文章摘要
曾新颖,张梅,李镒冲,黄正京,王丽敏.中国2011年城乡35岁及以上高血压患者社区管理现状及其效果影响因素分析[J].中华流行病学杂志,2016,37(5):612-617
中国2011年城乡35岁及以上高血压患者社区管理现状及其效果影响因素分析
Study on effects of community-based management of hypertension patients aged ≥35 years and influencing factors in urban and rural areas of China, 2010
收稿日期:2015-12-07  出版日期:2016-05-13
DOI:10.3760/cma.j.issn.0254-6450.2016.05.005
中文关键词: 社区高血压规范化管理  血压控制  影响因素  横断面研究
英文关键词: Standardized community-based management of hypertension  Blood pressure control  Influencing factors  Cross-section study
基金项目:
作者单位E-mail
曾新颖 100050 北京, 中国疾病预防控制中心慢性非传染性疾病预防控制中心  
张梅 100050 北京, 中国疾病预防控制中心慢性非传染性疾病预防控制中心  
李镒冲 100050 北京, 中国疾病预防控制中心慢性非传染性疾病预防控制中心  
黄正京 100050 北京, 中国疾病预防控制中心慢性非传染性疾病预防控制中心  
王丽敏 100050 北京, 中国疾病预防控制中心慢性非传染性疾病预防控制中心 wlm65@126.com 
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中文摘要:
      目的 了解社区高血压规范化管理在我国城市和农村地区的开展现状和效果,并探索影响高血压管理效果的因素。方法 2011年开展横断面调查所追访到的2010年中国慢性病及其危险因素监测的人群中,≥35岁、已被乡镇(社区)级或以上医院确诊为高血压并纳入社区高血压管理的患者。通过面对面问卷调查和身体测量收集研究对象一般社会人口特征、危险因素、并发症、参加社区高血压管理、血压治疗情况及血压值、身高、腰围、体重等指标。采用复杂抽样设计的Rao-Scott χ2检验比较组间差异,以泰勒级数线性化法并考虑初级抽样单元的有限总体校正估计率,复杂抽样设计的非条件多因素logistics回归分析高血压控制率的影响因素。结果 5120例患者纳入分析。36.57%(1903例)高血压患者接受管理时间≥2年,且城市(44.56%,1014例)高于农村(31.79%,889例)(P<0.05);在过去12个月内,接受血压测量和用药指导服务情况城乡间差异无统计学意义(P>0.05),接受过膳食和身体活动指导的比例分别为84.25%(4331例)和84.90%(4369例),均是城市高于农村(P<0.05),接受过戒烟/限烟和戒酒/限酒建议指导的比例分别为78.41%(1368例)和77.80%(1335例),均是农村高于城市(P<0.05)。在城市,接受规范化管理患者的平均SBP(142.79±17.39) mmHg和平均DBP(84.26±9.49) mmHg均低于接受非规范化管理患者,血压控制率(49.77%)高于接受非规范化管理患者(42.16%)(P<0.05);而在农村,规范化与非规范化管理患者血压控制率接近(P>0.05)。在城市,影响参加社区管理患者血压控制的因素包括受教育程度、人均年收入、体重、管理方式、血压测量次数、用药指导次数和身体活动指导;而在农村,则是人均年收入、体重、高血压家族史、用药指导次数和膳食指导。结论 城市社区高血压规范化管理控制血压的效果明显好于农村,农村地区提供的各项高血压管理服务质量较低。
英文摘要:
      Objective To understand the effects of standardized community-based management of hypertension in urban and rural areas in China and related influencing factors. Methods The study subjects were the hypertension patients aged ≥35 years who were recruited in 2011 from the participants of 2010 national chronic and non-communicable disease surveillance project. The hypertension patients were diagnosed in community health centers or higher level hospitals and included in community based hypertension management project. By face-to-face questionnaire survey and health examination, the information of the subjects'demographic characteristics, risk factors, complications, involvement in community-based management of hypertension, anti-hypertension treatment, blood pressure, body height, waistline and body weight were collected. In this study, Rao-Scott χ2 test was used to compare the variations among sub-groups. Taylor series linearization method was used to estimate the prevalence rate. The complex sampling and unconditional multivariate logistics regression analysis was conducted to identify the influencing factors for the control of hypertension. Results A total of 5 120 subjects were recruited in the analysis. The proportion of those receiving management for more than two years was 36.57%, and it was higher in urban area (44.56%) than in rural area (31.79%, P<0.05); In the past 12 months, 6.17% and 14.46% of the patients received no blood pressure measurement and drug therapy advice respectively, but there were no significant differences between urban group and rural group (P>0.05); In the past 12 months, the proportions of the patients receiving diet and physical activity advice were 84.25% and 84.90% respectively, and the proportions were higher in urban group than in rural group (P<0.05); In the past 12 months, the proportions of the subjects receiving tobacco and alcohol use advice were 78.41% and 77.80% respectively, and the proportions were higher in rural group than in urban group (P<0.05). In urban area, the subjects receiving standardized management had lower SBP (142.79±17.39) mmHg, lower DBP (84.26±9.49) mmHg and higher blood pressure control rate (49.77%) than those receiving no standardized management (P<0.05); while in rural area, no difference was found in BP control between the patients receiving and receiving no standardized management (P>0.05). In urban area, the influencing factors for BP control among the subjects receiving community based management were educational level, annual income, body weight, hypertension management mode, times of receiving BP measurement, times of receiving antihypertensive medicine advice and receiving physical activity advice; while in rural area, the influencing factors for BP control among the subjects receiving community based management were annual income, body weight, family history of hypertension, antihypertensive medicine awareness, times of receiving antihypertensive medicine advice and receiving diet advice. Conclusion The effects of community-based standardized management of hypertension were better in urban area than in rural area, and the quality of the services of community-based hypertension management was lower in rural area than in urban area.
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