华东地区23万成年人健康生活方式现状分析及与全因和心血管疾病死亡的关联

Analysis of current healthy lifestyle among 230000 adults in eastern China and association with all-cause and cardiovascular disease deaths

目的 了解华东地区居民健康生活方式现状及影响因素,并探讨其与全因死亡和心血管疾病死亡的关联,为制定适合该地区居民的健康生活方式指导方案提供依据。方法 该研究人群来自于心血管病高危人群早期筛查与综合干预项目,于2015年9月至2019年11月,抽取华东地区7省(直辖市)57个社区作为项目点,招募233 254名35~75岁常住居民为研究对象,问卷调查基本信息以及不吸烟或已戒烟、不饮酒或适量饮酒、充足的身体活动和健康饮食4种健康生活方式的遵循情况。采用SAS 9.4进行χ^(2)检验、多因素logistic回归、多重线性回归、多因素Cox回归分析。结果 4种健康生活方式中,不饮酒或适当饮酒、不吸烟或已戒烟的遵循率较高,分别为94.8%和80.3%,充足的身体活动和健康饮食的遵循比例较低(22.7%和11.0%)。遵循全部4种健康生活方式的比例为3.6%。多因素logistic回归分析结果显示,性别、受教育程度与每种健康生活方式的相关性均有统计学意义(P<0.05),与女性相比,男性遵从性低(不吸烟或已戒烟、不饮酒或适量饮酒、充足的身体活动和健康饮食的OR值分别为0.01、0.25、0.87和0.82);与小学及以下学历相比,本科及以上学历遵从性高(不吸烟或已戒烟、不饮酒或适量饮酒、充足的身体活动和健康饮食的OR值分别为1.87、1.21、2.64和1.88)。多因素Cox回归分析结果显示,充足的身体活动(HR=0.77)以及健康饮食(HR=0.82)与降低全因死亡风险相关,充足的身体活动与降低心血管疾病死亡风险相关(HR=0.75);与遵循0种健康生活方式相比,遵循4种健康生活方式与降低心血管疾病死亡风险相关(HR=0.39);每增加1种健康生活方式与降低全因死亡风险(HR=0.93)和心血管死亡风险均相关(HR=0.88),均有统计学意义(P<0.05)。结论 华东地区遵循全部4种健康生活方式的人群比例较低,且影响每种健康生活方式的因素不同。遵循健康生活方式与降低全因死亡和心血管疾病死亡存在相关性。需要通过实施针对不同人群的综合健康干预策略,帮助居民采纳并坚持健康的生活方式。

Objective To understand the current status and influencing factors of health lifestyles among residents in the eastern China,explore the association with all-cause and cardiovascular disease deaths,and provide the basis for formulating the healthy lifestyle guidance suitable for the residents in the area.Methods The study population was drawn from"Early Screening and Comprehensive Intervention in Population at High Risk for Cardiovascular Diseases".From September 2015 to November 2019,57 communities in 7 provinces in eastern China were selected as project sites,and 233254 permanent residents(35-75 years old)served as the subjects.The investigation was performed with the questionnaire(including the basic information,4 healthy lifestyle guidelines:no smoking or quitting,no drinking or moderate drinking,adequate physical activity and healthy diet).The χ^(2) test,multivariate logistic regression,multiple linear regression,multivariate Cox regression analysis and competing risk model analysis were used to analyze the data.The used software was SAS 9.4.Results Among the four healthy lifestyles,the adherence rates of no drinking or moderate drinking,no smoking or quitting were higher,at 94.8%and 80.3%,respectively;the adherence rates of adequate physical activity and healthy diet were lower,at 22.7%and 11.0%,respectively.The adherence proportion of all four healthy lifestyles was 3.6%.Multivariate logistic regression analysis showed that the gender and education level correlated to each heath lifestyle(P<0.05);as compared with females,the adherence rates of four healthy lifestyles in males were lower(OR values of no smoking or quitting,no drinking or moderate drinking,adequate physical activity and healthy diet were 0.01,0.25,0.87 and 0.82,respectively);as compared with subjects with primary school education or below,the adherence rates of four healthy lifestyles in subjects with bachelor degree or above were higher(OR values of no smoking or quitting,no drinking or moderate drinking,adequate physical activity and healthy diet were 1.87,1.21,2.64 and 1.88,respectively).Multivariate Cox regression analysis indicated that the sufficient physical activity(HR=0.77)and healthy diet(HR=0.82)were associated with reducing all-cause death risk.Sufficient physical activity was also associated with reducing cardiovascular disease death risk(HR=0.75).As compared with adhering to none of the healthy lifestyles,adhering to four health lifestyles was associated with reducing the cardiovascular disease death risk(HR=0.39).Each additional healthy lifestyle was associated with reducing risk of all-cause mortality(HR=0.93)and cardiovascular mortality(HR=0.88),P<0.05.Conclusion The proportion of people adhering to all four healthy lifestyles in the eastern China region is lower,and the factors of influencing each health lifestyle were different.Additionally,adhering to the healthy lifestyle is positively correlated with reducing all-cause and cardiovascular disease mortality.Therefore,it should help the residents for adopting and adhering to healthy lifestyles by implementing comprehensive health intervention strategies for different populations.