使用固体燃料与中国老年人高血压发病风险的前瞻性队列研究

A Prospective Cohort Study of Solid Fuels Use and Risk of Hypertension in Chinese Older Adults

背景人口老龄化造成以高血压为代表的慢性病患病率显著增加,带来了严重的医疗负担。我国目前仍有约4.5亿人口使用固体燃料烹饪或取暖,而由其产生的室内空气污染是中国面临的重要公共卫生问题。目前固体燃料的使用与中国老年人高血压发病风险之间的关系目前尚不清楚。目的通过前瞻性队列研究分析在中国城乡地区使用固体燃料与老年人高血压发病风险的关联,以便为老年高血压的防治提供理论依据。方法本研究为前瞻性队列研究。数据来源于2011—2018年中国老年健康影响因素跟踪调查问卷(CLHLS),采用基线问卷和体格检查收集数据。纳入2011—2012年队列研究中1453名基线非高血压人群为研究对象,年龄为≥65岁老年人,随访截至2018-12-31,以随访发生高血压为结局指标。根据烹饪燃料来源将研究对象分为清洁燃料(电磁炉等电器,管道天然气,太阳能)组(654名)和固体燃料(木炭,煤油,煤炭,柴草)组(799名)。采用多因素Cox比例风险回归模型分析固体燃料烹饪与高血压发病风险之间的关系。结果基线共纳入1453名非高血压人群,平均年龄(77.6±8.8)岁,中位随访时间7年,结局发生高血压共838名。本研究结果显示,农村地区使用固体燃料烹饪比例高于城市(70.3%与1.1%,P<0.05)。Cox比例风险回归模型分析结果显示,使用固体燃料烹饪可以增加老年人高血压的发病风险[HR=1.20,95%CI(1.05,1.38),P=0.01],调整协变量后仍表明使用固体燃料烹饪可以增加老年人高血压的发病风险[HR=1.21,95%CI(1.04,1.41),P=0.01]。此外,使用固体燃料烹饪与异常平均动脉压(MAP)呈正相关[HR=1.26,95%CI(1.02,1.55),P=0.03];在调整协变量后仍显示,使用固体燃料烹饪与异常MAP呈正相关[HR=1.28,95%CI(1.02,1.60),P=0.03]。结论在中国城乡地区使用固体燃料烹饪会增加老年人高血压的发病风险,而且可以影响MAP。减少使用固体燃料烹饪、提倡使用清洁燃料是高血压防控中一种简单、有效的措施。

Background The prevalence of hypertension in population is still increasing by year,and the significant increase in the prevalence of chronic diseases caused by aging of the population results in a serious medical burden.There are still about 450 million people in China who use solid fuels for cooking or heating,causing indoor air pollution as an important public health problem in China.At present,the relationship between solid fuels use and the risk of hypertension in Chinese older adults still remains unclear.Objective To analyze the association between solid fuels use and the risk of hypertension in older adults in urban and rural areas of China through a prospective cohort study,so as to provide a theoretical basis for the prevention and treatment of hypertension in the elderly.Methods This study is a prospective cohort study.Data were obtained from 2011 to 2018 China Longitudinal Healthy Longevity Survey(CLHLS)by using baseline questionnaire and physical examination.A total of 1453 non-hypertensive older adults aged 65 years and above from 2011 to 2012 cohort were included in the study,and the occurrence of hypertension during follow-up was considered as the outcome indicator,follow-up as of 2018-12-31.The included subjects were divided into the clean fuel(electrical appliances such as induction cooker,pipeline natural gas,solar energy)group(n=654)and solid fuel(charcoal,kerosene,coal,firewood)group(n=799).Multivariate Cox proportional hazard regression model was used to analyze the association between cooking with solid fuels and the risk of hypertension.Results A total of 1453 non-hypertensive older adults at baseline with an average age of(77.6±8.8)years and a median follow-up of 7 years,and a total of 838 people developed hypertension at the outcome.The results of this study showed that the proportion of cooking with solid fuels in rural areas was significantly higher than that in urban areas(70.3%vs.1.1%,P<0.05).Multivariate Cox proportional hazard regression model showed that cooking with solid fuels significantly increased the risk of hypertension〔HR=1.20,95%CI(1.05,1.38),P=0.01〕,and the adjustment for covariates still indicated that it increased the risk of hypertension〔HR=1.21,95%CI(1.04,1.41),P=0.01〕.In addition,cooking with solid fuels was positively associated with abnormal mean arterial pressure(MAP)〔HR=1.26,95%CI(1.02,1.55),P=0.03〕;and the adjustment for covariates still showed positive association of it with abnormal MAP〔HR=1.28,95%CI(1.02,1.60),P=0.03〕.Conclusion Cooking with solid fuels in urban and rural areas of China significantly increases the risk of hypertension in the elderly,as well as affects MAP.Reducing the use of solid fuels for cooking and promoting the use of clean fuels is a simple and effective measure in the prevention and control of hypertension.