泸水县农村居民慢性病患病及其影响因素的多水平模型分析

Prevalence and Determinants of Chronic Disease among Rural Residents in Lushui:a Multilevel Model Analysis

目的研究普遍开展基本公共卫生服务情况下泸水县农村居民的慢性病患病情况及其影响因素.方法2012年8月,问卷调查多阶段分层随机抽取的泸水县2 131名农村居民患病情况.以山区为组群水平解释变量,老年(≥60岁)为个体水平随机斜率变量,其他个体背景变量为固定斜率变量拟合多水平Logistic回归模型.结果泸水县2 131名农村居民的慢性病患病率为79.3‰(95%CI 67.8‰～90.8‰),低于2008年全国四类农村水平(119.6‰,P<0.05),与2007年当地1 163名农村居民的慢性病患病率(86.0‰,P>0.05)基本持平;年龄别慢性病患病率变化趋势与全国四类农村相似;患病率排名前五位的慢性病是高血压、慢性支气管炎、慢性肠胃炎、胆囊疾病和冠心病.多水平Logistic回归模型结果表明,山区与老年之间有跨层交互作用(P<0.05);性别对慢性病患病有正效应(OR=1.675 5,95%CI 1.063 0～2.640 6);以未婚为参照,在婚(OR=7.389 1,95%CI 3.162 3～17.255 0)、离婚或丧偶(OR=14.068 0,95%CI 4.976 9～40.366 5)对慢性病患病也有正效应.结论加强老年人健康管理服务、改变居民不良行为方式、改善山区居住环境和卫生条件等措施有助于人群健康水平的进一步提高.

Objective The study was aimed to assess the prevalence and risk factors of chronic disease among rural residents in Lushui,under the background of essential public health service implemented generally. Methods In August 2012,the questionnaire method was employed to investigate the morbidity in 2131 rural residents sampled by multistage stratified random sampling from Lushui population. The multilevel logistic regression model was fitted by group-level explanatory variable mountainous area, individual-level random slopes variable aged and other individual background variables. Results The prevalence of chronic disease among 2131 rural residents in Lushui was 79.3‰（95% CI 67.8‰-90.8‰）. It was lower than that of the rural region IV in China（119.6‰,P〈0.05）, and no significant difference with that of 1163 local rural residents in 2007（86.0‰,P〉0.05）. Its age trend was same as that of the rural region IV in China. The top five chronic diseases were hypertension, chronic bronchitis, chronic enterogastritis,cholecyst disease and coronary heart disease. The results of multilevel logistic regression model indicated that there were across-level interactions between mountainous area and aged（P〈0.05）,the gender had a positive effect to chronic disease（OR=1.6755, 95% CI 1.0630-2.6406）,and contrasting to unmarried,married（OR=7.3891,95% CI 3.1623-17.2550） and divorce or widowed（OR=14.0680,95% CI 4.9769-40.3665） also had a positive effect on the chronic disease. Conclusion For further improving the health level of population,the strategies,such as enhancing health management and service for the aged,changing bad behavior of people, improving living environment and sanitary conditions in the mountain areas, would be implemented.