健康管理对重庆市机关事业单位慢性病高风险人群高风险因素的影响

Effects of health management on risk factors of non-communicable disease among high risk population in government departments and institutions of Chongqing

目的评估健康管理对机关事业单位慢性病高风险人群风险因素的影响,为完善慢性病管理相关干预措施提供建议。方法于2016年12月至2017年3月,抽取重庆市4个经济文化相当的区,随机分为干预组和对照组,每组各2个区,在每个区中各随机整群抽取15个机关事业单位,被抽中单位的职工全部纳入筛查,筛查后干预组和对照组分别纳入380、576名慢性病高风险人员。干预组根据危险因素进行分级健康管理,具有1~2种慢性病高风险因素者进行基础健康管理,具有3种及以上慢性病高风险因素者在基础健康管理的基础上提供强化的健康管理;对照组不进行干预。评估管理1年后干预组与对照组高风险因素的变化情况。用SPSS 20.0软件进行χ^2检验,干预前后的净效应采用倍差法进行分析。结果干预组及对照组平均年龄分别为(41.4±9.4)、(39.9±9.3)岁。干预前,干预组与对照组的性别、婚姻状况、现在吸烟率和血清总胆固醇异常率差异均有统计学意义(P<0.05,P<0.01),年龄、民族、文化程度、血压高值的比例、空腹血糖异常率、中心性肥胖率和高风险分级分布差异均无统计学意义(P>0.05)。倍差法结果显示,健康管理可有效控制现在吸烟(OR=0.69,95%CI:0.54~0.87)、中心性肥胖(OR=0.67,95%CI:0.52~0.86)、血压高值(OR=0.49,95%CI:0.39~0.63)和血清总胆固醇异常(OR=0.59,95%CI:0.45~0.77)等慢性病高风险因素,降低高风险分级中高危人群所占比例(OR=0.47,95%CI:0.31~0.71)、不健康者所占比例(OR=0.66,95%CI:0.52~0.83),均有统计学意义(P<0.01)。结论机关事业单位慢性病高风险人群健康管理可以明显降低慢性病高风险因素水平,干预效果明显,针对高风险人群的健康管理模式值得推广应用。

Objective To assess the effects of health management on risk factors of non-communicable diseases(NCDs) among high risk population in government departments and institutions of Chongqing,and to provide the suggestion for improving the intervention measure related to NCDs management. Methods From December of 2016 to March of 2017,four economically and culturally equivalent districts in Chongqing were selected and randomly divided into intervention group and control group, with 2 districts in each group. Fifteen government departments or public institutions were randomly selected from each district. All employees in the selected units were included in the screening, 380 and 576 patients with high risk of NCDs were included in the intervention group and control group, respectively. The intervention group were intervened by grade health management according to risk factor level:the subjects with 1 or 2 risk factors were intervened by the basic health management,the subjects with ≥3 risk factors were intervened by strengthen health management on the basis of basic health management;the control group was not intervened. After intervention for 1 year,the changes of high risk factor were observed. The χ^2 test was used to analyze the data,the pure effects were analyzed by difference-in-difference method. Results The average ages of the intervention group and control group were(41.4±9.4) and(39.9±9.3) years old,respectively. Before intervention,there were significant differences of gender,marital status,current smoking rate and abnormal rate of serum total cholesterol(P<0.05),but there were no significant differences of age,nationality,education level,rate of high blood pressure,abnormal rate of fasting blood glucose,central obesity rate and high risk grading differences(P >0.05). The results of difference-in-difference method showed that the health management could control effectively the high risk factors of NCDs,such as current smoking rate(OR=0.69,95%CI:0.54-0.87),central obesity rate(OR=0.67,95%CI:0.52-0.86),high blood pressure(OR=0.49,95%CI:0.39-0.63),hypercholesterolemia(OR=0.59,95%CI:0.45-0.77);reduce the proportion of high risk population in high risk classification(OR=0.47,95%CI:0.31-0.71) and the proportion of unhealthy people(OR=0.66,95%CI:0.52-0.83),P<0.05. Conclusion Health management for high risk population working in government departments and institutions could reduce significantly the risk level of NCDs,the intervention effect was obvious. This model of health management for risk population should be promoted.