中国中老年人自评健康与心血管疾病发病风险的关联分析

Association between self-rated health and risk of cardiovascular disease among middle-aged and elderly Chinese

目的分析中国中老年人自评健康(SRH)与心血管疾病(CVD)发病风险的关联。方法资料来自2011至2012年启动的中国健康与养老追踪调查项目,采用与人口规模成比例的概率抽样,从28个省级行政单位的150个区(县)获取21133名研究对象,本研究最终将11701名对象纳入分析。基线调查中采用问卷调查收集研究对象的基本情况和自评健康等资料,随访中收集研究对象自报CVD发病情况。采用Cox比例风险回归模型分析SRH与CVD发病风险的关联,按年龄、性别、体重指数(BMI)等因素分层进行亚组分析,采用似然比检验分析交互作用。结果研究对象年龄为(57.9±9.7)岁,男性占48.1%(5626名)。SRH极好、很好、好、一般和不好者分别占4.2%(487名)、13.5%(1583名)、33.6%(3932名)、35.4%(4147名)和13.3%(1552名)。随访累计42104人年,期间发生CVD 590例。与SRH极好(很好)者相比,SRH好、一般和不好者CVD发病风险的HR(95%CI)分别为1.36(1.02~1.80)、1.66(1.26~2.19)和1.89(1.38~2.59)。亚组分析显示,在45~59、≥75岁组、男性组、女性组和正常BMI组中,与SRH极好(很好)者相比,SRH不好者CVD发病风险的HR(95%CI)分别为2.00(1.32~3.04)、3.87(1.04~14.46)、1.76(1.07~2.91)、1.92(1.27~2.91)和2.30(1.42~3.72)。SRH与年龄、性别、BMI不存在交互作用(P>0.05)。结论中国中老年人群SRH与CVD发病风险有关,与SRH极好(很好)者相比,SRH好、一般和不好者CVD发病风险增加。

Objective To analyze the association between the self?rated health(SRH)status and risk of cardiovascular disease(CVD)among the middle?aged and eldly Chinese.Methods Data were obtained from the China Health and Retirement Longitudinal Study(CHARLS),which enrolled 21133 participants by using the probability proportional to size(PPS)sampling from 150 counties/districts of 28 provinces in China from 2011 to 2012.A total of 11701 participants were included in the study.Basic information and SRH were obtained in the baseline survey via questionnaires.Information of CVD was self?reported during the follow?up.Cox proportional hazards modeling was used to analyze the association between the baseline SRH and risk of CVD.Subgroup analyses were performed by age,sex and body mass index(BMI),and their interactions with SRH for risk of CVD were examined by using the likelihood ratio test.A sensitivity analysis was conducted to test the robustness of the association.Results Participants were(57.9±9.7)years old,and men accounted for 48.1%(5626).SRH was reported as the excellent,very good,good,fair and poor among 4.2%(n=487),13.5%(n=1583),33.6%(n=3932),35.4%(n=4147)and 13.3%(n=1552),respectively.During 42104 person?years of followed up,590 cases of CVD were identified.Cox regression analyses showed that compared with the excellent/very good SRH,the HR(95%CI)of CVD risk for the good,fair and poor SRH was 1.36(1.02-1.80),1.66(1.26-2.19)and 1.89(1.38-2.59),respectively.Subgroup analyses showed that compared with the excellent/very good SRH,HR(95%CI)of CVD risk for poor SRH in the group of 45-59 years old,equal to or over 75 years old,men,women and normal BMI were 2.00(1.32-3.04),3.87(1.04-14.46),1.76(1.07-2.91),1.92(1.27-2.91)and 2.30(1.42-3.72),respectively.There were no interactions between age,sex,BMI and SRH(P>0.05).Conclusion SRH is associated with risk of CVD among middle?aged and elderly Chinese.The CVD risk for good,fair and poor SRH is higher than that for excellent/very good SRH.