社会经济地位、健康生活方式对心血管疾病影响的前瞻性队列研究  

Prospective Cohort Study of the Impact of Socioeconomic Status and Healthy Lifestyle on Cardiovascular Disease

作　　者：安芹彧 王艺颖 张小丹 张畑霖 詹清清 张福艳 刘涛 吴延莉[2] AN Qinyu;WANG Yiying;ZHANG Xiaodan;ZHANG Tianlin;ZHAN Qingqing;ZHANG Fuyan;LIU Tao;WU Yanli(Medical School,Guizhou University,Guiyang 550025,China;Research Institute of Chronic Disease Prevention and Treatment,Guizhou Center for Disease Control and Prevention,Guiyang 550004,China;School of Public Health,the Key Laboratory of Environmental Pollution Monitoring and Disease Control/Ministry of Education,Guizhou Medical University,Guiyang 550025,China)

机构地区：[1]贵州大学医学院,贵州省贵阳市550025 [2]贵州省疾病预防控制中心慢性病防治研究所,贵州省贵阳市550004 [3]贵州医科大学公共卫生与健康学院环境污染与疾病监控教育部重点实验室,贵州省贵阳市550025

出　　处：《中国全科医学》2025年第16期2017-2024,共8页Chinese General Practice

基　　金：贵州省科技计划项目(黔科合支撑[2018]2819)。

摘　　要：背景心血管疾病(CVD)是一个全球性的健康问题,目前尚不清楚社会经济地位(SES)和健康生活方式(HL)对CVD发病是否有影响。目的了解SES、HL与CVD的关系,为人群CVD防控提供依据。方法本研究采用多阶段整群随机抽样方法,于2010年抽取9280名贵州省12个县/区18岁及以上常住居民进行基线调查,于2016—2020年对该队列所有人群进行随访,由经过统一培训且考核合格的人员进行面对面访谈,包括基本情况、生活方式(吸烟、饮酒、蔬菜水果摄入等)、既往史等,根据调查对象是否发病分为CVD组(123名)和非CVD组(4025名);运用COX比例风险回归模型分析SES、HL对CVD发病的影响,采用加速失效时间模型分析不同SES、HL对CVD发病时间的影响。结果排除基线CVD患者、失访者及信息缺失者后,最终纳入分析的有效样本量为4148名,CVD发病123名,发病密度为4.13/1000人年。COX比例风险回归模型分析结果显示,与SES低分组人群相比,SES高分组人群CVD发病风险下降40.60%(HR=0.594,95%CI=0.402~0.878)。与≤6种HL人群相比,拥有8种、≥9种HL人群CVD发病风险分别下降44.40%(HR=0.556,95%CI=0.320~0.968)、49.20%(HR=0.508,95%CI=0.284~0.912)。与SES低分组且HL≤6种的人群相比,SES低分组且HL为7、8、≥9种的人群CVD发病风险无统计学意义(P>0.05);SES高分组且HL为8种和≥9种人群CVD发病风险将分别下降61.80%(HR=0.382,95%CI=0.163~0.894)、70.20%(HR=0.298,95%CI=0.119~0.748),CVD发病风险呈下降趋势(P_(趋势)<0.001)。加速失效时间模型结果显示,与SES低分组且HL≤6种的人群相比,SES高分组且拥有8种和≥9种HL人群CVD发病时间分别推迟1.148年(95%CI=0.049~2.247)、1.407年(95%CI=0.227~2.588)。结论不同SES、HL与CVD发病呈负相关;在高SES人群中,随着HL种类的增加CVD发病时间随之延长。低SES人群是贵州省CVD防控的重点人群,应采取措施提高其健康素养,同时针对性地开展CVD的健康教育与健康Background Cardiovascular disease(CVD)is a global health problem,and it is not known whether socioeconomic status(SES)and healthy lifestyle(HL)have an impact on CVD onset.Objective To understand the relationship between SES,HL and CVD,and to provide a basis for the prevention and control of CVD in the population.Methods A multi-stage cluster random sampling method was employed to select 9280 residents aged 18 and above from 12 counties and districts in Guizhou Province as the baseline sample in 2010.In 2016-2020 follow the cohort,face to face interview by unified training and qualified personnel,including basic situation,lifestyle(smoking,drinking,vegetables and vegetables,etc.),previous disease history,according to the survey was divided into CVD group(123)and non-CVD group(4025);we used COX proportional hazard regression models were used to analyze the effect of SES and HL on CVD incidence.Additionally,an accelerated failure time model was utilized to assess the impact of different SES and HL at the time of CVD onset.Results After excluding baseline CVD patients,lost-to-follow-up and missing information,the valid sample size included in the analysis was 4148,CVD onset 123,and the incidence density was 4.13/1000 person-years.The results of multivariate analysis showed that compared with low SES(≤7 points),the risk of CVD in high SES(>7 points)decreased by 40.60%(HR=0.594,95%CI=0.402-0.878).Compared with 6 HL populations,the population with 8 and 9 HL decreased by 44.40%(HR=0.556,95%CI=0.320-0.968)and 49.20%(HR=0.508,95%CI=0.284-0.912).Compared with the population in the low SES group and with HL≤6 conditions,there was no statistically significant risk of CVD incidence in the population in the low SES group with HL of 7,8,or≥9 conditions(P>0.05);those with high SES(>7 points)and HL of 8 or 9 decreased CVD risk by 61.80%(HR=0.382,95%CI=0.163-0.894)and 70.20%(HR=0.298,95%CI=0.119-0.748,respectively),showing a decreasing trend.The results of the accelerated failure time model showed that those with high SES(>7

关 键 词：心血管疾病 社会经济地位 健康生活方式 COX回归分析 队列研究 

分 类 号：R54[医药卫生—心血管疾病]