健康自评与老年人健康状况的前瞻性研究

Study on the relationship between self-rated health situation and health status in the elderly-an 8-year follow-up study from Multidimentional Longitudinal Study of Aging in Beijing

目的 探讨健康自评 (SRH)与老年人健康的关系。方法 1992年在北京城乡各随机抽取 1个区 县后 ,再采取分层、分段及整群抽样的方法抽取 5 5岁以上老年人 3 15 7名进行研究 ,并于1994、1997和 2 0 0 0年随访。结果 基线调查结果显示 ,SRH受年龄、性别、婚姻状态、教育水平和经济满意度的影响 ;SRH一般和不良老年人的慢性病总患病率以及脑血管病、心脏病、呼吸系统疾病和骨关节疾病患病率均明显高于SRH良好老年人。从 1992～ 2 0 0 0年 8年间共 993人死亡 ,SRH是老年人死亡的危险因素 ,SRH一般与不良者总死亡的危险分别高于SRH良好者 12 % (HR =1.12 ,95 %CI :0 .93～ 1.3 5 )和 5 3 % (HR =1.5 3 ,95 %CI :1.2 5～ 1.88) ,在控制混杂因素〔年龄、性别、地区 (城 乡 )、婚姻状态、教育水平、近一年就医次数和住院次数、患慢性病、日常生活自理能力、体重指数、认知功能、抑郁〕、剔除随访 1年和 3年内死亡者后 ,上述趋势依然存在。与SRH良好者相比 ,SRH不良者脑卒中和心脏病死亡的危险分别增加了 2 .2 5倍 (HR =2 .2 5 ,95 %CI:1.67～ 3 .0 4)和 2 .2 2倍 (HR =2 .2 2 ,95 %CI :1.61～ 3 .0 7)。结论 SRH与各种常见的老年慢性病患病率有关 ,同时又是预报死亡的独立危险因素 ,提示在老年卫生保健工作?

Objective To study the relationship between self-rated health (SRH) and prevalence of chronic diseases, and all-cause mortality in the elderly population. Methods In 1992, a cohort of 3 257 people ≥55 years old was selected from Beijing, the information of SRH and other related variables were collected from 3 157 subjects at the baseline survey. Three follow-up surveys were conducted in 1994, 1997 and 2000, respectively. Results The SRH was influenced by age, gender, marriage status and satisfaction on their own economic condition. Comparing the subjects with excellent SRH, the prevalence rates of chronic diseases, stroke, heart diseases and respiratory system diseases were almost doubled among those with average and poor SRH. By 2000, 993 death occurred. All-cause mortality was negatively associated with SRH, i.e. the risk of death was 12% which was 53% higher for the subjects with average SRH ( HR= 1.12,95%CI: 0.93- 1.35) and poor SRH ( HR= 1.53,95%CI: 1.25- 1.88) than those with excellent SRH, respectively. The risks of death from stroke and heart disease were 2.25 ( HR= 2.25,95%CI: 1.67- 3.04) and 2.22 ( HR= 2.22,95%CI: 1.61- 3.07) times higher among the subjects with poor SRH than those with excellent SRH respectively. After adjustment for age, gender, resident place, marriage status, education, satisfaction on their own economic condition, seeing doctors or hospitalized within the last 1 year, history of chronic disease, cognition function, body mass index, activities of daily living and depression, as well as deleted the subjects died within first or third year of the baseline survey respectively, poor SRH remained a significantly independent predictor to all-cause death as well as to the death of stroke and heart diseases. Conclusions The frequency of poor SRH was influenced by age, gender, marriage status and satisfaction on their own economic condition. Poor SRH was associated with the prevalence of chronic conditions and mortality among the elderly. The findings suggested that SRH might have served as an important indicator in the evaluation on health status among the elderly.