我国中老年人群慢性病共病模式及影响因素探究——基于系统聚类和Apriori算法

The Exploration of the Prevalence and the Determinants of the Chronic Disease Multimorbidity Patterns among Chinese Middle-aged and Elderly Population:Based on Hierarchical Clustering Analysis and Apriori Algorithm

目的 探究我国中老年人慢性病共病模式和影响因素。方法 使用中国健康与养老追踪调查(China health and retirement longitudinal study, CHARLS)2018年数据,纳入≥45岁人群19486名,采用系统聚类分析和Apriori算法探究慢性病共病模式,二分类logistic回归分析共病模式的影响因素。结果 我国≥45岁人群慢性病共病患病率为55.8%(95%CI:55.1%~56.5%)。研究得到高血压和关节炎两种共病模式,高血压共病模式以高血压为核心,包括血脂异常、糖尿病、心脏病、中风、记忆问题、情感问题;关节炎共病模式以关节炎为核心,包括肺部疾病、哮喘、胃部疾病、肝脏疾病、肾脏疾病。高血压、血脂异常、心脏疾病、关节炎、胃部疾病处于重要地位,胃部疾病是两种共病模式的桥梁疾病。高龄是两种共病模式的共同危险因素,重度体力活动是高血压共病模式的保护因素,是关节炎共病模式的危险因素。高龄会促使两共病模式的单病种人群进展为共病,中重度体力活动对高血压共病模式的单病种人群进展为共病具有保护作用。结论 我国≥45岁人群中超五成存在慢性病共病。高血压、关节炎和胃部疾病是共病模式的核心疾病。应重点防控高血压、血脂异常、心脏疾病、关节炎、胃部疾病。高血压共病模式人群要每周进行中高度身体活动,关节炎共病模式人群可以在医师指导下进行适度身体活动。两共病模式的单病种人群要警惕高龄带来的共病风险,高血压共病模式的单病种人群可增加体力活动以延缓共病风险。

Objective This study aimed to explore chronic disease multimorbidity among middle-aged and elderly people in China,and to explore the determinants of the multimorbidity patterns.Methods The data from the China Health and Retirement Longitudinal Study(CHARLS)2018 database with a total of 19486 people aged≥45 years were included in this study.Hierarchical clustering analysis and Apriori algorithm were conducted to explore multimorbidity patterns and binary logistic regression was applied in analyzing the determinants of the multimorbidity patterns.Results The prevalence of chronic diseases multimorbidity among people aged≥45 years was 55.8%(95%CI:55.1%-56.5%)(n=10878).Two multimorbidity patterns of hypertension and arthritis were developed in the study.The hypertension multimorbidity pattern was centered on hypertension,clustering dyslipidemia,diabetes,heart disease,stroke,memory problems and emotional problems.The arthritis multimorbidity pattern was centered on arthritis,including asthma,gastric disease,liver disease and kidney disease.Hypertension,dyslipidemia,heart disease,arthritis,and gastric disease were at the forefront,with gastric disease as the bridge disease between the two multimorbidity patterns.Older age was a risk factor for both multimorbidity patterns.Heavy physical activity was a protective factor for the hypertension multimorbidity pattern and a risk factor for the arthritis multimorbidity pattern.Advanced age can contribute to progression to multimorbidity in a single-patient population with two multimorbidity patterns,and moderate to heavy physical activity is protective against progression to multimorbidity in a single-patient population with a multimorbidity pattern of hypertension.Conclusion Over 50%of the middle-aged and elderly population have multimorbidity.Hypertension,arthritis and gastric disease are the core diseases of the multimorbidity patterns.The focus should be on preventing and controlling hypertension,dyslipidemia,heart disease,arthritis,and gastric disease.People of the hypertension multimorbidity pattern should perform moderate to high physical activity weekly,and people of the arthritis multimorbidity pattern can perform moderate physical activity with the knowledge of their physicians.Single-patient populations with two multimorbidity patterns should be alert to the multimorbidity risk associated with advanced age,and single-patient populations with hypertension multimorbidity patterns may increase physical activity to delay multimorbidity risk.