| 宋子伟,张梅,张笑,赵振平,黄正京,李纯,邓晓庆,王丽敏.2015年我国35岁及以上高血压患者社区健康管理与高血压治疗控制情况分析[J].中华流行病学杂志,2021,42(11):2001-2009 |
| 2015年我国35岁及以上高血压患者社区健康管理与高血压治疗控制情况分析 |
| Study on community health management and control of hypertension in patients aged 35 years and above in China, 2015 |
| 收稿日期:2021-07-27 出版日期:2021-11-20 |
| DOI：10.3760/cma.j.cn112338-20210727-00590 |
| 中文关键词: 高血压患者 社区管理 血压控制 影响因素 |
| 英文关键词: Hypertension patient Community management Blood pressure control Influencing factor |
| 基金项目:国家重点研发计划（2018YFC1311706） |
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| 摘要点击次数: 2644 |
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| 中文摘要: |
| 目的 了解2015年我国≥ 35岁高血压患者的社区健康管理及高血压治疗控制情况并探索其影响因素。方法 利用2015年中国成人慢性病与营养监测项目收集的问卷调查及体格测量等信息，以乡镇卫生院（社区卫生服务中心）或以上级别医疗卫生机构医生诊断为高血压的≥ 35岁的患者为研究对象，对样本进行复杂加权后，分析其一般特征、高血压社区健康管理情况及高血压治疗控制情况。结果 共纳入高血压患者23 974名，经复杂加权后，我国≥ 35岁高血压患者的社区健康管理率为54.10%（95%CI：51.02%~57.17%），社区规范管理率为45.72%（95%CI：42.93%~48.51%）；高血压治疗率为88.16%（95%CI：87.00%~89.31%），控制率为22.67%（95%CI：21.25%~24.09%），治疗控制率为27.76%（95%CI：26.09%~29.42%）。多因素分析结果显示，城市和农村年龄≥ 65岁（OR=1.40，95%CI：1.05~1.87；OR=3.11，95%CI：2.22~4.36）、按医嘱服药（OR=2.15，95%CI：1.46~3.15；OR=1.35，95%CI：1.13~1.62）、进行血压监测（OR=2.34，95%CI：1.88~2.90；OR=3.10，95%CI：2.72~3.53）的高血压患者更愿意接受高血压社区健康管理；文化程度大专及以上（OR=0.51，95%CI：0.39~0.66）、适量饮酒（OR=0.69，95%CI：0.57~0.84）或过量饮酒（OR=0.73，95%CI：0.58~0.92）的城市高血压患者接受社区高血压管理的情况不佳。城市和农村超重（OR=0.74，95%CI：0.61~0.91；OR=0.83，95%CI：0.71~0.98）、肥胖（OR=0.54，95%CI：0.45~0.65；OR=0.67，95%CI：0.54~0.83）的高血压患者血压控制情况较差，按医嘱服药（OR=4.58，95%CI：3.16~6.63；OR=2.84，95%CI：2.18~3.69）的高血压患者的血压控制状况较好。地处中部（OR=0.74，95%CI：0.61~0.89）、过量饮酒（OR=0.72，95%CI：0.54~0.97）的城市高血压患者血压控制情况较差，合并其他慢性疾病（OR=1.22，95%CI：1.04~1.44）、参加高血压社区规范管理（OR=1.29，95%CI：1.06~1.58）的城市高血压患者血压控制情况较好；地处中、西部地区（OR=0.71，95%CI：0.58~0.87；OR=0.62，95%CI：0.47~0.80）、适量饮酒（OR=0.81，95%CI：0.67~0.98）、人均每日食盐摄入量>6 g （OR=0.80，95%CI：0.69~0.93）的农村高血压患者血压控制情况较差，进行血压监测（OR=1.38，95%CI：1.18~1.61）的农村高血压患者血压控制情况较好。结论 我国≥ 35岁高血压患者社区健康管理情况较之前有所改善，但是高血压控制情况距离相关政策指标还有一定差距。 |
| 英文摘要: |
| Objective To understand the current status of community health management, treatment and control of hypertension in patients aged 35 years and above in China in 2015, and identify the influencing factors. Methods Using the questionnaire survey results and physical measurement information collected by China Chronic Diseases and Nutrition Monitoring System in 2015, hypertension patients aged 35 years and above diagnosed at township health center level (community health service centers) or above were selected as the research subjects. The patients were complexly weighted to analyze their general characteristics, community health management, treatment and control status. Results This study included 23 974 hypertension patients aged 35 years and above diagnosed by medical and health institutions at township level and above in 2015. After complex weighting, the community health management rate of hypertension patients aged 35 years and above was 54.10% (95%CI:51.02%-57.17%), the standardized community management rate was 45.72% (95%CI:42.93%-48.51%), the treatment rate was 88.16% (95%CI:87.00%-89.31%), and the control rate was 22.67% (95%CI:21.25%-24.09%), the treatment control rate was 27.76% (95%CI:26.09%-29.42%). Multivariate analysis showed that patients in urban areas as well as in rural areas who were aged over 65 years old (OR=1.40, 95%CI:1.05-1.87; OR=3.11, 95%CI:2.22-4.36), taking medicine as prescribed (OR=2.15, 95%CI:1.46-3.15; OR=1.35, 95%CI:1.13-1.62), monitoring blood pressure (OR=2.34, 95%CI:1.88-2.90; OR=3.10, 95%CI:2.72-3.53) were more willing to accept community health management of hypertension. Urban hypertension patients with high education level (OR=0.51, 95%CI:0.39-0.66), moderate alcohol consumption (OR=0.69, 95%CI:0.57-0.84) or excessive alcohol consumption (OR=0.73, 95%CI:0.58-0.92) had a poor acceptance of community hypertension management. Overweight (OR=0.74, 95%CI:0.61-0.91; OR=0.83, 95%CI:0.71-0.98), obesity (OR=0.54, 95%CI:0.45-0.65; OR=0.67, 95%CI:0.54-0.83) patients in urban areas as well as in rural areas with hypertension had poor blood pressure control, and patient taking medication as prescribed (OR=4.58, 95%CI:3.16-6.63; OR=2.84, 95%CI:2.18-3.69) had better blood pressure control. Urban hypertension patients in central China (OR=0.74, 95%CI:0.61-0.89) or with excessive alcohol consumption (OR=0.72, 95%CI:0.54-0.97) had poor blood pressure control while urban hypertension patients with other chronic diseases (OR=1.22, 95%CI:1.04-1.44) and participating in standardized hypertension community management (OR=1.29, 95%CI:1.06-1.58) had better blood pressure control.Rural hypertension patients who located in central and western China (OR=0.71, 95%CI:0.58-0.87; OR=0.62, 95%CI:0.47-0.80), with moderate alcohol consumption (OR=0.81, 95%CI:0.67-0.98), taking salt more than 6 g per day (OR=0.80, 95%CI:0.69-0.93) had poor blood pressure control, and the rural hypertension patients who underwent blood pressure monitoring (OR=1.38, 95%CI:1.18-1.61) had better blood pressure control. Conclusions The community health management of hypertension in patients aged 35 years and above has been improved in China, but there is still a certain gap between the control of hypertension and related indicators. It is necessary to take multi standardized intervention measures for the better prevention and control of hypertension. |
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