中国中老年人慢性病共病现状及其空间分布研究

Prevalence and Spatial Analysis of Chronic Comorbidity among Chinese Middle-aged and Elderly People

背景在全球老龄化背景下,我国慢性病患者基数明显增加,且多病共存情况愈发普遍,严重威胁我国中老年人的生命安全与生活质量。数据的空间属性是了解疾病流行规律的有效途径,目前尚缺乏关于慢性病共病空间分布的研究。目的对我国≥45岁中老年人慢性病共病现状及其空间分布规律进行分析,为慢性病共病区域化防控措施的制定提供数据支撑。方法于2021年3月,在中国健康与养老追踪调查(CHARLS)第四期追访数据中抽取≥45岁人群的社会人口学特征和14种慢性病患病情况进行分析,最终纳入样本19498例。基于地理信息系统(GIS)技术,采用ArcGIS 10.2软件和Geoda 1.18软件对中老年人慢性病共病情况进行空间统计分析。结果2018年,我国中老年人的慢性病共病发生率为55.77%(10874/19498),不同性别、年龄、学历、婚姻状况者的慢性病共病发生率比较,差异有统计学意义(P<0.05)。与其他慢性病共病发生率最高的为关节炎或风湿病(58.23%,6332/10874),发生率最高的2种慢性病共病组合模式为胃病+关节炎或风湿病(16.68%,655/3928),发生率最高的3种慢性病共病组合模式为高血压+胃病+关节炎或风湿病(8.12%,227/2796)。各省份的慢性病共病发生率为39.86%(广东省,405/1016)~75.25%(新疆维吾尔自治区,76/101)。全局空间自相关分析显示,慢性病共病发生率的Moran's I值=0.303542(P=0.006),表明慢性病共病发生率的空间分布呈正自相关。局部空间自相关分析显示,青海省、甘肃省及福建省的Moran's I值具有统计学意义(均有P<0.05),其中青海省和甘肃省的聚集类型为高-高相关、福建省的聚类类型为低-低相关。结论我国中老年人的慢性病共病发生率较高,且空间分布上存在差异,风湿病、高血压、胃病等高共病发生率的慢性病应受到关注,重点防控区域集中在我国西北部。

Background Concurrent with global aging,China is seeing significantly increased base-case prevalence of chronic diseases and growing prevalence of multimorbidity,which seriously affect the safety and quality of life in middleaged and elderly Chinese people.Understanding the spatial attributes of data is an effective way to learn the epidemic regularity of the disease.There is no research on the spatial distribution of chronic comorbidity.Objective To analyze the prevalence and spatial distribution of chronic comorbidity in Chinese middle-aged and elderly people(≥45 years),providing support for the development of measures for regional containment of chronic diseases.Methods This study was carried out in March 2021.Data about sociodemographic characteristics and prevalence of 14 chronic diseases stemmed from the four wave of the China Health and Retirement Longitudinal Study,involving 19498 people aged 45 and above.The geographic information system,ArcGIS 10.2 and Geoda 1.18 were used to conduct a spatial statistical analysis of prevalence of these chronic diseases.Results In 2018,the prevalence of chronic comorbidity among middle-aged and elderly Chinese people was 55.77%(10874/19498).And the prevalence of chronic comorbidity varied significantly by sex,age,educational background and marital status(P<0.05).Arthritis or rheumatism was found to be the disease that most frequently coexisted with other diseases(58.23%,6332/10874).In terms of two comorbidities coexisted,gastric disease with arthritis or rheumatism had the highest prevalence(16.68%,655/3928).As for three comorbidities coexisted,hypertension with gastric disease and arthritis or rheumatism had the highest prevalence(8.12%,227/2796).The regional prevalence of comorbidity ranged from 39.86%(405/1016 for Guangdong)to 75.25%(76/101 for Xinjiang).Global spatial autocorrelation analysis showed that the spatial distribution of the chronic comorbidity prevalence showed a positive autocorrelation indicated by the Moran's I〔0.303542(P=0.006)〕.Local spatial autocorrelation analysis showed that the Moran's I value of Qinghai,Gansu and Fujian were statistically significant(P<0.05).The cluster type of Qinghai and Gansu was high-high,and that of Fujian was low-low.Conclusion The prevalence of chronic comorbidity among middle-aged and elderly Chinese people was high,with spatial differences.Priority should be given to the containment of highly prevalent chronic diseases,such as rheumatism,hypertension and gastric disease,and the key regions for containment were mainly in the northwest part of China.