北京市通州区社区居民高血压控制情况及其影响因素研究

Analysis of Hypertension Control among Community Residents in Tongzhou District of Beijing

目的了解北京市通州区社区居民的高血压患病情况、控制情况及其影响因素,分析确诊高血压患者血压控制与社区卫生服务利用的关系。方法选取2015年7—9月北京市通州区社区卫生服务中心服务范围内的≥18岁的7 008例常住人口,采用《通州区社区居民健康状况和卫生服务需求调查表》进行问卷调查,并进行体格检查,包括身高、体质量、腰围、血压,采用多因素Logistic回归分析确诊高血压患者血压控制的影响因素。结果高血压患病率为30.66%(2 149/7 008);男性患病率为34.01%(1 191/3 502),高于女性的27.32%(958/3 506)(χ2=36.820,P<0.001)。高血压确诊率为61.47%(1 321/2 149);男性确诊率为54.58%(650/1 191),低于女性的70.04%(671/958)(χ2=53.620,P<0.001)。确诊高血压患者血压控制率为43.38%(573/1 321)。不同医疗保险、半年内健康体检情况、1年内基层医生提供血压测量的确诊高血压患者血压控制率比较,差异均有统计学意义(χ2值分别为60.195、4.319、11.014,P<0.05)。多因素Logistic回归分析结果显示,家庭总月收入[OR=1.087,95%CI(1.022,1.157)]、新农合[OR=1.775,95%CI(1.185,2.659)]、1年内基层医生提供血压测量[OR=1.383,95%CI(1.095,1.745)]是确诊高血压患者血压控制情况的保护因素,城镇职工医保[OR=0.654,95%CI(0.431,0.993)]是确诊高血压患者血压控制情况的危险因素(P<0.05)。结论通州区社区18岁及以上居民高血压患病情况较严重,确诊高血压患者血压控制情况较差。应采取提供定期血压测量、改善经济状况等综合措施来加强居民的血压控制,对城镇职工和公费医疗人群应给予高度关注和进一步研究。

Objective To investigate the prevalence,control situation and influencing factors of hypertension among community residents in Tongzhou District of Beijing,and to analyze the relationship between the control of blood pressure and the utilization of community health services among patients with hypertension.Methods A total of 7 008 residents aged 18 and older were selected within the service area of community health service centers in Tongzhou District of Beijing from July to September in 2015.Questionnaire on Health Status and Health Service Demand among Community Residents in Tongzhou District was adopted to conduct questionnaire survey,and physical examinations were conducted to examine height,weight,waistline and blood pressure.Multiple Logistic regression was used to analyze factors affecting blood pressure control among patients with hypertension.Results The prevalence of hypertension in the investigated population was 30.66%(2 149/7 008).The prevalence of hypertension in male was 34.01%(1 191/3 502),which was higher than 27.32%(958/3 506)in female(χ2=36.820,P<0.001).The awareness rate of hypertension was 61.47%(1 321/2 149).The awareness rate of hypertension in male was 54.58%(650/1 191),which was lower than 70.04%(671/958)in female(χ2=53.620,P<0.001).And the blood pressure control rate of patients with hypertension was 43.38%(573/1 321).There was a significant difference in the control rate among hypertension patients with different medical insurance(χ2=60.195,P<0.05),having the health examination or not in half a year(χ2=4.319,P<0.05),and having blood pressure measurements provided by primary care doctors or not in a year(χ2=11.014,P<0.05).Multiple Logistic regression analysis showed that the total monthly household income〔OR=1.087,95%CI(1.022,1.157)〕,new rural cooperative medical scheme〔OR=1.775,95%CI(1.185,2.659)〕and having blood pressure measured by primary care doctors in a year〔OR=1.383,95%CI(1.095,1.745)〕were protective factors of blood pressure control(P<0.05),while urban employees basic medical insurance〔OR=0.654,95%CI(0.431,0.993)〕was the risk factor(P<0.05).Conclusion The prevalence of hypertension in residents aged 18 and older of Tongzhou District is high and the control of blood pressure in patients with hypertension is not good.Comprehensive measures should be taken to strengthen the control of blood pressure,such as providing regular blood pressure measurements and physical examination,and improving residents'economic condition.For patients with socialized medicine and urban employees basic medical insurance,more attention and further studies should be given to deal with the control of their blood pressure.