中国中老年人心脏代谢性共病与失能的关系

doi:10.13481/j.1671-587X.20210329

摘要/Abstract

摘要： 目的

探讨中国中老年人心脏代谢性共病（CMM）与失能的关系，为我国中老年人群的失能风险评估提供依据。

方法

基于2011－2015年中国健康与养老追踪调查数据，以45岁以上中国中老年人群为研究对象，描述其人口学特征，采用广义估计方程分析CMM与失能的关系。

结果

纳入测量日常活动能力（ADL）功能的对象18 051名和测量工具性日常活动能力（IADL）功能的对象18 541名。在控制年龄和性别等混杂变量后，患有CMM者与ADL失能风险增加（OR=2.18，95%CI：1.95~2.43）以及IADL失能风险增加（OR=1.64，95%CI：1.50~1.80）有关联。患有1种、2种、3种及以上心脏代谢性疾病（CMD）者，发生ADL失能的风险分别是无CMD者的1.29倍、2.13倍和3.41倍，发生IADL失能的风险分别是无CMD者的1.17倍、1.60倍及2.26倍。患有2种、3种、4种CMD的患者中，ADL失能风险最高的组合分别为高血压和卒中（OR=6.00，95%CI：4.27~8.44），高血压、卒中和血脂异常（OR=11.43，95%CI：6.27~20.80），高血压、心脏病、卒中和血脂异常（OR=9.44，95%CI：4.19~21.20）；IADL失能风险最高的组合分别为高血压和卒中（OR=5.76，95%CI：4.07~8.17），高血压、卒中和血脂异常（OR=6.93，95%CI：3.45~13.90），高血压、心脏病、卒中和血脂异常（OR=8.56，95%CI：4.27~17.10）。

结论

CMM是影响中老年人群失能风险的重要因素。不同的CMD数量与疾病组合对中老年人失能的影响程度可能存在差异。

关键词: 心脏代谢性共病, 失能, 中老年人, 心脏代谢性疾病

Abstract: Objective

To discuss the associations between cardiometabolic multimorbidity（CMM） and disability in the middle-aged and older Chinese adults ，and to provide the evidence for the risk assessment of disability of the middle-aged and older Chinese adults.

Methods

The participants aged over 45 years old were selected as the subjects based on the China Health and Retirement Longitudinal Survey from 2011 to 2015. The descriptive statistics were presented for the demographic characteristics.The generalized estimating equation model was used to assess the associations between the CMM and disability.

Results

This study included 18 051 participants with activities of daily living （ADL） assessment and 18 541 with instrumental activities of daily living （IADL） assessment， respectively. After adjusted for covariates， CMM was associated with the higher risks for ADL （OR=2.18， 95%CI： 1.95－2.43） and IADL （OR=1.64， 95%CI： 1.50－1.80） disabilities. Compared with the participants without cardiometabolic disease （CMD）， the risks for ADL disability were 1.29， 2.13 ，and 3.41 times， and the risks for IADL disability were 1.17， 1.60 and 2.26 times in the participants with 1， 2， and 3 or more kinds of CMDs.In the participants with 2， 3， and 4 kinds of CMDs， the patterns with the highest risk for ADL disability were hypertension and stroke （OR=6.00， 95%CI： 4.27－8.44），hypertension， stroke and dyslipidemia （OR=11.43， 95%CI： 6.27－20.80），hypertension， heart disease， stroke and dyslipidemia （OR=9.44， 95%CI：4.19－21.20）；the patterns with the highest risk for IADL disability were hypertension and stroke （OR=5.76，95%CI：4.07－8.17）， hypertension， heart disease and stroke （OR=6.93， 95%CI：3.45－13.90）， and hypertension， heart disease， stroke and dyslipidemia （OR=8.56， 95%CI： 4.27－17.10）.

Conclusion

CMM is positively associated with the risk of disability in the middle-aged and older Chinese adults.Different counts and combinations of CMD may have differences in the influence degrees in the disability among the middle-aged and older Chinese adults.

Key words: cardiometabolic multimorbidity, disability, middle-aged and older adults, cardiometabolic disease

中图分类号:

R195

王瑞芬, 罗颜, 陈子烁, 黄紫婷, 苏鹤轩, 徐慧雯, 许蓓蓓, 杨金霞. 中国中老年人心脏代谢性共病与失能的关系[J]. 吉林大学学报(医学版), 2021, 47(3): 761-769.

Ruifen WANG, Yan LUO, Zishuo CHEN, Ziting HUANG, Hexuan SU, Huiwen XU, Beibei XU, Jinxia YANG. Associations between cardiometabolic multimorbidity and disability in middle-aged and older Chinese adults[J]. Journal of Jilin University(Medicine Edition), 2021, 47(3): 761-769.

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Characteristic	ADL disability (N=18 051)		IADL disability (N=18 541)
Characteristic	N (η/%)	Prevalence ^a (η/%)	N (η/%)	Prevalence (η/%)
Age (year)
45－54	6 489 (35.9)	3.7	6 745 (36.4)	5.2
55－64	6 294 (34.9)	6.6	6 641 (35.8)	8.1
65－74	3 490 (19.3)	11.7	3 459 (18.7)	14.5
≥75	1 778 (9.8)	22.3	1 696 (9.1)	26.1
Gender
Female	10 094 (55.9)	7.9	9 726 (52.5)	10.4
Male	7 957 (44.1)	9.1	8 815 (47.5)	10.4
Marital status
Single/divorced/separate/widowed	2 458 (13.6)	14.3	2 387 (12.9)	17.2
Married/cohabitated	15 593 (86.4)	7.4	16 154 (87.1)	9.3
Residential region
Rural	10 765 (59.6)	8.4	11 069 (59.7)	10.8
Urban	7 286 (40.4)	8.4	7 472 (40.3)	9.8
Educational level
≤Primary education	12 126 (67.2)	9.5	12 484 (67.3)	12.1
>Primary education	5 925 (32.8)	5.9	6 057 (32.7)	6.4
Smoking status
Never-smoker	11 798 (65.4)	8.3	11 877 (64.1)	10.5
Former-smoker	1 505 (8.3)	12.7	1 514 (8.2)	14.2
Current-smoker	4 748 (26.3)	7.2	5 150 (27.8)	9.0
Alcohol consumption
Never-drinker	10 852 (60.1)	8.4	10 788 (58.2)	10.6
Former-drinker	1 669 (9.2)	15.8	1 607 (8.7)	18.1
Current-drinker	5 530 (30.6)	5.9	6 146 (33.1)	7.7
Hypertension
No	11 451 (63.4)	6.4	11 968 (64.5)	8.5
Yes	6 600 (36.6)	11.6	6 573 (35.5)	13.6
Heart disease
No	15 922 (88.2)	7.6	16 576 (89.4)	9.7
Yes	2 129 (11.8)	13.7	1 965 (10.6)	15.6
Stroke
No	17 661 (97.8)	7.6	18 185 (98.1)	9.7
Yes	390 (2.2)	38.7	356 (1.9)	41.7
Diabetes
No	16 973 (94.0)	7.9	17 561 (94.7)	10.0
Yes	1 078 (6.0)	14.9	980 (5.3)	16.9
Dyslipidemia
No	16 433 (91.0)	8.1	17 016 (91.8)	10.1
Yes	1 618 (9.0)	11.4	1 525 (8.2)	13.2
Other somatic conditions
0	5 329 (29.5)	5.6	5 958 (32.1)	7.2
1	5 839 (32.3)	7.7	5 919 (31.9)	10.2
≥2	6 883 (38.1)	10.6	6 664 (35.9)	12.8

Item	β	SE	Z score	P	OR（95%CI）
Stroke included
CMM
No (<2 CMDs)	R	R	R	R	R
Yes (≥2 CMDs)	0.78	0.06	13.91	< 0.001	2.18 (1.95－2.43)
Number of CMD
0	R	R	R	R	R
1	0.26	0.04	4.96	< 0.001	1.29 (1.17－1.43)
2	0.75	0.06	11.00	< 0.001	2.13 (1.86－2.43)
≥3	1.23	0.09	13.00	< 0.001	3.41 (2.83－4.10)
Stroke excluded
CMM
No (<2 CMDs)	R	R	R	R	R
Yes (≥2 CMDs)	0.65	0.06	11.16	< 0.001	1.92 (1.71－2.16)
Number of CMD
0	R	R	R	R	R
1	0.26	0.05	5.16	< 0.001	1.30 (1.18－1.44)
2	0.68	0.07	9.61	< 0.001	1.98 (1.72－2.27)
≥3	1.03	0.10	10.06	< 0.001	2.79 (2.28－3.41)

Item	β	SE	Z score	P	OR（95%CI）
Stroke included
CMM
No (<2 CMDs)	R	R	R	R	R
Yes (≥2 CMDs)	0.50	0.05	10.46	< 0.001	1.64 (1.50－1.80)
Number of CMD
0	R	R	R	R	R
1	0.16	0.04	4.51	< 0.001	1.17 (1.10－1.26)
2	0.47	0.06	8.34	< 0.001	1.60 (1.43－1.78)
≥3	0.82	0.09	9.42	< 0.001	2.26 (1.91－2.68)
Stroke excluded
CMM
No (<2 CMDs)	R	R	R	R	R
Yes (≥2 CMDs)	0.39	0.05	7.96	< 0.001	1.48 (1.34－1.62)
Number of CMD
0	R	R	R	R	R
1	0.17	0.04	4.77	< 0.001	1.18 (1.10－1.27)
2	0.40	0.06	6.87	< 0.001	1.49 (1.33－1.66)
≥3	0.65	0.09	7.19	< 0.001	1.92 (1.61－2.29)

Number of CMD	Hypertension	Heart disease	Stroke	Diabetes	Dyslipidemia	β	SE	Z scores	P	OR (95% CI)
0						R	R	R	R	R

1			√			1.76	0.24	7.42	< 0.001	5.83 (3.66－9.29)
				√		0.37	0.17	2.21	0.027	1.45 (1.04－2.01)
		√				0.33	0.11	2.95	0.003	1.40 (1.12－1.74)
	√					0.22	0.06	3.91	< 0.001	1.25 (1.12－1.39)
					√	－0.24	0.22	－1.11	0.265	0.79 (0.52－1.20)
2	√		√			1.79	0.17	10.31	< 0.001	6.00 (4.27－8.44)
		√			√	0.81	0.22	3.70	< 0.001	2.25 (1.46－3.45)
	√			√		0.70	0.16	4.41	< 0.001	2.02 (1.48－2.75)
	√				√	0.60	0.13	4.57	< 0.001	1.83 (1.41－2.37)
	√	√				0.55	0.10	5.46	< 0.001	1.73 (1.42－2.11)
		√		√		0.73	0.38	1.91	0.056	2.07 (0.98－4.34)
				√	√	0.33	0.37	0.89	0.374	1.39 (0.67－2.89)
3	√		√		√	2.44	0.31	7.96	< 0.001	11.43 (6.27－20.80)
	√	√	√			1.53	0.42	3.62	< 0.001	4.63 (2.02－10.60)
	√	√		√		1.19	0.23	5.13	< 0.001	3.28 (2.08－5.16)
	√			√	√	0.96	0.21	4.62	< 0.001	2.60 (1.73－3.91)
	√	√			√	0.60	0.18	3.39	0.001	1.82 (1.29－2.58)
		√		√	√	0.65	0.57	1.13	0.257	1.91 (0.62－5.82)
4	√	√	√		√	2.25	0.41	5.41	< 0.001	9.44 (4.19－21.20)
4	√	√		√	√	1.14	0.23	5.07	< 0.001	3.13 (2.02－4.87)

Number of CMD	Hypertension	Heart disease	Stroke	Diabetes	Dyslipidemia	β	SE	Z score	P	OR (95%CI)
0						R	R	R	R	R

1			√			1.49	0.24	6.11	< 0.001	4.43 (2.75-7.13)
		√				0.32	0.08	4.12	< 0.001	1.37 (1.18-1.60)
	√					0.13	0.04	3.32	0.001	1.14 (1.05-1.22)
				√		0.15	0.14	1.10	0.270	1.16 (0.89-1.51)
					√	0.05	0.12	0.43	0.665	1.05 (0.83-1.34)

2	√		√			1.75	0.18	9.85	< 0.001	5.76 (4.07-8.17)
		√		√		1.01	0.29	3.47	0.001	2.75 (1.55-4.87)
		√			√	0.58	0.19	3.07	0.002	1.79 (1.23-2.60)
	√			√		0.37	0.14	2.71	0.007	1.45 (1.11-1.89)
	√	√				0.35	0.08	4.48	< 0.001	1.42 (1.22-1.66)
	√				√	0.20	0.11	1.84	0.065	1.22 (0.99-1.50)
				√	√	-0.15	0.32	-0.48	0.631	0.86 (0.46-1.60)

3	√		√		√	1.94	0.36	5.44	< 0.001	6.93 (3.45-13.90)
	√	√	√			1.39	0.42	3.31	0.001	3.99 (1.76-9.07)
	√	√		√		0.93	0.20	4.62	< 0.001	2.53 (1.71-3.75)
	√			√	√	0.43	0.19	2.28	0.023	1.54 (1.06-2.24)
	√	√			√	0.13	0.15	0.91	0.360	1.14 (0.86-1.52)

4	√	√	√		√	2.15	0.35	6.05	< 0.001	8.56 (4.27-17.10)
4	√	√		√	√	0.69	0.19	3.61	< 0.001	1.98 (1.37-2.88)