河北省35~75岁居民4种健康生活方式与全因死亡和心血管病(CVD)死亡关系,为促进居民遵循健康生活方式提供科学依据。
    方法 收集2016年9月 — 2022年12月全国 CVD 高危人群早期筛查与综合干预项目中河北省邯郸市大名县、邢台市清河县、张家口市宣化区、石家庄市裕华区、承德市承德县、廊坊市三河市、保定市曲阳县、沧州市黄骅市、衡水市深州市、唐山市遵化市和秦皇岛市抚宁区11个区县CVD高危筛查项目点不吸烟、不饮酒或适量饮酒、充足的身体活动和健康饮食4种健康生活方式和社会经济特征信息完整且无CVD和癌症病史的48377名35~75岁居民的相关数据,并与死因监测平台进行匹配,追踪截至2022年12月31日的死亡结局,并采用多因素Cox比例风险回归模型分析不吸烟、不饮酒或适量饮酒、充足的身体活动和健康饮食4种健康生活方式与全因死亡和CVD死亡的关系。
    结果 河北省纳入分析的48377名35~75岁居民中,遵循不吸烟、不饮酒或适量饮酒、充足的身体活动和健康饮食的居民分别为3951347026100406606人,遵循率分别为81.68%、97.21%、20.70%和13.66%;遵循全部4种健康生活方式居民1360人,遵循率为2.81%。截至2022年12月31日,河北省纳入分析的35~75岁居民全因死亡和CVD死亡分别为878和478例,死亡比例分别为1.81%和0.99%;不吸烟、不饮酒或适度饮酒、充足的身体活动、健康饮食居民的全因死亡和CVD死亡例数分别为629和346例、847和463例、153和85例、88和48例,全因死亡和CVD死亡的比例分别为1.59%和0.88%、1.80%和0.98%、1.52%和0.85%、1.33%和0.73%;具有0、1、2、3、4种健康方式居民的全因死亡和CVD死亡例数分别为18和9例、171和88例、528和294例、154和82例、7和5例,全因死亡和CVD死亡的比例分别为2.86%和1.43%、2.79%和1.43%、1.81%和1.01%、1.39%和0.74%、0.51%和0.37%。在调整了性别、年龄、文化程度、婚姻状况、职业、家庭年收入、居住地和有无社会医疗保险等混杂因素后,多因素Cox比例风险回归分析结果显示,河北省遵循充足的身体活动和健康饮食健康生活方式35~75岁居民的全因死亡风险分别为未遵循充足的身体活动和健康饮食健康生活方式35~75岁居民的0.74倍(HR = 0.74,95%CI = 0.61~0.90)和0.76倍(HR = 0.76,95%CI = 0.60~0.96),遵循4种健康生活方式35~75岁居民的全因死亡风险为4种健康生活方式均未遵循35~75岁居民的0.26倍(HR = 0.26,95%CI = 0.11~0.63)。
    结论 河北省35~75岁居民4种健康生活方式遵循率较低,遵循充足的身体活动、健康饮食和全部4种健康生活方式可降低当地居民的全因死亡风险。

     

    Abstract:
    Objective To investigate the relationship between four healthy lifestyle factors and all-cause and cardiovascular disease (CVD) mortality among residents aged 35 – 75 years in Hebei province, and to provide scientific evidence for promoting healthy lifestyles.
    Methods Data were collected from 48 377 residents aged 35 – 75 years in 11 districts and counties of Hebei province (Daming county, Handan city; Qinghe county, Xingtai city; Xuanhua district, Zhangjiakou city; Yuhua district, Shijiazhuang city; Chengde county, Chengde city; Sanhe city, Langfang city; Quyang county, Baoding city; Huanghua city, Cangzhou city; Shenzhou city, Hengshui city; Zunhua city, Tangshan city; and Funing district, Qinhuangdao city) who participated in the National Early Screening and Comprehensive Intervention Program for High-Risk Populations of CVD from September 2016 to December 2022. These participants had complete information on four healthy lifestyle factors (non-smoking, no or moderate alcohol consumption, adequate physical activity, and a healthy diet) and socio-economic characteristics, and no history of CVD or cancer. Mortality data were obtained by linking with the cause-of-death surveillance platform, with follow-up until December 31, 2022. Multivariable Cox proportional hazards regression models were used to analyze the relationship between the four healthy lifestyle factors and all-cause and CVD mortality.
    Results Among the 48 377 residents aged 35 – 75 years included in the analysis, 39 513 (81.68%), 47 026 (97.21%), 10 040 (20.70%), and 6 606 (13.66%) adhered to non-smoking, no or moderate alcohol consumption, adequate physical activity, and a healthy diet, respectively. Only 1 360 (2.81%) adhered to all four healthy lifestyle factors. By December 31, 2022, there were 878 (1.81%) all-cause deaths and 478 (0.99%) CVD deaths. Among those adhering to non-smoking, no or moderate alcohol consumption, adequate physical activity, and a healthy diet, there were 629 and 346, 847 and 463, 153 and 85, and 88 and 48 all-cause and CVD deaths, respectively, with corresponding mortality rates of 1.59% and 0.88%, 1.8% and 0.98%, 1.52% and 0.85%, and 1.33% and 0.73%. Among residents with 0, 1, 2, 3, and 4 healthy lifestyle factors, there were 18 and 9, 171 and 88, 528 and 294, 154 and 82, and 7 and 5 all-cause and CVD deaths, respectively, with corresponding mortality rates of 2.86% and 1.43%, 2.79% and 1.43%, 1.81% and 1.01%, 1.39% and 0.74%, and 0.51% and 0.37%. After adjusting for potential confounders including sex, age, education level, marital status, occupation, annual household income, residence, and social health insurance, multivariable Cox proportional hazards regression analysis showed that adherence to adequate physical activity and a healthy diet was associated with a 26% (HR = 0.74, 95%CI: 0.61 – 0.90) and 24% (HR = 0.76, 95%CI: 0.60 – 0.96) lower risk of all-cause mortality, respectively, compared to non-adherence. Adherence to all four healthy lifestyle factors was associated with a 74% (HR = 0.26, 95%CI: 0.11 – 0.63) lower risk of all-cause mortality compared to non-adherence to any of the four factors.
    Conclusions The adherence rates to the four healthy lifestyle factors were low among residents aged 35 – 75 years in Hebei province. Adherence to adequate physical activity, a healthy diet, and all four healthy lifestyle factors can reduce the risk of all-cause mortality.

     

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