上海市35岁及以上居民2型糖尿病流行现状及影响因素分析

Prevalence and influencing factors of type 2 diabetes mellitus among residents(≥35 years old)in Shanghai

目的了解上海市35岁及以上常住居民2型糖尿病流行情况及影响因素,为制定适合上海市的糖尿病防治策略提供科学依据。方法于2017年10—12月,采用多阶段抽样方法选取上海市7个区21496名35岁及以上常住居民为研究对象,进行问卷调查、体格检查和实验室检查。采用SAS 9.4软件进行统计学分析,采用复杂抽样加权下的描述性流行病学方法分析人群2型糖尿病流行及知晓、治疗、控制现状,应用多因素logistic回归分析2型糖尿病患病影响因素。结果上海市35岁及以上人群2型糖尿病患病率为21.70%(95%CI:16.21%-27.19%)。男性2型糖尿病患病率高于女性,差异有统计学意义(P<0.01)。患病率随年龄增加呈明显上升趋势,趋势有统计学意义(P_(趋势)<0.01),城市地区最高,农村地区最低,趋势有统计学意义(P_(趋势)<0.01)。糖调节异常患病率为17.11%(95%CI:15.36%-18.85%),随年龄增加呈明显上升趋势,趋势有统计学意义(P_(趋势)<0.01)。2型糖尿病知晓率、治疗率和治疗控制率分别为57.18%(95%CI:50.73%-63.63%)、51.31%(95%CI:44.80%-57.82%)和39.53%(95%CI:35.75%-43.31%)。知晓率随年龄增加呈上升趋势,趋势有统计学意义(P_(趋势)<0.01)。城市地区知晓率最高,农村最低,趋势有统计学意义(P趋势<0.05)。多因素logistic回归分析结果显示,高年龄(与35-44岁相比,45-59岁OR=1.46,95%CI:1.21-1.76;60-74岁OR=1.66,95%CI:1.32-2.09;≥75岁OR=2.78,95%CI:2.06-3.75)、有糖调节异常史(OR=56.97,95%CI:39.13-82.95)、有2型糖尿病家族史(OR=1.96,95%CI:1.23-3.12)、高血压(OR=1.87,95%CI:1.32-2.67)、血脂异常(OR=1.83,95%CI:1.57-2.14)、超重或肥胖(OR=1.66,95%CI:1.48-1.86)与2型糖尿病患病高风险相关(P<0.01),而女性(OR=0.74,95%CI:0.66-0.82)与2型糖尿病患病低风险相关(P<0.01)。结论上海市35岁及以上居民2型糖尿病及糖调节异常患病率处于较高水平,但知晓率、治疗率及治疗控制率较低,应针对重点人群采取有效措施积极干预。

Objective To understand the prevalence and influencing factors of type 2 diabetes mellitus(T2 DM)in residents(≥35 years old)of Shanghai,and to provide the scientific basis for formulating the prevention and treatment strategy of diabetes in present city.Methods From October to December 2017,the multistage sampling method was used to select 21496 residents(≥35 years old)from 7 districts of Shanghai as the subjects,the investigation was performed with the questionnaires,physical examination and laboratory tests.The prevalence,awareness,treatment and therapeutic control of T2 DM were analyzed by complex weighting analysis;and the influencing factors of T2 DM were analyzed by multivariate logistic regression.The used software was SAS 9.4.Results According to WHO diagnostic criteria,the morbidity of T2 DM in residents(≥35 years old)of Shanghai was21.70%(95%CI:16.21%-27.19%).The morbidity of males was significantly higher than that in females(P<0.01).The morbidity of T2 DM increased with age(Ptrend<0.01),the morbidity of T2 DM in urban area was significantly higher than that in rural area(Ptrend<0.01).The morbidity of impaired glucose regulation was 17.11%(95%CI:15.36%-18.85%),and increased with age(Ptrend<0.01).The awareness rate,treatment rate,therapeutic control rate of T2 DM were 57.18%(95%CI:50.73%-63.63%),51.31%(95%CI:44.80%-57.82%)and 39.53%(95%CI:35.75%-43.31%),respectively.The awareness rate of T2 DM increased with age(Ptrend<0.01).The awareness rate in urban area was the highest and the awareness rate in rural area was the lowest(Ptrend<0.05).The multivariate logistic regression showed that age(as compared with 35-44 years old,45-59 years old OR=1.46,95%CI:1.21-1.76;60-74 years old OR=1.66,95%CI:1.32-2.09;≥75 years old OR=2.78,95%CI:2.06-3.75),history of impaired glucose regulation(OR=56.97,95%CI:39.13-82.95),family history of T2 DM(OR=1.96,95%CI:1.23-3.12),hypertension(OR=1.87,95%CI:1.32-2.67),dyslipidemia(OR=1.83,95%CI:1.57-2.14),overweight or obesity(OR=1.66,95%CI:1.48-1.86)were the high risk factors of T2 DM(P<0.01).Female(OR=0.74,95%CI:0.66-0.82)was the low risk factor of T2 DM(P<0.01).Conclusion The morbidity levels of T2 DM and impaired glucose regulation in residents(≥35 years old)of Shanghai are high,but the awareness,treatment and therapeutic control rates of T2 DM are low.It should take the measures and intervention for important residents.