中国中老年人症状性膝骨关节炎的发病率及危险因素

Incidence and risk factors of symptomatic knee arthritis in middle-aged and elderly people in China

目的明确中国中老年人群症状性膝关节骨关节炎(SKOA)的发病率及其危险因素,为卫生健康政策的制定和医师的临床决策提供参考。方法中国健康与养老追踪调查(CHARLS)是一项对全国45岁以上人群的纵向调查。SKOA定义为医生诊断的关节炎和自我报告膝关节疼痛同时存在。本研究分别从2011、2013、2015和2018 CHARLS的"基本信息"和"身体健康状况与功能"等数据库中提取年龄、性别、地区、教育程度等研究相关变量,并根据受访者ID合并成纵向研究数据库,计算各调查年份受访者的协变量构成比、SKOA累积发病率和95%,置信区间(CI),最后使用Cox比例风险模型明确SKOA的风险因素。结果2011年至2013年,2013年至2015年和2015至2018年中国中老年人群SKOA年龄标化发病率分别为7.09%(6.27%~8.01%),13.13%(12.10%~14.24%)和23.10%(22.45%~23.79%),呈明显上升的趋势;女性发病率高于男性,随着年龄增加而增加。女性[风险比值(HR)1.67,χ^(2)=9.98,P<0.001]、年龄增加(50~60岁HR=1.60,χ^(2)=7.67,P<0.001;60~70岁HR=1.96,χ^(2)=10.76,P<0.001;年龄≥70岁HR=2.16,χ^(2)=9.94,P<0.001)和农村地区(HR=1.24,χ^(2)=4.74,P<0.001)SKOA的发生风险较高。高等教育水平(初、高中及职业教育HR=0.68,χ^(2)=-4.57,P<0.001;大学及以上HR=0.59,χ^(2)=-2.55,P=0.01)和运动(HR=0.32,χ^(2)=-7.08,P<0.001)SKOA的发生风险较低。结论我国中老年人群SKOA发病率较高,且呈上升的趋势。文化程度较低和缺乏运动被证实是发生SKOA的危险因素。

Objective To investigate the incidence of symptomatic keen osteoarthritis(SKOA)and its risk factors among the Chinese elderly population,and to provide references for the formulation of health policies and clinicians'decision-making.Methods The China Health and Retirement Longitudinal Study(CHARLS)is a nationwide longitudinal survey of persons aged≥45 years.SKOA was diagnosed when both self-reported knee pain and self-reportedphysician-diagnosis arthritis existed.Relevant variables such as age,gender,regions,education were extracted from the"Demographic Background"and"Health Status and Functioning"databases of CHARLS in 2011,2013,2015 and 2018,and combined into a longitudinal study database according to the respondent ID.The constituent ratio of covariates,the cumulative incidence of SKOA and 95%confidence interval(CI)of the respondents in each survey year were calculated.Finally,Cox proportional hazards model was used to identify the risk factors of SKOA.Results In 2011 to 2013,2013 to 2015,and 2015 to 2018,the cumulative incidence of SKOA among middle-aged and elder Chinese adults were 7.09%(6.27-8.01)%,13.13%(12.10-14.24)%,and 23.10%(22.45-23.79)%,respectively.It was on a marked upward trend.The incidence was higher among females than males,increases with age.Female[hazard ratio(HR)=1.67,χ^(2)=9.98,P<0.001],increasing age(50-60 years HR=1.60,χ^(2)=7.67,P<0.001,60-70 years HR=1.96,χ^(2)=10.76,P<0.001,age≥70 years HR=2.16,χ^(2)=9.94,P<0.001),and rural area(HR=1.24,χ^(2)=4.74,P<0.001)were associated with a higher risk of incident SKOA.Education level(junior and high school and vocational education HR=0.68,χ^(2)=-4.57,P<0.001;above college HR=0.59,χ^(2)=-2.55,P=0.01)and physical activities(HR=0.32,χ^(2)=-7.08,P<0.001)were associated with a lower risk of incident SKOA.Conclusions The cumulative incidence of SKOA in middle-aged and elderly population in China is relatively high and is on the rise.Low education and lack of physical activities are confirmed to be risk factors of incident SKOA.