中国老年人肥胖流行特征及其与五种慢性病关系的人群归因分析

The epidemiological characteristics of obesity among the Chinese elderly population and its attributable fractions for chronic diseases

目的 调查中国老年人群肥胖流行特征及其与五种常见慢性病的关系. 方法 2013年开展了31个省（市、自治区）第四次中国慢性病及其危险因素监测,该调查采用多阶段分层整群随机抽样方法,在298个监测点对51 778例60岁及以上居民进行了问卷调查,体重、身高、腰围和血压测量,以及血糖和血脂的检测.采用体重指数（BMI）和腰围（WC）作为肥胖及中心型肥胖测量指标.在对样本经过复杂加权计算后,比较不同性别、年龄、城乡和地区老年人群的肥胖和中心型肥胖流行状况以及不同体重指数组间五种慢性病的差异,采用非条件Logistic回归分析肥胖和中心型肥胖与这五种慢性病的关系,并进一步计算人群归因分值（AFP）. 结果 60岁及以上老年人肥胖率和中心型肥胖率分别为13.2％和55.4％,女性高于男性（肥胖率：16.3％比9.9％）（x2=97.9,P＜0.05）和（中心型肥胖率：64.4％比46.0％）（x 2=254.2,P＜0.05）,城市高于农村（肥胖率：15.6％比12.0％）（x 2=8.8,P＜0.05）和（中心型肥胖率：62.0％比52.1％）（x2=32.2,P＜0.05）.高血压、糖尿病、血脂异常、心肌梗死和脑卒中这五种常见慢性病患病率均随着BMI和WC的增加而上升.调整混杂因素后Logistic回归结果显示,与正常BMI组相比,肥胖组患高血压、糖尿病、血脂异常和脑卒中的OR值为1.43～2.68,肥胖对老年人患这四种慢性病的AFP为0.05～0.18;与正常WC相比,中心型肥胖组患高血压、糖尿病、血脂异常、心肌梗死和脑卒中的OR值为1.35～1.88,中心型肥胖对这五种慢性病的AFP为0.16～0.33. 结论 肥胖及中心型肥胖在城市老人和女性老人中患病率比较高,肥胖及中心型肥胖与高血压、糖尿病、血脂异常和脑卒中存在关联性;另外,中心型肥胖还与心肌梗死的患病存在关联.

Objective To investigate the epidemiological characteristics of obesity and its relationships to five common chronic diseases among the Chinese elderly population.Methods In 2013,The 4th Chronic Non-communicable Disease ＆ Risk Factor Surveillance in China was conducted in 31 provinces.A multistage cluster sampling method was used at 298 National Disease Surveillance Points（DSPs）.A total of 51778 adults aged 60 and over received a standardized questionnaire,physical examinations,and laboratory tests for blood lipid ＆ glucose levels.The body mass index（BMI）was used for obesity measurement and waist circumference（WC）for central obesity measurement.After weighting adjustment of the sample,the prevalence of obesity and central obesity was compared between different genders,among different age groups,and among different regions.The unconditional Logistic regression model was applied to analyze the relationships of five selected chronic diseases with BMI and WC.Population attributable fractions （AFP）were also calculated.Results Among the elderly,the prevalence of obesity and central obesity was 13.2 % and 55.4 %,respectively.Both were higher in women（16.3% and 64.4%）than in men（9.9% and 46.0%）and higher in the urban areas （15.6% and 62.0%） than in the rural areas （12.0% and 52.1%） （all P 〈 0.05）.The increased prevalence of five common chronic diseases was correlated with increased BMI and WC（all P〈0.05）.After adjustment for confounders,obesity was associated with increased prevalence of hypertension,diabetes,dyslipidemia,and stroke （ORs：1.43-2.68,AFP s：0.05-0.18）;central obesity was associated with increased prevalence of the five chronic diseases （ORs：1.35-1.88,AFPs：0.16-0.33）Conclusions High prevalence of obesity and central obesity can be seen in aged women and the urban elderly population.Obesity and central obesity are both related to hypertension,diabetes,dyslipidemia,and stroke.Besides,central obesity is also associated with myocardial infarction.