杭州市城区便秘流行病学调查与分析

Epidemiological investigation of constipation in urban areas of Hangzhou,China

目的分析杭州市城区便秘流行病学调查结果,了解近年该地区便秘患病率及其危险因素。方法2022年8月至2023年6月期间,采用整群随机抽样法,对杭州市区望江、四季青、浦沿、长河、紫阳、萧山城厢、转塘和半山8个街道的43个社区居民开展横断面调查,由社区医生面对面填写书面调查问卷。以Bristol粪便分型结合罗马Ⅳ功能性胃肠病诊断标准,调查居民便秘的患病率,运用多因素logistic回归分析便秘的危险因素。结果共计有10479名居民接受调查,男性5551例(53.0%),女性4928例(47.0%)。总体便秘患病率为10.6%(1107/10479),男、女患病率分别为11.0%(613/5551)和10.0%(494/4928),差异无统计学意义(P>0.05)。不同体质指数(BMI)人群便秘患病率差异无统计学意义(P>0.05)。70岁以上人群患病率最高为15.4%(264/1717)。不同职业、婚姻状态和不同文化程度的人群便秘患病率的差异均有统计学意义(均P<0.001)。既往有高血压或糖尿病的人群、有长期服药史的人群以及父母或子女有便秘史者,其便秘患病率均高于无此类情况者,差异亦有统计学意义(均P<0.001)。将可干预的因素纳入多因素logistic回归分析的结果显示,食水果少(OR=1.284,95%CI:1.061~1.553,P=0.010)、饮食口味喜辛辣偏咸(OR=1.234,95%CI:1.039~1.466,P=0.016)、睡眠时间过长(OR=1.644,95%CI:1.260~2.144,P<0.001)、睡眠无规律(OR=1.370,95%CI:1.127~1.665,P=0.002)及几乎不运动(OR=1.388,95%CI:1.168~1.649,P<0.001)均为发生便秘的危险因素;而饮食混合搭配(OR=0.709,95%CI:0.608~0.826,P<0.001)和肉食为主(OR=0.604,95%CI:0.495~0.736,P<0.001)、饮酒量适中(OR=0.659,95%CI:0.534~0.812,P<0.001)或少及不饮酒(OR=0.523,95%CI:0.428~0.638,P<0.001)、不吸烟(OR=0.819,95%CI:0.674~0.995,P<0.001)为便秘的保护性因素。未发现主食偏好与便秘的患病风险存在关联(精粮:OR=1.147,95%CI:0.944~1.393,P=0.167;无特殊偏好:OR=0.935,95%CI:0.783~1.117,P=0.459)。被调查者对便秘自我主观评价与客观标准符合率,阴性高于阳性(95.8%比38.0%)。结论便秘在杭州市城区人群中患病率偏高。良好的生活和饮食习惯可明显降低便秘的发病率。应加强便秘的预防宣教工作,倡导健康的生活方式。

Objective To determine the prevalence and risk factors of constipation in Hangzhou urban areas by analyzing data from a recent epidemiological survey.Methods From August 2022 to June 2023,a cross-sectional survey was conducted on 43 communities on eight streets in suburbs of Hangzhou,including Wangjiang,Sijiqing,Puyan,Changhe,Ziyang,Xiaoshanchengxiang,Zhuantang,and Banshan.Written questionnaires were filled out face to face by community doctors.The prevalence of constipation was investigated using a combination of the Bristol stool typing method and the Rome IV criteria.The risk factors for constipation were analyzed using multivariate logistic regression analysis.Results The study cohort comprised 10,479 participants,5551 of whom were male(53.0%)and 4928 female(47.0%).The overall prevalence of constipation was 10.6%(1107/10,479).The prevalence was 11.0%(613/5551)for male and 10.0%(494/4928)for female participants;this difference is not statistically significant(P>0.05).There were no significant differences in the prevalence of constipation between different categories of body mass index(P>0.05).The prevalence of constipation was highest in individuals aged 70 years and above,accounting for 15.4%(264/1717)of all cases.There were significant differences in the prevalence of constipation between different occupations,marital statuses,and educational levels(P<0.001).Patients with hypertension or diabetes mellitus had a higher prevalence of constipation than those without these conditions,those who had been taking long-term medication had a higher prevalence of constipation than those who did not,parents of children with constipation had a higher prevalence of constipation than those with children who did not have constipation,and there were other significant differences in various variables(P<0.001).Multivariate logistic regression analysis of modifiable factors revealed that eating less fruit(OR=1.284,95%CI:1.061–1.553,P=0.010),liking spicy and salty food(OR=1.234,95%CI:1.039–1.466,P=0.016),sleeping for too long(OR=1.644,95%CI:1.260–2.144,P<0.001),irregular sleep patterns(OR=1.370,95%CI:1.127–1.665,P=0.002)and minimal exercise(OR=1.388,95%CI:1.168–1.649,P<0.001)were all risk factors for constipation;whereas mix diets(OR=0.709,95%CI:0.608–0.826,P<0.001),meat diets(OR=0.604,95%CI:0.495–0.736,P<0.001),moderate alcohol consumption(OR=0.659,95%CI:0.534–0.812,P<0.001),less or no drinking(OR=0.523,95%CI:0.428–0.638,P<0.001),and non-smoking(OR=0.819,95%CI:0.674–0.995,P<0.001)protected against constipation.We found no association between dietary preferences and the risk of constipation(refined grains:OR=1.147,95%CI:0.944–1.393,P=0.167;no specific preference:OR=0.935,95%CI:0.783–1.117,P=0.459).The rate of agreement between self-evaluation of constipation by the respondents and objective criteria was higher for negatives(95.8%)than for positives(38.0%).Conclusion The prevalence of constipation is relatively high in the urban population of Hangzhou.A good lifestyle and diet can significantly reduce its incidence.There should be more emphasis on preventive education,promotion of prevention of constipation,and advocacy for a healthy lifestyle.