华北地区23万人健康生活方式与心血管死亡和全因死亡的关系研究

Study on the association between healthy lifestyles of 230000 people in North China and cardiovascular and all-cause mortality

目的探索华北地区成年人健康生活方式依从性、影响因素及其与心血管死亡和全因死亡的关系。方法选取2015—2021年心血管病高危人群早期筛查与综合干预项目中来自华北地区62个项目点,年龄35~75岁人群为研究对象。本研究调查不吸烟、不饮酒或适量饮酒、充足体力活动、健康饮食4种健康生活方式,通过被动随访获取研究对象的生存状态。采用多元logistic回归分析探索人群特征与健康生活方式的相关性,使用多元Cox比例风险回归模型分析健康生活方式与全因死亡和心血管死亡的相关性。结果228876名研究对象中,不吸烟178178人(77.85%)、不饮酒或适量饮酒211997人(92.63%)、有充足体力活动70391人(30.76%)、遵循健康饮食37780人(16.51%),只有10669人(4.66%)遵循上述4种健康生活方式。女性、老年人、非农民工作者、高收入或高学历人群、有心血管病病史的受试者更有可能坚持种类更多的健康生活方式(P<0.01)。在中位随访的3.55年中,经多变量调整发现,坚持不吸烟和充足体力活动的研究对象有更低的心血管死亡风险和全因死亡风险。随着健康生活方式数量的增加,心血管死亡风险和全因死亡风险呈下降趋势,与没有任何1种健康生活方式的居民相比,坚持4种健康生活方式的人群心血管死亡风险(HR=0.39,95%CI:0.22~0.69)和全因死亡风险(HR=0.59,95%CI:0.43~0.80)更低。结论华北地区健康生活方式依从性虽高于全国平均水平,但仍未达到理想状态,应基于影响因素和华北地区特点制定针对性的健康促进策略,以期改善华北地区人群健康状况,降低疾病负担。

Methods A study was conducted on individuals aged between 35 and 75 from 62 project sites in North China who were part of the early screening and comprehensive intervention program for cardiovascular disease high-risk populations from 2015 to 2021.This study investigated four healthy lifestyle behaviors:non-smoking,no or moderate alcohol consumption,sufficient physical activity,and a healthy diet.The survival status of the study participants was obtained through passive follow-up.Multivariate logistic regression analysis was used to explore the correlation between population characteristics and healthy lifestyles.The association between healthy lifestyles and all-cause and cardiovascular mortality was analyzed utilizing a multivariate Cox proportional hazards regression model.Results Among the 228876 study participants,178178 individuals(77.85%)followed non-smoking,211997(92.63%)followed none or moderate alcohol use,70391(30.76%)followed sufficient physical activity,and 37780(16.51%)followed a healthy diet.Only 10669(4.66%)participants adhered to all four healthy lifestyle factors.Women,elderly,non-migrant workers,high-income or highly educated individuals,or those with a history of cardiovascular diseases were more likely to adhere to a greater number of healthy lifestyle behaviors(P<0.01).After a median follow-up of 3.55 years and adjusting for multiple variables,it was found that individuals who adhered to non-smoking and sufficient physical activity had lower cardiovascular and all-cause mortality risks.As the number of healthy lifestyle behaviors increased,there was a decreasing trend in the risk of cardiovascular mortality and all-cause mortality.The population with all four healthy lifestyle behaviors had a lower cardiovascular mortality risk(HR=0.39,95%CI:0.22-0.69)and an all-cause mortality risk(HR=0.59,95%CI:0.43-0.80).Conclusions Although the adherence to healthy lifestyle behaviors in North China is better than in other areas of China,it has not yet reached an ideal state.Health education and targeted health promotion strategies should be implemented to improve adherence to these factors,which can effectively enhance the health status of the population in North China and reduce the burdenofdiseases.