不同级别医院医护人员缺血性心血管疾病发病风险评估

Risk Assessment of Ischemic Cardiovascular Disease Among Health Care Workers at Different Levels of Hospitals

目的调查广西柳州市三级及社区医院医护人员心血管疾病及危险因素的流行情况,分析并比较两者未来10年缺血性心血管病(ICVD)的发病风险及危险因素评估。方法入选在广西柳州市某医院进行体检的年龄≥35岁医护人员2423例。对受检者进行问卷调查及生化检查,采用"国人ICVD10年发病危险度评估表"评估35~59岁人群10年ICVD发病风险。定义ICVD发病风险>10%为发病人群,采用广义多因素降维法(GMDR)分析各危险因素间的交互作用及多元logistics回归分析各危险因素与发病风险的相关性。结果三级医院医护人员的体质量,BMI,收缩压,舒张压,TC,FBG及10年患病危险度水平,高胆固醇血症,高血压患病率及相对危险度超过10%占比均高于社区人员(P<0.001)。调整性别后,GMDR分析发现全部医护人员最佳交互模型为年龄和收缩压,测试集精确度为0.8825,交叉一致性为9/10(P<0.001);三级医院医护人员最佳交互模型为年龄和收缩压,测试集精确度为0.8714,交叉一致性为9/10(P=0.004);社区医院医护人员最佳交互模型为体质量指数和收缩压,测试集精确度为0.9386,交叉一致性为10/10(P<0.004)。logistics回归分析交互效应的贡献程度。全部医护人员收缩压升高发病风险增加(OR=1.32,95%CI=0.84~1.56,P<0.05),年龄及血压均升高发病风险增加(OR=1.55,95%CI=1.03~2.27,P<0.001);三级医院医护人员年龄及血压均升高时,发病风险增加(OR=1.31,95%CI=1.01~2.12,P<0.001);社区医院医护人员收缩压升高发病风险增加(OR=1.17,95%CI=0.82~1.47,P<0.05),体质量指数及血压均升高发病风险增加(OR=1.89,95%CI=1.08~2.74,P<0.001)。结论收缩压升高是医院医护人员10年ICVD发病风险的重要贡献因素,需加强干预。

Objective To investigate the prevalence of cardiovascular diseases and risk factors among health care workers in tertiary and community hospitals in Liuzhou,Guangxi,and to analyze and compare the risk of ischemic cardiovascular disease(ICVD)and risk factor assessment for both in the next 10 years.Methods 2423 health care workers aged≥35 years who underwent physical examination in a hospital in Liuzhou,Guangxi were enrolled.Questionnaires and biochemical examinations were conducted to assess the 10-year risk of ICVD in people aged 35~59 years using the"National ICVD 10-year risk assessment scale".The risk of ICVD incidence>10%was defined as the incidence group,and the interaction between risk factors and the correlation between risk factors and incidence risk was analyzed by the generalized multifactor downscaling method(GMDR)and multiple logistic regression.Results Body mass,BMI,systolic blood pressure,diastolic blood pressure,TC,FBG and 10-year risk level of morbidity,hypercholesterolemia,hypertension prevalence and relative risk over 10%were higher among health care workers in tertiary care hospitals than in community workers(P<0.001).After adjusting for gender,GMDR analysis revealed that the best interaction model for all health care workers was age and systolic blood pressure,with a test set accuracy of 0.8825 and cross-consistency of 9/10(P<0.001);the best interaction model for health care workers in tertiary hospitals was age and systolic blood pressure,the accuracy of test set was 0.8714,the cross consistency was 9/10(P=0.004);the best interaction model was body mass index and systolic blood pressure,the accuracy of test set was 0.9386,the cross consistency was 10/10(P<0.004).logistics regression was used to analyze the contribution of interaction effects.The risk of morbidity increased with elevated systolic blood pressure(OR=1.32,95%CI=0.84 to 1.56,P<0.05)and with both age and blood pressure(OR=1.55,95%CI=1.03 to 2.27,P<0.001)in all health care workers;the risk of morbidity increased with both age and blood pressure in tertiary care workers(OR=1.31,95%CI=1.01 to 2.12,P<0.001);increased risk of morbidity in community hospital health care workers with elevated systolic blood pressure(OR=1.17,95%CI=0.82 to 1.47,P<0.05)and increased risk of morbidity with elevated body mass index and blood pressure(OR=1.89,95%CI=1.08 to 2.74,P<0.001).Conclusion Elevated systolic blood pressure is an important contributor to the 10-year risk of developing ICVD in hospital health care workers and requires enhanced intervention.