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

Abstract

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

CLC Number:

R195

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.

Figures/Tables 7

Tab.1

Tab.2

Tab.3

Tab.4

Tab.5

Tab.6

Tab.7

References

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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)

Associations between cardiometabolic multimorbidity and disability in middle-aged and older Chinese adults

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Item	Reference group	β	SE	Z score	P	OR (95%CI)
Hypertension+dyslipidemia+stroke	Hypertension+dyslipidemia	1.84	0.34	5.39	<0.001	6.30 (3.23－12.20)
Hypertension+heart disease+stroke	Hypertension+heart disease	1.15	0.44	2.61	0.009	3.17 (1.33－7.53)
Hypertension+heart disease+dyslipidemia+stroke	Hypertension+heart disease+ dyslipidemia	1.61	0.46	3.50	0.001	4.99 (2.03－12.20)

Item	Reference group	β	SE	Z score	P	OR (95% CI)
Hypertension+dyslipidemia+stroke	Hypertension+dyslipidemia	1.48	0.36	4.17	<0.001	4.40 (2.19－8.83)
Hypertension+heart disease+stroke	Hypertension+heart disease	0.95	0.42	2.26	0.024	2.59 (1.14－5.90)
Hypertension+heart disease+dyslipidemia+stroke	Hypertension+heart disease+ dyslipidemia	1.90	0.41	4.68	<0.001	6.68 (3.02－14.80)

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