慢性病高风险人群缺血性心血管病10年发病风险干预效果评价

Effects of lifestyle intervention on ten-year risk for ischaemic cardiovascular disease in high risk residents with non-communicable diseases

目的评价深圳市福田区慢性病高风险人群缺血性心血管病(ICVD)10年发病风险干预效果,为后续深入开展慢性病高风险人群健康管理工作提供科学依据。方法于2013年10-11月从深圳市福田区115个社区中通过简单随机抽样的方法抽取12个,从中筛查出慢性病高风险人群1 923名。根据社区来源不同非随机分为干预组和对照组,干预组提供以健康生活方式指导为主的健康管理,对照组不主动采取任何形式的干预活动,进行为期2年的干预和随访。共得到1 563名(干预组1 002名、对照组561名)研究对象。干预前后均计算ICVD 10年发病风险绝对危险。采用SPSS 17.0统计软件进行t检验、Wilcoxon符号秩和检验和χ~2检验,采用倍差法评价ICVD 10年发病风险绝对危险干预效果。结果男性干预组、男性对照组、女性干预组和女性对照组干预前ICVD 10年发病风险绝对危险分别为3.54%±3.05%、4.02%±3.56%、2.30%±2.27%和3.05%±2.71%,中位数(P_(25),P_(75))分别为2.90%(1.50%,3.90%)、2.90%(1.50%,5.40%)、2.10%(0.50%,3.90%)、2.90%(0.50%,3.90%);干预后ICVD 10年发病风险绝对危险分别为3.61%±3.28%、5.07%±5.13%、2.75%±2.92%和4.21%±3.93%,中位数(P_(25),P_(75))分别为2.90%(1.50%,5.40%)、3.90%(1.50%,7.30%)、2.10%(0.30%,3.90%)和2.90%(1.50%,5.40%)。调整混杂因素后,男性或女性ICVD 10年发病风险绝对危险干预效果倍差法模型中,βE分别为-0.973和-0.714,均有统计学意义(P<0.01),显示干预使男性或女性干预组ICVD 10年发病风险绝对危险分别下降0.973%和0.714%。干预后,男性干预组ICVD 10年发病风险绝对危险高危个体所占比例由2.23%变为3.23%,差异无统计学意义(P>0.05);男性对照组ICVD 10年发病风险绝对危险高危个体所占比例由3.72%上升至9.50%,差异有统计学意义(P<0.01)。女性干预组ICVD 10年发病风险绝对危险中危个体所占比例由8.01%上升至10.03%,高危个体所占比例由0.67%上升至1.67%;女性对照组ICVD 10年发病风险绝对危险中危个体所占比例由11.92%上升至28.53%,高危个体所占比例由2.19%上升至5.95%,差异均有统计学意义(P<0.01)。女性干预组相应指标上升幅度低于女性对照组。结论对慢性病高风险人群开展针对性干预能够一定程度上改善ICVD 10年发病风险绝对危险,为探索慢性病高风险人群健康管理模式提供了可借鉴的经验。

Objective To evaluate the effects of lifestyle intervention on ten-year risk for ischaemic cardiovascular disease(ICVD)in high risk residents with non-communicable diseases(NCDs),and to provide the scientific evidence for the health management of high risk residents with NCDs in Futian district of Shenzhen city. Methods A total of 12 communities were randomly selected from 115 Futian districts of Shenzhen city in Oct.-Nov. of 2013,and 1 923 residents with high risk of NCDs were screened. The subjects were non-randomly divided into intervention group and control group according to different communities,1 563 subjects(1 002 cases in intervention group with health management of healthy lifestyle,561 cases in control group without any intervention measure) were followed up for 2 years. The absolute risk of ICVD for ten-years was calculated before and after intervention. The t test,Wilcoxon signed rank test and Chi-square test were used to analyze the data,the used software was SPSS 17.0. The intervention effects on absolute risk of ICVD for ten-years was assessed by difference-in-difference method. Results For male intervention and control groups,female intervention and control groups,the arithmetical average absolute ICVD risk for ten-years before intervention were 3.54% ±3.05% and 4.02%±3.56%;2.30%±2.27% and 3.05% ±2.71%,respectively;the median M(P25,P75) were 2.90%(1.50%,3.90%) and 2.90%(1.50%,5.40%);2.10%(0.50%,3.90%) and 2.90%(0.50%,3.90%),respectively;after intervention ICVD risk for ten-years were 3.61% ±3.28% 、5.07%±5.13% 、2.75%±2.92% and 4.21% ±3.93%,respectively;the median M(P25,P75) were 2.90%(1.50%,5.40%) and 3.90%(1.50%,7.30%);2.10%(0.30%,3.90%) and2.90%(1.50%,5.40%),respectively. After controlling the confounding factors,the absolute ICVD risk for ten-years among both male and female intervention groups by difference-in-difference method, were-0.973% and-0.714%,respectively(reducing0.973% and 0.714%,P<0.01). After 2 years of intervention,the proportion of high ICVD risk for ten-years in male intervention group increased from 2.23% to 3.23%,but P>0.05;the proportion of high ICVD risk for ten-years in male control group increased from 3.72% to 9.50%,P<0.01;the proportion of middle ICVD risk for ten-years in female intervention group increased from 8.01%to 10.03%,the proportion of high ICVD risk for ten-years in female intervention group increased from 0.67% to 1.67%,the proportion of middle ICVD risk for ten-years in female control group increased from 11.92% to 28.53%,the proportion of high ICVD risk for ten-years in female control group increased from 2.19% to 5.95%,P <0.01. Conclusion Targeted health management measures can improve the absolute risk of ten-year ICVD risk for high risk group of NCDs,and provide the experience for health management in high risk residents with NCDs.