中国及各省份人群不同肥胖指标心血管疾病负担比较

Provincial disparities in the burden of cardiovascular diseases attributable to general, abdominal and visceral adiposity: Result from a recent national representative study

目的探讨我国不同地区由肥胖引起的心血管疾病负担的差异。方法基于中国高血压调查(CHS),随机选取30036名35岁以上研究对象进行随访。使用来自CHS的数据计算全国和各省的不同肥胖指标的加权患病率,采用cox回归分析计算不同肥胖指标全国及分省的心血管疾病校正风险比(HR)并估算人群归因百分比(PAFs)。结果 CHS参与人群325552名,纳入本研究22793名(平均4.56年的随访,其中1109名参与者发生了至少一次心血管事件)。在全国层面,与正常体重(BMI<24 kg/m^(2))相比,在调整了年龄、教育水平、吸烟、饮酒等多种危险因素后,所有肥胖指标均与心血管疾病风险增加有统计学差异。其中,超重和肥胖的HR分别为正常体重指数的1.18倍(95%CI 1.03~1.34)和1.53倍(95%CI 1.29~1.81),超重人群心血管疾病的PAFs为6.20%(95%CI 6.16%~6.24%),肥胖7.08%(95%CI 6.99%~7.17%);腹型肥胖的HR为1.44(95%CI 1.27-1.62),PAFs为13.30%(95%CI 13.21%~13.37%);体脂率的HR为1.25(95%CI 1.10~1.41),PAFs为8.99%(95%CI 8.94%~9.04%);内脏脂肪指数的HR为1.43(95%CI 1.23~1.65),PAFs为5.14%(95%CI5.07%~5.21%)。对于各省而言,肥胖的PAFs分布北部和西部省份最高,南部和沿海省份最低。体重指数肥胖的PAFs天津最高为13.31%,海南最低为2.37%;腹型肥胖的PAFs天津最高20.78%,海南最低5.38%。结论我国心血管疾病很大比例可归因于肥胖。腰围指标较其他肥胖指标心血管疾病PAFs更高,我国北方和经济社会地位较低的省份心血管疾病PAFs显著偏高。

Objective To explore the difference of cardiovascular disease burden attributable to adipose in different regions of China. Method Based on the Chinese hypertension survey(CHS), 30036 subjects over 35 years old were randomly selected for follow-up. The data from CHS were used to calculate the weighted prevalence of different obesity indexes. Cox regression analysis was used to calculate the adjusted hazard ratio (HR) in China and provinces, and the population attributable fractions(PAFS) were estimated. Results The study included 325552 CHS participants,22793 cohort study populations(with an average follow-up of 4.56 years, 1109 participants had at least one cardiovascular event). At national level, compared with normal weight(BMI<24 kg/m^(2)), after adjusting for age, education level, smoking, drinking and other risk factors, all obesity indexes were statistically different with the increased risk of CVD. The HR for overweight and obesity were 1.18 times higher than normal body mass index(95%CI 1.03~1.34) and 1.53(95%CI 1.29~1.81), the PAFs of CVD was 6.20%(95%CI 6.16%~6.24%) for overweight, 7.08%(95%CI 6.99%~7.17%) for obesity;The HR of abdominal obesity was 1.44(95%CI 1.27~1.62), 13.30%(95%CI 13.21%~13.37%) for PAFs;HR for body fat percentage was 1.25(95%CI 1.10~1.41), 8.99%(95%CI 8.94%~9.04%) for PAFs;HR of visceral fat index was 1.43(95%CI 1.23~1.65), and 5.14%(95%CI 5.07%~5.21%) for PAFs. At province level, the PAFs for obesity ranged from 13.31% in Tianjin to 2.37% in Hainan, from 20.78% in Tianjin to 5.38% in Hainan for abdominal obesity, with highest PAFs being in north and west provinces, lowest in south and coastal provinces. Conclusion A large proportion of CVD in China are attributable to adipose. PAFs of Waist circumference is higher than other adipose index and the PAFs of northern China and provinces with low economic and social status is significantly higher.