中国家庭清洁燃料使用情况与高血压患病率关系的性别及地区差异

Gender and regional differences in the relationship between household clean fuel use and hypertension prevalence in China

目的探索中国不同性别及不同地区未服用降压药人群的高血压患病率或血压水平是否与不同清洁等级的家庭燃料有关。方法本研究基于前瞻性城乡流行病学研究中国地区数据(PURE-China研究),于2005—2009年在我国12个省招募参与者,完成问卷调查和体格检查。本文纳入38839名参与者。采用广义线性混合模型,分别估算高血压患病率的校正比值比(aOR)和血压值的回归系数。对不同性别和不同地区(东、中、西部)进行亚组分析。结果与清洁等级最低的家用固体燃料组相比,使用清洁等级较高的家用燃料与较低的高血压患病率和较低血压水平相关[液体燃料:高血压,aOR=0.71,95%CI 0.57~0.88,收缩压/舒张压,β(95%CI)为-4.13(-5.83~-2.42)/-1.56(-2.56~-0.55);气体燃料:高血压,aOR=0.73,95%CI 0.67~0.78,收缩压/舒张压,β(95%CI)为-4.51(-5.13~-3.87)/-1.42(-1.80~-1.03);电:高血压,aOR=0.57,95%CI 0.46~0.70,收缩压/舒张压,β(95%CI)为-7.86(-9.49~-6.24)/-3.82(-4.82~-2.82)]。在女性[液体燃料:高血压,aOR=0.60,95%CI 0.46~0.79,收缩压/舒张压,β(95%CI)为-5.40(-7.43~-3.37)/-2.35(-3.65~-1.06)];气体燃料:高血压,aOR=0.69,95%CI 0.63~0.76,收缩压/舒张压,β(95%CI)为-4.82(-5.56~-4.08)/-1.59(-2.07~-1.12);电:高血压,aOR=0.57,95%CI 0.45~0.73,收缩压/舒张压,β(95%CI)为-7.45(-9.33~-5.57)/-4.25(-5.45~-3.05)]和东部地区人群[液体燃料:高血压,aOR=0.59,95%CI 0.44~0.79,收缩压/舒张压,β(95%CI)为-6.09(-8.27~-3.91)/-1.94(-3.39~-0.49);气体燃料:高血压,aOR=0.80,95%CI 0.73~0.88,收缩压/舒张压,β(95%CI)为-2.84(-3.63~-2.05)/-1.09(-1.61~-0.57);电:高血压,aOR=0.65,95%CI 0.47~0.89,收缩压/舒张压,β(95%CI)为-6.57(-9.12~-4.01)/-2.86(-4.56~-1.17)]中,呈现更强的相关性。结论在未服用降压药的中国人群中,使用较清洁家庭燃料类型的人群表现出较低的高血压患病率和血压水平。家用清洁能源可减轻高血压的负担。

Objective To explore whether the prevalence of hypertension or blood pressure in different gender and different regions of China was related to the different grades of clean household fuels among people without antihypertensive drugs.Methods This study was based on data from the Prospective Urban and Rural Epidemiology Study in China(PURE-China Study),which recruited participants in 12 provinces in China from 2005 to 2009,completing questionnaires and physical examinations.Finally,38839 participants were included for the analysis.Generalized linear mixed models were used to estimate the adjusted odds ratio(aOR)of hypertension prevalence and regression coefficients of blood pressure values,respectively.Subgroup analyses were performed for different genders and different regions(East,Central,and West).Results Compared with the least clean household solid fuel group,cleaner fuel was significantly associated with lower hypertension prevalence and lower blood pressure[liquid:hypertension,aOR=0.71,95%CI 0.57-0.88,systolic blood pressure(SBP)/diastolic blood pressure(DBP),β(95%CI)=-4.13(-5.83,-2.42)/-1.56(-2.56,-0.55);gas:hypertension,aOR=0.73,95%CI 0.67-0.78,SBP/DBP,β(95%CI)=-4.51(-5.13,-3.87)/-1.42(-1.80,-1.03);electricity:hypertension,aOR=0.57,95%CI 0.46-0.70,SBP/DBP,β(95%CI)=-7.86(-9.49,-6.24)/-3.82(-4.82,-2.82),respectively].A stronger and significant correlation was observed between cleaner fuel use and hypertension or blood pressure in females[liquid:hypertension,aOR=0.60,95%CI 0.46-0.79,SBP/DBP,β(95%CI)=-5.40(-7.43,-3.37)/-2.35(-3.65,-1.06);gas:hypertension,aOR=0.69,95%CI 0.63-0.76,SBP/DBP,β(95%CI)=4.82(-5.56,-4.08)/-1.59(-2.07,-1.12)J;electricity:hypertension,aOR=0.57,95%CI 0.45-0.73,SBP/DBP,β(95%CI)=-7.45(-9.33,-5.57)/-4.25(-5.45,-3.05)Jand populations in the East regions[liquid:hypertension,aOR=0.59,95%CI 0.44-0.79,SBP/DBP,β(95%CI)=-6.09(-8.27,3.91)/-1.94(-3.39,-0.49);gas:hypertension,aOR=0.80,95%CI 0.73-0.88,SBP/DBP,β(95%CI)=-2.84(-3.63,-2.05)/-1.09(-1.61,-0.57);electricity:hypertension,aOR=0.65,95%CI 0.47-0.89,SBP/DBP,β(95%CI)=-6.57(-9.12,-4.01)/-2.86(-4.56,-1.17)].Conclusions In Chinese populations not taking antihypertensive drugs,those using cleaner home fuel types have lower prevalence of hypertension and blood pressure levels.Cleaner household energy may reduce the burden of hypertension.