江苏省淮安市社区高血压患者单片复方制剂使用情况及其影响因素分析

Application status and influencing factors of single-pill combination antihypertensive therapy in Huai′an City, Jiangsu Province, China

目的了解江苏省淮安市社区高血压患者单片复方制剂(SPC)的使用情况,并分析其影响因素。方法该研究为横断面研究。采用分阶段随机抽样法,于2022年6至12月抽取江苏省淮安市清江浦区、淮阴区为一级抽样单位,然后再从中抽取10个社区卫生服务中心作为研究单位。入选已纳入研究单位高血压慢病管理的全部患者。根据是否使用SPC,将入选患者分为SPC组和非SPC组。通过调查问卷、现场测量和实验室检查等方法收集入选患者的相关临床资料。采用多因素logistic回归模型分析社区高血压患者使用SPC的影响因素。结果入选患者4094例,年龄(71.6±5.9)岁,男性1959例(47.85%),其中SPC组496例,非SPC组3598例,社区高血压患者中SPC的使用率为12.12%(496/4094)。SPC组中≥65岁、规律运动、已婚患者的比例低于非SPC组,血肌酐、甘油三酯、低密度脂蛋白胆固醇水平高于非SPC组,中等教育及以上、职工医疗保险、高血压诊断单位为市级医院及以上、高血压病程≥10年患者的比例高于非SPC组(均P<0.05)。多因素logistic回归分析结果显示,年龄(OR=1.653,95%CI:1.117~2.445)、是否规律运动(OR=1.307,95%CI:1.075~1.590)、血肌酐水平(OR=1.003,95%CI:1.001~1.005)、低密度脂蛋白胆固醇水平(OR=1.153,95%CI:1.045~1.273)、教育程度(OR=1.645,95%CI:1.349~2.006)、婚姻状况(OR=1.377,95%CI:1.011~1.875)、医疗保险类型(OR=1.374,95%CI:1.121~1.684)、高血压诊断单位等级(OR=1.366,95%CI:1.114~1.675)和高血压病程(OR=1.305,95%CI:1.075~1.585)是社区高血压患者是否使用SPC的独立影响因素(均P<0.05)。结论江苏省淮安市社区高血压患者SPC的使用率较低,年龄、是否规律运动、血肌酐水平、低密度脂蛋白胆固醇水平、教育程度、婚姻状况、医疗保险类型、高血压诊断单位等级、高血压病程是社区高血压患者使用SPC的独立影响因素。

Objective To investigate the application status and influencing factors of single-pill combination(SPC)therapy among hypertensive patients in the community in Huai′an region,Jiangsu Province,China.Methods This was a cross-sectional study.From June to December 2022,the stratified random sampling method was used to select Qingjiangpu and Huaiyin districts of Huai′an City,Jiangsu Province,as primary sampling units,followed by the selection of 10 community health centers as study units.All patients who had been enrolled in the chronic management of hypertension in the study unit were enrolled.According to whether SPC was used or not,the enrolled patients were divided into the SPC group and non-SPC group.Relevant clinical data of the enrolled patients were collected by questionnaires,on-site measurements,and laboratory tests.A multifactorial logistic regression model was used to analyze the factors influencing the use of SPC in community-dwelling hypertensive patients.Results The study included 4094 patients with an average age of(71.6±5.9)years,1959 males(47.85%),496 in the SPC group,and 3598 in the non-SPC group.The utilisation rate of SPC among hypertensive patients in the community was 12.12%(496/4094).The SPC group had lower proportions of patients aged≥65 years,exercising regularly,and married,higher levels of blood creatinine,triglycerides,and LDL cholesterol,and higher proportions of patients with secondary education,employee health insurance,hypertension diagnosis unit of municipal hospital,and duration of hypertension≥10 years compared to the non-SPC group(all P<0.05).Furthermore,the results of multivariate logistic regression analysis indicated that age<65 years(OR=1.653,95%CI:1.117-2.445),irregular exercise habits(OR=1.307,95%CI:1.075-1.590),higher education level(OR=1.645,95%CI:1.349-2.006),unmarried/divorced/widowed(OR=1.377,95%CI:1.011-1.875),employee medical insurance(OR=1.374,95%CI:1.121-1.684),diagnostic unit level at the municipal hospital or higher(OR=1.366,95%CI:1.114-1.675),and hypertension duration≥10 years(OR=1.305,95%CI:1.075-1.585)were factors influencing the use of SPC.Conclusions The utilization rate of SPC antihypertensive drugs was low in the community of Huai′an,Jiangsu Province.The SPC group had higher blood pressure control rates than the non-SPC group.Factors such as age,exercise habits,education level,marital status,type of health insurance,diagnosis unit level,and hypertension course may influence the use of SPC.