高血压和年龄的交互作用对老年人认知功能受损患病风险的影响

Interaction effect of hypertension and age on the risk of cognitive impairment in the elderly

目的探讨高血压和高龄(≥80岁)的交互作用对老年人认知功能受损患病风险的影响。方法数据来源于2018年中国老年健康影响因素跟踪调查(Chinese Longitudinal Healthy Longevity Survey,CLHLS),按照简易精神状态评价量表(Mini‑Mental State Examination,MMSE)将年龄≥65岁老年人分为认知功能受损组和认知正常组,采用logistic回归模型分析高血压、高龄对认知功能受损的影响,采用相乘和相加模型分析高血压与高龄的交互作用。结果最终纳入≥65老年人11508名,认知功能受损2101例,患病率18.3%;高血压6183例,患病率53.7%。调整相关因素后,多因素logistic回归分析结果仍显示高血压人群(OR=1.787,95%CI:1.262~2.530)、高龄老人(OR=5.472,95%CI:2.986~9.865)患认知功能受损风险较高(均P<0.05);高血压与高龄存在相乘交互作用(OR=1.520,95%CI:1.056~2.188);高血压且高龄老人患认知功能受损的风险是非高血压非高龄老人的4.617倍(95%CI:3.606~5.913);相对超额危险度比(relative excess risk of interaction,RERI)为8.363(95%CI:6.438~10.288),交互作用归因比(attributable proportion of interaction,API)为0.667(95%CI:0.623~0.711),交互作用指数(synergy index,SI)为3.631(95%CI:2.983~4.421)(均P<0.05)。结论高血压与高龄对认知功能受损的影响存在相乘及相加交互作用。

Objective To investigate the interaction effect of hypertension and advanced age(≥80 years old)on the risk of cognitive impairment in the elderly.Methods Based on the Chinese Longitudinal Healthy Longevity Survey(2018),according to the Mini-Mental State Examination(MMSE),the elderly aged≥65 years were divided into cognitive impaired group and cognitive intact group.The logistic regression model was utilized to analyze the influence of hypertension and advanced age on cognitive impairment.The multiplicative and additive models were applied to analyze the interaction effect of hypertension and advanced age.Results A total of 11508 elderly people were included,and 2101 cases of cognitive impairment were identified,with a prevalence rate of 18.3%.The prevalence of hypertension was 53.7%(6183 cases).After adjusting for confounding factors by multivariate logistic regression,the results still showed that the hypertensive population(OR=1.787,95%CI:1.262-2.530)and the advanced age population(OR=5.472,95%CI:2.986-9.865)had a higher risk of cognitive impairment,and there was a multiplicative interaction between hypertension and advanced age(OR=1.520,95%CI:1.056-2.188)(all P<0.05).The risk of cognitive impairment in hypertensive and advanced age individuals was 4.617 times that of the non-hypertensive and non-advanced age(95%CI:3.606-5.913),the relative excess risk of interaction(RERI)was 8.363(95%CI:6.438-10.288),the attributable proportion of interaction(API)was 0.667(95%CI:0.623-0.711),and the synergy index(SI)was 3.631(95%CI:2.983-4.421)(all P<0.05).Conclusion The effects of hypertension and advanced age on cognitive impairment are multiplicative and additive.