摘要
目的 了解北京城乡老年人群血脂异常的患病、知晓、治疗和控制情况,探索血脂异常与全因死亡的关联,为北京老年社区人群的血脂管理提供科学依据.方法 数据来源于北京城乡老年人群健康综合研究(Beijing Elderly Comprehensive Health Cohort Study,BECHCS)的基线和随访资料.BECHCS采用多阶段整群抽样方法,于2009年在北京市海淀区万寿路街道随机抽取2 102名老年居民作为城市地区研究对象,2014年在北京市密云区随机抽取2 397名老年居民作为农村地区研究对象,共4499名社区老人纳入研究,进行问卷调查、体格检查和实验室检测.采用SPSS 24.0软件进行x2检验、多因素logistic回归分析.采用多因素Cox比例风险模型分析血脂异常对全因死亡的影响.结果 共纳入4 499名老年人,平均年龄为(70.5±6.8)岁.调查人群总胆固(TC)升高、甘油三酯(TG)升高、低密度脂蛋白胆固醇(LDL-C)升高和高密度脂蛋白胆固醇(HDL-C)降低的患病率分别为12.09％、14.34％、11.22％和9.27％,血脂异常的患病率、知晓率、治疗率和控制率分别为40.30％、45.67％、23.50％和14.73％.多因素logistic回归分析结果显示,女性(OR=1.789)、初中及以上(OR=1.375)、超重(OR=1.890)、肥胖(OR=2.449)、患高血压(OR=1.399)、患糖尿病(OR=1.466)、血尿酸 200～419μmol/L(OR=1.487)及≥420μmol/L(OR=2.660)、城镇(OR=1.920)的老年人群血脂异常的患病风险更高,均有统计学意义(P＜0.05).多因素Cox比例风险模型分析结果显示,在调整可能的混杂因素后,HDL-C降低能显著增加老年人群的全因死亡风险(HR=1.286,95％CI:1.017～1.627),TC 升高(HR=0.946,95％CI:0.744～1.203)、TG 升高(HR=1.067,95％CI:0.849～1.341)、LDL-C 升高(HR=0.985,95％CI:0.769～1.262)和总体血脂异常(HR=0.996,95％CI:0.843～1.176)对老年人群的全因死亡影响均无统计学意义(P＞0.05).结论 北京城乡老年人群血脂异常的患病率较高,知晓率、治疗率和控制率较低,应针对HDL-C降低的老年人群进行重点干预和管理,以降低全因子死亡风险.
Abstract
Objective To understand the prevalence,awareness,treatment and control of dyslipidemia among the urban and rural elderly in Beijing,explore the relationship between dyslipidemia and all-cause death,and provide the scientific basis for lipid management of urban and rural elderly in Beijing.Methods The data were from the baseline and follow-up data of Beijing Elderly Comprehensive Health Cohort Study(BECHCS).The multi-stage cluster sampling method was used to select 2 102 urban elderly from Wanshou Road in Haidian district in 2009 and 2 397 rural elderly from Miyun district of Beijing in 2014 as the subjects,respectively.A total of 4 499 older adults were included in the study.The investigation was conducted with the questionnaire,physical examination and laboratory test.The x2 test and multivariate logistic regress were used to analyze the data.The multivariate Cox proportional risk model was used to analyze the effect of dyslipidemia on all-cause death.Results The average age of 4 499 subjects was(70.5±6.8)years old.The morbidity rates of elevated total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C)and decreased high density lipoprotein cholesterol(HDL-C)were 12.09％,14.34％,11.22％,and 9.27％,respectively;the rates of morbidity,awareness,treatment,and control of dyslipidemia were 40.30％,45.67％,23.50％,and 14.73％,respectively.The multivariate logistic regress results showed that the risk in elderly with female(OR=1.7 89),educational level≥junior middle school(OR=1.375),overweight(OR=1.890),obesity(OR=2.449),hypertension(OR=1.399),diabetes(OR=1.466),blood uric acid 200-419 μmol/L(OR=1.487)and ≥420 μmol/L(OR=2.660)and living in urban(OR=1.920)was much higher(P＜0.05).The multivariate Cox proportional risk model analysis results showed that after adjusting possible confounding factors,the decreased HDL-C could significantly increase the risk of all-cause mortality in elderly(HR=1.286,95％CI:1.017-1.627).There was not significant influence of elevated TC(HR=0.946,95％CI:0.744-1.203),elevated TG(HR=1.067,95％CI:0.849-1.341),elevated LDL-C(HR=0.985,95％CI:0.769-1.262)and total dyslipidemia(HR=0.996,95％CI:0.843-1.176)on all-cause death in elderly(P＞0.05).Conclusion The dyslipidemia morbidity among urban and rural elderly in Beijing was higher,while the rates of awareness,treatment,and control were lower.It should take the intervention and management for reducing HDL-C level of elderly to reduce the risk of all-cause mortality.
基金项目
国家自然科学基金(82173589)
国家自然科学基金(82173590)
浙江省智能预防医学重点实验室(2-6-2020E10004)
首都卫生发展科研专项(2022-2G-5031)
军队保健重点课题(22BJZ25)
国家重点研发计划(2022YFC2503605)
NETL
NSTL
万方数据