2017—2021年新疆生产建设兵团某师心血管代谢性共病群体脆弱性动态评价  

Status and annual change of vulnerability among middle-aged and elderly people with cardiometabolic multimorbidity in a division of Xinjiang Production and Construction Corps,2017–2021:baseline and follow-up data analysis

作　　者：王梓琪 陈洁婷[2] 张梅[1] 井明霞[1] WANG Ziqi;CHEN Jieting;ZHANG Mei;JING Mingxia(Department of Preventive Medicine,School of Medicine,Shihezi University,Shihezi 832003,China;Department of Humanities Nursing,School of Medicine,Shihezi University,Shihezi 832003,China)

机构地区：[1]石河子大学医学院预防医学系,石河子832003 [2]石河子大学医学院人文护理学教研室,石河子832003

出　　处：《中国公共卫生》2024年第11期1303-1311,共9页Chinese Journal of Public Health

基　　金：教育部人文社会科学研究青年基金新疆项目(19XJJCZH001);石河子大学自主资助支持校级科研项目(ZZZC201811A)。

摘　　要：目的动态评价2017—2021年新疆生产建设兵团某师心血管代谢性共病(CMM)群体的脆弱性,并对障碍因子进行诊断识别,为该群体的健康干预提供科学依据。方法收集新疆生产建设兵团某师3个城市和2个团场社区参加2017年7月基线调查以及2018年7月、2019年7月和2021年7月3次随访调查839例≥45岁心血管代谢性疾病(CMD)患者的相关数据,结合“风险因素–抵御风险能力–社会服务体系”脆弱性概念框架构建针对CMM群体的脆弱性评价指标体系,运用熵权法动态评价2017—2021年新疆生产建设兵团某师CMM群体的脆弱性水平,采用核密度估计不同社区类型中CMM群体脆弱性水平的时空演变特征,通过计算各维度脆弱性贡献率探究不同共病组合脆弱性水平及其分级变化情况,并引入障碍度模型识别脆弱性障碍因子。结果新疆生产建设兵团某师CMM群体总体脆弱性和风险因素脆弱性平均得分分别从2017年的(–0.190±0.106)分和(0.021±0.030)分上升至2021年的(–0.101±0.019)分和(0.045±0.039)分,抵御风险能力脆弱性和医疗服务体系脆弱性平均得分分别从2017年的(0.087±0.069)分和(0.125±0.070)分下降至2021年的(0.084±0.073)分和(0.063±0.077)分;时空演变特征结果显示,CMM群体脆弱性水平为城市社区>城郊社区>农村社区,CMM群体脆弱性空间差异为城市社区<城郊社区<农村社区;各维度脆弱性贡献率占比依次为保障型(52.29%)、能力型(41.84%)和风险型(5.87%);2017—2021年新疆生产建设兵团某师CMM群体各共病组合脆弱性得分均逐年增加,其中有63.64%的疾病组合发生脆弱性程度变迁,有36.36%的疾病组合脆弱性等级保持不变;从高脆弱性与低脆弱性二维视角分析,共病组合中除缺血性心脏病+脑卒中组合、高血压+糖尿病组合、缺血性心脏病+高血压+糖尿病组合和缺血性心脏病+高血压+脑卒中组合外的其他组合均未发生明显改变;障�Objective To analyze the status,annual change,and major factors of vulnerability among middle-aged and elderly people with cardiometabolic multimorbidity(CMM)in a division of the Xinjiang Production and Construction Corps from 2017 to 2021 to provide a basis for population health interventions.Methods Study data were collected from 839 patients aged≥45 years with cardiovascular metabolic disease(CMD)who participated in a baseline survey in July 2017 and 3 follow-up surveys in July 2018,July 2019,and July 2021 in 3 urban and 2 regimental communities in a division of the Xinjiang Production and Construction Corps.Based on the vulnerability conceptual framework of"risk factors-resilience-social service system",a vulnerability assessment index system for the CMM population was constructed.The entropy weighting method was used to dynamically evaluate the vulnerability level of the CMM population from 2017 to 2021.Kernel density estimation was used to analyze the spatial and temporal evolution characteristics of the vulnerability level of the CMM population in different community types.The contribution rate of each vulnerability dimension was calculated to explore the vulnerability level and its hierarchical changes in different comorbidity combinations.The obstacle degree model was introduced to identify the influencing factors of vulnerability.Results The mean scores of overall and risk factor vulnerability of the CMM population increased from–0.190±0.106 and 0.021±0.030 in 2017 to–0.101±0.019 and 0.045±0.039 in 2021.The mean scores of health resilience and health service system vulnerability decreased from 0.087±0.069 and 0.125±0.070 in 2017 to 0.084±0.073 and 0.063±0.077 in 2021,respectively.The results of the spatial and temporal analysis showed a decreasing order of absolute difference in annual peak vulnerability scores and an increasing order of variation in annual peak nuclear density of vulnerability scores for the CMM population from urban,suburban,and rural communities.The average percentages

关 键 词：心血管代谢性共病(CMM)群体 脆弱性 动态评价 

分 类 号：R54[医药卫生—心血管疾病]