文化程度和肥胖指标交互作用对糖尿病前期患病影响研究

The effects of interaction between educational level and obesity indicators on pre-diabetes

目的了解文化程度与体质指数(BMI)和腰围身高比(WHt R)对糖尿病前期影响及交互作用,为糖尿病前期干预提供依据。方法于2012年采用与人口规模成比例的整群抽样方法对江苏省昆山市18岁及以上居民进行抽样调查,现场调查采取面对面问卷调查、身体测量和实验室检测,采集血样检测空腹血糖、餐后2 h血糖。采用SAS 9.3进行分析,样本数据经过复杂加权,糖尿病前期的影响因素及其交互作用采用多因素logistic回归模型进行分析。结果 2012年昆山市加权后糖尿病前期患病率(95%CI)为17.16%(16.73%~17.59%),男、女性分别为17.67%(17.03%~18.30%)和16.69%(16.10%~17.27%)。调整年龄、性别、吸烟、饮酒及日常体力活动分级等混杂因素后,BMI(OR=1.18,95%CI:1.13~1.24)和WHt R(OR=1.19,95%CI:1.11~1.28)与糖尿病前期存在统计学关联(P<0.01)。文化程度与肥胖指标(BMI和WHt R)呈现交互作用(P<0.01)。不同文化程度分层中,较高的BMI水平和较高的WHt R水平与糖尿病前期患病存在正相关(P<0.05,P<0.01)。结论糖尿病前期患病率在较低文化程度与肥胖人群中较高,应加大对此类人群的健康教育与生活方式指导,避免其进展为糖尿病。

Objective To estimate the effects of interaction between educational level and obesity indicators on pre-diabetes, and to provide the basis for intervening pre-diabetes. Methods In 2012 the cluster sampling method with probability proportional to size（PPS） was used to select the residents（≥18 years old） from Kunshan city of Jiangsu province as the subjects. The investigation was conducted with questionnaire, physical examination and test of fasting blood glucose or postprandial 2 h blood sugar. SAS 9.3 was used to analyze the data with complex weighting, and the multivariate logistic regression model was used to analyze the interaction and influencing factors on pre-diabetes. Results The morbidity of pre-diabetes with complex weighting in2012 was 17.16%（16.73%-17.59%）, the morbidities of pre-diabetes in males and females were 17.67%（17.03%-18.30%） and16.69%（16.10%-17.27%）, respectively. After adjusting confounding factors（age, sex, smoking and alcohol status and physical exercise）, BMI（OR =1.18, 95% CI： 1.13-1.24） and waist-to-height ratio（OR =1.19, 95% CI： 1.11-1.28） were positively associated with increased pre-diabetes（P0.01）. There was the interaction between education level and obesity indicators（BMI and WHt R）, P〈 0.01. The high levels of BMI and WHt R were correlated positively with the morbidity of pre-diabetes among residents with stratification of different education levels（P0.05）. Conclusion The morbidity of pre-diabetes in residents with loweducation level and obesity is higher. Therefore, the health education and healthy life style should be advocated among those residents to avoid the progress to diabetes.