首页|基层老年慢性病患者心血管疾病综合发生风险的影响因素研究

基层老年慢性病患者心血管疾病综合发生风险的影响因素研究

A Study on the Factors Influencing the Comprehensive Risk of Cardiovascular Disease in Elderly Patients with Chronic Disease in Primary Care

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背景 心血管疾病是造成我国居民死亡和疾病负担的首要病因,防控形势严峻.心血管疾病风险影响因素管理是预防心血管疾病的重要基础.但目前国内外应用单导联可穿戴心电设备针对基层老年慢性病患者心血管疾病发生风险的影响因素调查研究较少,且在既往研究中也未以整体观对患者包含不同数量风险的变量重要性进行排序.目的 分析基层管理的 65 岁以上老年慢性病患者心血管疾病综合发生风险的影响因素,为基层心血管疾病综合防控提供客观依据及帮助.方法 选取 2021 年 12 月—2022 年 9 月宁夏回族自治区 26 家基层医疗卫生机构的 3 039 例 65岁以上+高血压、糖尿病、冠心病其中至少 1 种慢性病的患者为研究对象.依据 72 h心电图分析结果划分为正常组632 例、风险组 2 407 例.分析两组患者基本资料,确定最佳λ值,绘制模型,采用LASSO回归和多因素Logistic回归分析探讨老年慢性病患者心血管疾病综合风险影响因素;并对影响心血管疾病综合风险及包含不同数量风险的变量排序.结果 两组患者年龄、性别、BMI、教育程度、职业、城乡分布、吸烟、运动、冠心病+糖尿病、高血压+冠心病及糖尿病比较,差异均有统计学意义(P<0.05);最佳λ值为 0.015 685 31.LASSO回归和多因素Logistic回归模型分析显示年龄、BMI、城乡分布、吸烟、高血压+冠心病+糖尿病是心血管疾病综合风险的影响因素(P<0.05).受试者工作特征曲线下面积(AUC)=0.650(95%CI=0.627~0.673,P<0.001).影响综合风险及不同数量风险种类变量排序前五位的分别为:年龄、BMI、城乡分布、饮茶、运动;年龄、高血压+冠心病、性别、城乡分布、吸烟;年龄、高血压+冠心病、性别、BMI、城乡分布;糖尿病+冠心病、年龄、高血压+冠心病、高血压+冠心病+糖尿病、高血压+糖尿病.结论 年龄、BMI、城乡分布、吸烟、高血压合并冠心病及糖尿病是 65 岁以上+慢性病患者发生心血管疾病风险的影响因素.除年龄外,BMI及生活习惯对心血管疾病综合风险的发生影响较为重要,随着+风险种类数量的增多,慢性病尤其慢性病共病的影响增强.基层医护团队应以单导联可穿戴设备为载体定期对老年慢性病患者进行心血管疾病综合发生风险管理,其不但可高效、低成本的实现心血管疾病发生风险的一级、二级预防及健康管理,并可加速基层医疗服务应加快从不连贯的诊疗服务向全程健康管理的转变.
Background Cardiovascular disease is the primary cause of death and Disease burden of Chinese residents,and the situation of prevention and control is grim.Management of risk factors for cardiovascular disease is an important foundation for preventing cardiovascular disease.However,there is currently limited research on the influencing risk factors of cardiovascular disease risk in elderly patients with chronic disease in primary care using single lead wearable electrocardiogram devices both domestically and internationally,and previous studies have not ranked the importance of variables containing different quantities of risk in patients from a holistic perspective.Objective The aim of this study is to analyze the influencing factors of the comprehensive risk of cardiovascular disease in elderly patients with chronic disease aged 65 and above in primary care in Ningxia,and to provide objective basis and assistance for the comprehensive prevention and control of cardiovascular disease in primary care.Methods From December 2021 to September 2022,totally 3 039 patients over 65 years old with hypertension,diabetes and coronary heart disease,including at least one chronic disease,from 26 primary care health center in Ningxia were selected as the research subjects.According to the analysis of the 72 hour electrocardiogram,there were 632 cases in the normal group and 2 407 cases in the risk group.Analyze the basic information of two groups of patients to determine the best λ Value,draw a model,and use LASSO regression and multivariate Logistic regression to analyze the comprehensive risk factors of cardiovascular disease in elderly patients with chronic diseases;and rank the variables that affect the overall risk of cardiovascular disease and include different numbers of risks among patients.Results The differences in age,gender,BMI,education level,occupation,urban-rural distribution,smoking,exercise,coronary heart disease combined with diabetes,hypertension combined with coronary heart disease and diabetes between the two groups of patients were statistically significant(P<0.05);optimum λvalue was 0.015 685 31.LASSO regression and multivariate logistic regression model analysis showed that age,BMI,urban-rural distribution,smoking Hypertension combined with coronary heart disease and diabetes is a influencing factor for cardiovascular disease(P<0.05).Auc was 0.650(95%CI=0.627-0.673,P<0.001)The top five variables that affect comprehensive risk and different types of risk are age,BMI,urban-rural distribution,tea drinking,and exercise;Age,hypertension combined with coronary heart disease,gender,urban-rural distribution,smoking;Age,hypertension combined with coronary heart disease,gender,BMI,urban-rural distribution;Diabetes combined with coronary heart disease,age,hypertension combined with coronary heart disease,hypertension combined with coronary heart disease and diabetes,hypertension combined with diabetes.Conclusion Age,BMI,urban and rural distribution,smoking,hypertension with coronary heart disease and diabetes are the influencing factors of cardiovascular disease risk in patients over 65 years old with chronic diseases.In addition to age,BMI and lifestyle habits have a significant impact on the overall risk of cardiovascular disease.As the number of comorbidities increases,the impact of chronic diseases,especially chronic disease comorbidities,increases.Primary care medical teams should regularly conduct comprehensive CVD risk management for elderly patients with multiple chronic diseases using single lead wearable devices.This not only enables efficient and low-cost implementation of primary and secondary prevention and health management of CVD risks,but also accelerates the transformation of primary medical services from inconsistent diagnosis and treatment services to full process health management.

Chronic diseasePrimary health care organizationsAgedCardiovascular diseasesRoot cause analysisRanking of variables

余新艳、苏鹏、袁晓静、姜清茹、杨建云、赵旭东、王一凡、张海澄

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750001 宁夏回族自治区银川市第一人民医院健康管理体检中心

063210 河北省唐山市,华北理工大学公共卫生学院

221000 江苏省徐州市中心医院

750001 宁夏回族自治区银川市第一人民医院景城社区卫生服务站

750001 宁夏回族自治区银川市第一人民医院新华街社区卫生服务中心

750001 宁夏回族自治区银川市第一人民医院前进街明德社区卫生服务站

100044 北京市,北京大学人民医院心内科

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慢性病 基层医疗卫生机构 老年人 心血管疾病 影响因素分析 变量排序

国家社会科学基金重大项目银川市科技创新重点重大专项

18ZDA086-42021-SF-009

2024

中国全科医学
中国医院协会

中国全科医学

CSTPCD北大核心
影响因子:2.04
ISSN:1007-9572
年,卷(期):2024.27(10)
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