体质指数在老年人脑血管病与心脏病关联中的中介作用  

The mediating role of body mass index on the association of cerebrovascular disease with heart disease in the elderly

作　　者：刘建康 蔺婧 徐富升 张愿 侯亚冰 李书[1] 陈妍春 张馨予[1] 王耀刚[1] LIU Jian-kang;LIN Jing;XU Fu-sheng;ZHANG Yuan;HOU Ya-bing;LI Shu;CHEN Yan-chun;ZHANG Xin-yu;WANG Yao-gang(School of Public Health,Tianjin Medical University,Tianjin 300070,China)

机构地区：[1]天津医科大学公共卫生学院,天津300070

出　　处：《中国慢性病预防与控制》2022年第4期246-250,共5页Chinese Journal of Prevention and Control of Chronic Diseases

基　　金：国家自然科学基金项目(91746205,71904142)。

摘　　要：目的 了解中国老年人脑血管病与心脏病的关系,并分析体质指数(BMI)在该种关联中的作用,为评价和制定心脏病防控策略提供科学依据。方法 利用中国老年健康影响因素追踪调查(CLHLS)2008—2018年的随访数据,选取≥65岁的老年人作为研究样本。采用Stata 15.0和R 4.0.4进行独立样本t检验和χ2检验,采用Cox回归分析老年人脑血管病对心脏病的影响,并采用因果中介分析方法对BMI在这种关联模式中的作用进行分析。结果 共纳入2008年基线调查的研究对象11 101人,心脏病的中位随访时间为3.3年,总随访时间为47 703.4人年,随访结束后,心脏病发病人数为979人,发病率为20.5/1 000人年。在非脑血管病者中心脏病发病人数为917人,发病率为20.0/1 000人年;脑血管病患者中心脏病发病人数为62人,发病率为32.0/1 000人年。多因素Cox回归分析结果显示,调整年龄、性别、吸烟状况、饮酒状况、锻炼状况、受教育程度、婚姻状况、睡眠时间、BMI和其他慢性疾病数量后,老年人脑血管病与患心脏病风险增加有关(HR=1.43,95%CI:1.10~1.85)。中介效应检验结果显示,以BMI 18.5~23.9 kg/m2为参照组,BMI≥24.0 kg/m2在这种关联模式中存在中介作用,中介效应占比为36.4%。结论 老年人脑血管病是心脏病的独立风险因素,BMI≥24.0 kg/m2在这种关联模式中存在中介效应,对老年人进行脑血管病与BMI的评估与控制,对于促进老年人心脏健康,降低中国疾病负担具有重要意义。Objective To understand the association of cerebrovascular disease with heart disease,and analyze the mediating role of body mass index(BMI) in this association,and provide the scientific basis for the evaluation and formulation of heart disease prevention and control strategies. Methods The follow-up data of Chinese Longitudinal Healthy Longevity Survey(CLHLS) in2008-2018 were used to select residents ≥65 years old as the subjects. The t test and χ2test were used to analyze the data.Cox regression model was used to analyze the influence of elderly cerebrovascular disease on heart disease. The causal mediation analysis method was used to analyze the role of BMI in the association model. The used software were Stata 15.0 and R 4.0.4.Results A total of 11 101 subjects were included in the 2008 baseline survey,the median of follow-up time for heart disease was3.3 years,total follow-up time was 47 703.4 person years. After follow-up,the number of heart disease patients was 979 cases,the morbidity was 20.5/1 000 person years. The number of heart disease patients in non-cerebrovascular disease subjects was 917,the morbidity was 20.0/1 000 person years;the number of heart disease patients in cerebrovascular disease subjects was 62,the morbidity was 32.0/1 000 person years. The multiple factors cox regression analysis showed that after adjustment for age,gender,smoking status,drinking status,exercise status,education level,marital status,sleep status,BMI and number of other chronic diseases,the cerebrovascular disease was related to the increasing risk of heart disease in elderly(HR=1.43,95%CI:1.10-1.85).The mediation test showed that BMI 18.5-23.9 kg/m2served as the control group,BMI ≥24 kg/m2has a mediating role in the relationship between cerebrovascular disease and heart disease in the elderly,and the proportion of mediating effect was 36.4%.Conclusion Cerebrovascular disease is an independent risk factor for heart disease in the elderly. BMI≥24 kg/m2has a mediating effect in this relationship model. The evalu

关 键 词：脑血管病 心脏病 体质指数 老年人群 

分 类 号：R541[医药卫生—心血管疾病]