2018年中国四省育龄女性心血管代谢性危险因素流行特征

Epidemiological characteristics of cardio-metabolic risk factors in women aged 15-49 years in 4 provinces of China in 2018

目的 探讨中国四省育龄女性心血管代谢性危险因素的流行特征以及人口、社会经济特征对其的影响。方法 于2018年采用分层多阶段整群随机抽样的方法,选取河北、浙江、陕西及湖南省32个社区2851名15~49岁女性作为研究对象,利用其人口社会经济因素、血生化数据和体格测量数据,对肥胖、中心性肥胖、甘油三酯(triglyceride, TG)升高、总胆固醇(total cholesterol, TC)升高、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol, HDL-C)降低、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol, LDL-C)升高、血压升高、血糖升高和危险因素聚集进行分析。应用χ2检验进行单因素分析,Cochran-Armitage趋势检验进行趋势分析,采用多项Logit模型分析人口经济因素与各心血管代谢危险因素的关联性。结果 15~49岁育龄女性心血管代谢危险因素检出率较高的为中心性肥胖(26.76%)、超重(22.41%)、中心性肥胖前期(17.47%)、HDL-C降低(15.36%)、TG升高(11.78%)、TC边缘升高(11.40%)、TG边缘升高(11.12%)、血压升高(9.71%)、高血压(9.12%)。不同年龄、收入和文化程度的育龄女性心血管代谢性危险因素的检出率差异有统计学意义(P<0.05)。除HDL-C降低外,其余代谢性危险因素的检出比例随年龄增长呈现上升趋势(P趋势<0.05);随着文化程度提高,超重、肥胖、中心性肥胖前期、中心性肥胖、TG升高、HDL-C降低、血压升高、高血压、血糖升高、糖尿病的检出率呈现下降趋势(P趋势<0.05)。多项Logit模型分析结果显示,40~49岁组发生各项代谢性危险因素的风险均高于15~29岁组,且在高血压、血压升高、血糖升高中更为显著,分别为15~29岁组的8.51倍(95%CI 5.45~13.27)、3.14倍(95%CI 2.20~4.48)和2.66倍(95%CI 1.52~4.66)。高收入人群发生TC边缘升高、TC升高、LDL-C边缘升高的风险较高(OR=1.85,95%CI 1.44~2.38;OR=2.01,95%CI 1.25~3.22;OR=2.16, 95%CI 1.61~2.90),发生超重、血压升高的风险较低(OR=0.79,95%CI 0.64~0.98;OR=0.69,95%CI 0.50~0.94)。文化程度为大专及以上者发生肥胖、高血压和糖尿病的风险较初中及以下者下降50%左右(OR=0.52,95%CI 0.35~0.78;OR=0.43,95%CI 0.27~0.67;OR=0.52,95%CI 0.28~0.96)。结论2018年中国四省15~49岁女性中心性肥胖、超重、中心性肥胖前期和HDL-C降低在心血管代谢性危险因素中较为严重。高年龄、低文化程度的女性代谢性危险因素检出较高。

OBJECTIVE To analyze the prevalence of cardio-metabolic(CM)risk in women aged 15-49 years in 4 provinces of China and the influence of socioeconomic factors on them.METHODSA total of 2851 women aged 15-49 years from Community-based Cohort Study on Nervous System Disease in 2018 were selected.Obesity,central obesity,elevated triglyceride(TG),elevated total cholesterol(TC),decreased high-density lipoprotein cholesterol(HDL-C),elevated low-density lipoprotein cholesterol(LDL-C),elevated blood pressure,elevated blood glucose and risk factor aggregation were analyzed.X?test was used for univariate analysis,multinomial Logit model was used to evaluate the relationship between socioeconomic factors and CM risk factors,and Cochran-Armitage trend test was used for trend analysis.RESULTS The detection rate of CM risk factors in this study from high to low were central obesity(26.76%),overweight(22.41%),pre central obesity(17.47%),decreased HDL-C(15.36%),elevated TG(11.78%),borderline elevated TC(11.40%),borderline elevated TG(11.12%),elevated blood pressure(9.71%)and hypertension(9.12%).The prevalence rates of CM risk factors were different among different age groups,income groups and education levels(P<0.05).In addition to decreased HDL-C,the prevalence of other metabolic risk factors increased with age(Prend<0.05).With the improvement of educational level,the prevalence rates of overweight,obesity,central obesity,central obesity,elevated TG,decreased HDL-C,elevated blood pressure,hypertension,elevated blood pressure and diabetes showed a downward trend(Prend<0.05).Multinomial Logit model showed that the rick of metabolic risk factors in the age group of 40 to 49 years old was higher than that in the younger age group aged 15-29 years,and was more significant in hypertension,elevated blood pressure and elevated blood glucose,which were 8.51 times(95%CI 5.45-13.27),3.14 times(95%CI 2.20-4.48)and 2.66(95%CI 1.52-4.66)times of the younger age group,respectively.Women with high-income level have a higher risk of borderline elevated TC,elevated TC and borderline elevated LDL-C(OR=1.85,95%CI 1.44-2.38;0R=2.01,95%CI 1.25-3.22;0R=2.16,95%CI 1.61-2.90),but the lower risk of overweight and elevated blood pressure(OR=0.79,95%CI 0.64-0.98;OR=0.69,95%CI 0.50-0.94).The risk of obesity,hypertension and diabetes of people with college degree or above was about 50%lower than those with junior high school education or below(0R=0.52,95%CI 0.35-0.78;0R=0.43,95%CI 0.27-0.67;0R=0.52,95%CI 0.28-0.96).CONCLUSION Central obesity,overweight,pre central obesity and HDL-C decrease were prominent CM risk factors in women aged 15-49 years in four provinces of China in 2018.The detection rate of CM risk factors is higher in women of high age group or low education level.