健康管理对重庆市机关事业单位慢性病高风险人群生活方式的影响

Effect of health management on lifestyle among high risk population of non-communicable diseases in government departments and public institutions in Chongqing

目的评估健康管理对机关事业单位慢性病高风险人群生活方式的影响,为探索慢性病高风险人群健康管理提供可借鉴的经验。方法于2016年12月-2017年3月对重庆市4个区县机关事业单位的职工进行整群抽样筛查慢性病高风险人群,筛查发现的慢性病高风险人群在签署知情同意书后分别纳入干预组与对照组,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,评估健康管理1年后干预组与对照组生活方式及风险分级的变化。用SPSS 25.0软件对数据进行χ^2检验,干预前后的净效应采用倍差法进行分析。结果干预组与对照组分别有380名与576名机关事业单位高风险人群纳入研究,干预组及对照组平均年龄分别为(41.48±9.36)岁与(39.89±9.27)岁。干预前干预组与对照组性别和婚姻状况上两组差异有统计学意义(χ^2=7.25、5.71,均P<0.05),在年龄、民族、文化程度差异无统计学意义(χ^2=7.37、1.48、5.33,均P>0.05)。倍差法回归分析结果显示,健康管理对现在吸烟率、身体活动水平充分、奶制品摄入达标、蔬菜水果摄入不足、高风险因素分级影响的贡献率分别是-0.38、0.59、0.62、-0.26、-0.74,均存在统计学意义(Waldχ^2=9.34、4.53、14.72、4.45、12.38,均P<0.01)。与干预前相比,干预后干预组现在吸烟率、身体活动水平充分、奶制品摄入达标、蔬菜水果摄入不足、高风险因素分级的OR值分别为0.69(0.54~0.87)、1.81(1.05~3.12)、1.86(1.36~2.56)、0.77(0.61~0.98)和0.48(0.32~0.72)。结论针对机关事业单位慢性病高风险人群实施健康管理可以促进该人群健康行为的形成,降低风险水平,是值得推广应用的有效措施。

Objective To evaluate the effect of health management on lifestyle among high risk population of non-communicable diseases in government departments and public institutions in Chongqing,and to provide the experience for exploring health management targeting high risk population.Methods Staff members from government departments and public institutions of four districts/counties in Chongqing were sampled by cluster sampling method,and the high risk population of non-communicable diseases were screened and enrolled into the intervention group and the control group with written informed consent.The intervention group was intervened by health management according to the risk level.Risk population with one or two risk factors received basic health management,while those with more than three risk factors received intensified health management based on basic health management.The control group was not intervened.After one-year health management intervention,the changes of lifestyle and risk classification in the intervention group and the control group were evaluated.SPSS 25.0 software was used to conduct Chi-square test on the data.The effects of health management before and after the intervention were analyzed by the difference-in-difference method.Results The average ages of the intervention group(n=380)and the control group(n=576)were(41.48±9.36)and(39.89±9.27)years old,respectively.Before the intervention,statistically significant differences were found in the gender and marital status between the intervention group and the control group(χ^2=7.25,χ^2=5.71,both P<0.05),but no statistically significant differences were found in age,ethnic group and educational background between the two groups(χ^2=7.37,χ^2=1.48,χ^2=5.33,all P>0.05).The results of difference-in-difference regression analysis indicated that the contribution rates of health management to the changes of current smoking rate,adequate physical activity,adequate intake of dairy products,inadequate intake of vegetables and fruits and classification of high risk factors were-0.38,0.59,0.62,-0.26 and-0.74,showing statistically significant differences(Waldχ^2=9.34,Waldχ^2=4.53,Waldχ^2=14.72,Waldχ^2=4.45,Waldχ^2=12.38,all P<0.01).Compared with before the intervention,the odd ratios of current smoking rate,adequate physical activity,adequate intake of dairy products,inadequate intake of vegetables and fruits and classification of high risk factors were 0.69(0.54-0.87),1.81(1.05-3.12),1.86(1.36-2.56),0.77(0.61-0.98)and 0.48(0.32-0.72),respectively.Conclusions Implementing heath management targeting high risk population of non-communicable diseases in government departments and public institutions can promote the formation of healthy lifestyle and reduce the risk level,and these effective measures should be promoted.