北京市心脑血管疾病高危人群过早死亡及其影响因素的随访研究

Follow-up study of premature death and influencing factors in high-risk population with cardio-cerebrovascular diseases of Beijing

目的 了解北京市心脑血管疾病高危人群过早死亡情况及其影响因素,为中老年人心脑血管疾病防治及危险因素控制提供依据。方法 数据来源于“北京市社区脑卒中筛查及防控项目”,该项目于2010-2012年开展基线调查,从北京市16个区(县)筛选研究对象,开展问卷调查、体格检查,随访至2021年12月31日,选取38 093名心脑血管疾病高危居民作为调查对象。使用SPSS 21.0软件进行χ^(2)检验及趋势χ^(2)检验。采用Cox比例风险回归模型分析过早死亡的相关影响因素。结果 38 093名研究对象年龄58~69岁,平均随访时间为(9.52±1.42)年,期间过早死亡1 158人,过早死亡率为3.19/1000人年。过早死亡的主要死因为癌症(42.49%)和心脑血管疾病(35.58%)。城区居民癌症导致的过早死亡占比(50.69%)高于郊区(34.26%),心脑血管疾病导致的过早死亡占比(28.10%)低于郊区(43.08%),差异均有统计学意义(P<0.01)。Cox比例风险回归模型分析结果显示,男性(HR=1.739,95%CI:1.498~2.019)、较低年龄组(58~59岁HR=3.558,95%CI:2.922~4.334;60~64岁HR=2.263,95%CI:1.949~2.627)、较低文化程度(小学及以下HR=1.812,95%CI:1.437~2.285;初中或中专或高中HR=1.514,95%CI:1.165~1.968)、居住于郊区(HR=1.159,95%CI:1.022~1.314)、已戒烟(HR=1.358,95%CI:1.090~1.692)、现在吸烟(HR=1.220,95%CI:1.038~1.433)、不健康饮食习惯(HR=1.130,95%CI:1.006~1.270)、体检血压升高(HR=1.302,95%CI:1.155~1.468)者过早死亡风险较高;中水平体力活动(HR=0.804,95%CI:0.666~0.971)、高水平体力活动(HR=0.629,95%CI:0.504~0.785)、超重(HR=0.814,95%CI:0.711~0.933)、肥胖(HR=0.844,95%CI:0.721~0.989)者过早死亡风险较低。基线携带1~2、3~4、≥5项可干预危险因素者发生过早死亡风险分别是携带0项者的1.365倍(95%CI:1.043~1.785)、1.470倍(95%CI:1.124~1.922)及1.839倍(95%CI:1.315~2.572)。结论 北京市58~69岁心脑血管疾病高危人群过早死亡以癌症和心脑血管疾病为主,应重点关注男性、低年龄组、低文化程度、居住于郊区、吸烟、不健康饮食、血压值超标等过早死亡风险较高人群。

Objective To understand the premature death and influencing factors in high-risk population with cardiocerebrovascular diseases of Beijing,and provide the basis for the prevention and treatment of cardiovascular and cerebrovascular diseases and the risk factor control in the middle-aged and elderly people.Methods The data were from"Beijing Community Stroke Screening and Prevention and Control Project",the project conducted a baseline survey from 2010 to 2012,the subjects from 16 districts(counties)in Beijing were screened,the investigation was performed with questionnaire and physical examination.Follow-up visits was conducted to December 31,2021.A total of 38093 residents at high risk of cardiovascular and cerebrovascular diseases were selected.The χ^(2) test and trend χ^(2) test were used to analyze the data.Cox proportional hazards regression models was used to analyze influencing factors associated with premature death.Results The subjects were 38093 cases(58-69 years old),the average follow-up duration was(9.52±1.41)years,the number of premature death was 1158 cases,the premature mortality was 3.19/1000 person years.The main causes of premature death were cancer(42.49%)and cardiovascular and cerebrovascular diseases(35.58%).The proportion of premature deaths caused by cancer in urban residents was higher(50.69%)than that(34.26%)in suburbs residents,the proportion(28.10%)of premature deaths caused by cardiovascular and cerebrovascular diseases in urban residents was significantly lower than that(43.08%)in suburbs residents(P<0.01).The results of the Cox proportional hazards regression model analysis showed that male(HR=1.739,95%CI:1.498-2.019),lower age group(58-59 years old HR=3.558,95%CI:2.922-4.334;60-64 years old HR=2.263,95%CI:1.949-2.627),lower educational level(primary school and below HR=1.812,95%CI:1.437-2.285;junior high school or technical secondary school or senior high school HR=1.514,95%CI:1.165-1.968),living in the suburbs(HR=1.159,95%CI:1.022-1.314),having quit smoking(HR=1.358,95%CI:1.090-1.692),current smoking(HR=1.220,95%CI:1.038-1.433),unhealthy eating habits(HR=1.130,95%CI:1.006-1.270),elevated physical blood pressure(HR=1.302,95%CI:1.155-1.468)had a higher risk of premature death;early mortality risk was lower in moderate physical activity(HR=0.804,95%CI:0.666-0.971),high physical activity(HR=0.629,95%CI:0.504-0.785),overweight(HR=0.814,95%CI:0.711-0.933),obese(HR=0.844,95%CI:0.721-0.989).The risk of premature death among 1-2,3-4 and≥5 interventionable risk factors at baseline was 1.365 times(95%CI:1.043-1.785),1.470 times(95%CI:1.124-1.922)and 1.839 times(95%CI:1.315-2.572)compared with those with 0,respectively.Conclusion The premature death of cardiovascular and cerebrovascular diseases in high-risk people aged 58 to 69 in Beijing is mainly cancer and cardiovascular and cerebrovascular diseases;emphasis should be placed on people with higher risk of premature death including men,low age group,low educational level,living in suburbs,smoking,unhealthy diet,and excessive blood pressure values.