上海部分社区老年人共病患病模式及其影响因素分析

Analysis on Combinations of Multimorbidity in the Elderly in Shanghai Communities and the Influence Factors

目的探讨社区老年人群慢性病共病患病模式及其影响因素。方法采用整群抽样方法获得19 185例上海市某社区65岁及以上老年人群资料。分析老年人群共病患病模式,并根据慢性病共病数量,将结果变量分为4组:0、1、2、3+,利用多分类Logistic回归进行共病影响因素分析。结果老年人群共病患病率为22.26%,其中患任2种慢性病者16.02%,最常见模式依次为高血压+糖尿病(8.14%)、高血压+冠心病(6.35%)和高血压+脂肪肝(5.20%);患任3种慢性病者5.18%,最常见模式依次为高血压+冠心病+糖尿病(2.03%)、高血压+糖尿病+脂肪肝(1.75%)和高血压+冠心病+脂肪肝(1.02%)。多分类Logistic回归结果显示,高龄(75~79岁组65~69岁组,80岁及以上组65~69岁组)、丧偶、超重或肥胖、既往吸烟(已戒烟)者有较高的共病患病风险。结论上海社区老年人共病患病率较高,最常见共病模式为高血压、糖尿病、冠心病和脂肪肝中2种/3种疾病共存,年龄、丧偶、超重或肥胖、以前吸烟史可能是共病的危险因素,应根据老年人共病的患病模式及危险因素,制定针对性的健康管理措施、分配医疗资源。

Objective To discuss the combinations of multimorbidity of chronic diseases in the elderly in communitiesand the related influence factors. Methods The data of 19185 elderly people aged at 65 and over were collected through clusterrandom sampling method; the multimorbidity was analyzed and according to the number of chronic diseases, the outcomevariables were divided into 4 groups： group 0, group 1, group2 and group 3＋; multinomial logistic regression was appliedin analyzing the influence factors of multimorbidity. Results The prevalence rate of multimorbidity in the elderly was 22.26%,including 16.02% of the elderly with any2 kinds of chronic diseases, the most prevalent combination ranged as follows： hy-pertension ＋ diabetes （8.14%）, hypertension ＋ coronary heart disease （6.35%） and hypertension ＋ fatty liver （5.20%）,and including 5.18% of the elderly with any 3 kinds of chronic diseases, the most common combination ranged as follows：hypertension ＋ coronary heart disease＋ diabetes （2.03%）, hypertension ＋ diabetes＋ fatty liver （1.75%） and hypertension＋ coronary heart disease ＋ fatty liver （1.02%）; the results of multinomial logistic regression analysis indicated that senileage, widowhood, overweight or obesity and smoking quitting were the risk factors for multimorbidity. Conclusions The pre-valence rate of multimorbidity in the elderly in Shanghai communities is high, the most common multimorbidity are the com-binations with any2 or 3 diseases among hypertension, diabetes, coronary heart disease and fatty liver; senile age, widowhood,overweight or obesity and smoking quitting may be the risk factors for multimorbidity; proper measures of health managementshould be taken and appropriate distribution of medical resources should be made.