基于基本公共卫生服务项目构建中老年人群高血压风险评估模型  

Establishment of a hypertension risk assessment model among middle-aged and elderly populations based on the basic public health service program

作　　者：林天祥 邱银伟[1] 汪炜[1] 赵艳荣[1] 姜学文 杨清[1] LIN Tianxiang;QIU Yinwei;WANG Wei;ZHAO Yanrong;JIANG Xuewen;YANG Qing(Department of Public Health Surveillance and Advisory,Zhejiang Provincial Center for Disease Control and Prevention,Hangzhou,Zhejiang 310051,China)

机构地区：[1]浙江省疾病预防控制中心公共卫生监测与业务指导所,浙江杭州310051

出　　处：《预防医学》2022年第8期816-820,共5页CHINA PREVENTIVE MEDICINE JOURNAL

基　　金：浙江省卫生健康科技计划(2021PY004)。

摘　　要：目的基于基本公共卫生服务项目居民电子健康档案,建立中老年人群高血压风险评估模型,为预防高血压提供指导。方法通过浙江省某县基本公共卫生服务项目居民电子健康档案收集2019—2020年≥40岁居民人口学信息及体检资料;采用多因素logistic回归模型筛选高血压风险因素,采用校正公式将各风险因素的OR值转换为近似RR值,代入哈佛公共卫生学院提供的疾病风险计算公式建立高血压风险评估模型;采用受试者工作特征(ROC)曲线评价模型的预测效果。结果纳入7275人,年龄为(66.15±7.91)岁;男性3189人,女性4086人,男女比为0.78∶1;新发高血压190例,占2.61%。多因素logistic回归分析结果显示,控制性别和年龄后,超重、肥胖、中心性肥胖、三酰甘油(TG)边缘升高、TG升高、空腹血糖(FPG)异常、血压高值和高血压家族史纳入高血压风险评估模型,近似RR值分别为1.66、1.96、1.54、1.17、1.64、1.45、1.69和1.11。模型的ROC曲线下面积(AUC)为0.678(95%CI:0.641~0.715,P<0.001),最佳阳性阈值为0.899,利用该模型评估高血压相对风险高于0.899的研究对象有139例,灵敏度为73.16%,特异度为55.79%。结论本研究构建的高血压风险评估模型可用于评估中老年人群高血压发病相对风险,在健康管理中具有一定的应用价值。Objective To establish a hypertension risk assessment model among the middle-aged and elderly popula⁃tions based on residents'electronic healthcare records of the basic public health service program,so as to provide in⁃sights into prevention of hypertension.Methods Demographic features and physical examinations were collected among residents at ages of 40 years and older from residents'electronic healthcare records of the basic public health service program in a county of Zhejiang Province from 2019 to 2020.The risk factors of hypertension were identified using a multivariable logistic regression model,and the odds ratio(OR)for each risk factor was transformed into approximate rel⁃ative risk(RR),which was included in the formula for calculation of the disease risk proposed by Harvard School of Public Health to create a hypertension risk assessment model.The predictive value of the model was evaluated using a receiver operator characteristic(ROC)curve.Results Totally 7275 subjects were enrolled,with a mean age of(66.15±7.91)years,and the participants included 3189 males and 4086 females,with a male-to-female ratio of 0.78∶1.There were 190 cases with new-onset hypertension(2.61%).Multivariable logistic regression analysis revealed that over⁃weight,obesity,central obesity,borderline high triacylglycerol(TG),elevated TG,abnormal fasting plasma glucose(FPG),prehypertension and family history of hypertension were included in the hypertension risk assessment model,with approx⁃imate RR values of 1.66,1.96,1.54,1.17,1.64,1.45,1.69 and 1.11.The area under the ROC curve(AUC)of the model was 0.678(95%CI:0.641-0.715,P<0.001),and the optimal positive cut-off was 0.899.The model predicted 139 subjects with RR>0.899 for hypertension,with a sensitivity of 73.16%and specificity of 55.79%.Conclusions The hy⁃pertension risk assessment model created in this study is feasible to predict the RR for developing hypertension among the middle-aged and elderly populations,which has a predictive value in healthcare management.

关 键 词：高血压 风险因素 风险评估 基本公共卫生服务项目 

分 类 号：R544.1[医药卫生—心血管疾病]