广州厂企职工血压水平与心脑血管疾病死亡的关系

A cohort study on the relationship between blood pressure levels and the mortality of cerebro-cardiovascular diseases in Guangzhou workers

目的 分析工人高血压与心脑血管疾病 (CVD)死亡的相对危险度 (RR) ,探讨减少工人CVD死亡危险性的预防办法。方法 由广州 399家工厂年龄 35岁或以上的 78379名工人组成队列 ,进行前瞻性研究。资料处理采用分层和多因素调整统计分析方法 (Cox模型 )。结果 (1)队列中男4870 5名、女 2 96 74名 ,追踪 8.0年 ,CVD死亡 36 3人 ,男 30 5人、女 5 8人 ,粗死亡率分别为 78.5 8/ 10万人年和 2 4.5 5 / 10万人年 ,主要死于脑卒中、冠心病和高血压。 (2 )与理想或正常血压比 ,高血压CVD死亡的RR(95 % )分别为男 6 .19(4.85～ 7.91)、女 2 .78(1.5 9～ 4.85 ) ;男性工人基线无患病者和非CVD患者Ⅰ级高血压CVD死亡的RR和CVD患者Ⅱ级高血压CVD死亡的RR明显增加 ,分别为 3.98、3 .2 5和 3 .15 ,理想或正常血压与Ⅰ级高血压和Ⅱ级高血压CVD死亡的RR增加趋势差异有显著性 (P<0 .0 1)。(3)按年龄、吸烟、饮酒、文化程度和职业接触有害因素分层后 ,年轻、吸烟、不饮酒、文化程度较高者以及职业接触有害因素者的高血压患者CVD死亡RR较高。结论 血压水平与心脑血管疾病死亡率呈连续性相关 ,高血压对CVD死亡的影响在较年轻时已经出现 ;应采用综合预防办法减少CVD死亡危险性。

Objective To study the relative risk(RR) of mortalities of cerebro-cardiovascular diseases(CVD) in Guangzhou workers with hypertension. Method Prospective cohort study was conducted in 78 379 workers,aged≥35,from 399 factories.Cox regression model were mainly used for data analysis. Results (1)There were 48 705 male and 29 674 female workers in the cohort.All workers were followed-up for 8 years.363 CVD deaths(male 305,female 58) mainly died of stroke,coronary heart disease and hypertension.The crude mortalities were 78.58/100 000 person years in male and 24.55/100 000 person years in female.(2)Compared with the optimal or normal blood pressure(ONBP),the RR(95%) of CVD deaths with high blood pressure(HBP) were 6.19(4.85～7.91) in male and 2.78(1.59～4.85) in female.In male,compared with ONBP,the RR of CVD deaths without illness but with 1st-grade HBP at baseline,and of those suffered non-CVD but with 1st-grade HBP at baseline,and of those suffered CVD with 2nd-grade HBP at baseline were 3.98,3.25 and 3.15 respectively(P<0.01).(3)After stratifrying of age,smoking,drinking,educational levels and occupational exposure,the RR of CVD deaths was higher in those who were younger,or ever-smoking,non-drinking,higher educational level,exposed to occupational hazards and with hypertension. Conclusion There is relationship between BP levels and CVD mortality.High BP may affect CVD deaths at younger age.Comprehensive measures should be used to reduce the risk of CVD deaths.