| 周阳,王非,罗家有,肖淑娟,谢心怡,余奕扬,丁梦妤,陈艳华,罗米扬.湖南省中小学生常见病多病关联因素及特征分析[J].中华流行病学杂志,2026,47(3):438-448 |
| 湖南省中小学生常见病多病关联因素及特征分析 |
| Related factors and characteristics of common disease multimorbidity among primary and secondary school students in Hunan Province |
| 收稿日期:2025-05-13 出版日期:2026-03-19 |
| DOI：10.3760/cma.j.cn112338-20250513-00310 |
| 中文关键词: 中小学生|常见病|多病|多病共患模式 |
| 英文关键词: Primary and secondary school students|Common diseases|Multimorbiditiy|Multimorbidity patterns |
| 基金项目:湖南省学生常见病和健康影响因素监测与干预 |
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| 中文摘要: |
| 目的 了解湖南省中小学生常见病多病共患检出率、关联因素及多病共患模式，为制定中小学生常见病多病干预措施提供科学依据。方法 2023年9-11月采用分层整群随机抽样方法，选取湖南省255 107名7~18岁儿童青少年作为研究对象进行体格检查和问卷调查，收集身高、体重、常见病监测信息（包括超重/肥胖、近视、血压偏高、龋齿和脊柱弯曲异常5种常见病），以及饮食行为、身体活动、行为方式等信息。多病定义为同时患有≥2种上述常见病。通过χ2检验进行组间比较，采用ArcGIS软件进行常见病多病共患检出率空间分布绘图及空间自相关分析，采用log-binomial模型分析常见病多病关联因素，采用关联规则（Apriori算法）挖掘中小学生常见病多病共患模式。结果 湖南省中小学生常见病多病共患检出率为47.23%，其中高中生（62.30%）高于初中生（51.08%）和小学生（38.21%）；男生（45.44%）低于女生（49.18%）；城区学生（50.77%）高于郊县学生（45.33%）（均P<0.001）。多病共患检出率由7岁的27.88%上升至18岁的60.12%，随年龄呈上升趋势（趋势P<0.001）。空间分析显示，排名前3位的分别是长沙市（55.43%）、益阳市（50.77%）和岳阳市（50.20%），最低为湘潭市（41.57%）。学段、性别、城乡、身体活动、睡眠时间、屏幕时间为中小学生常见病多病关联因素。支持度位于前3位的多病共患模式分别为“超重/肥胖→近视”“近视→超重/肥胖”和“血压偏高→近视”；具有较高置信度和提升度的多病共患模式分别为“脊柱弯曲异常→近视”“近视+血压偏高→超重/肥胖”和“血压偏高→超重/肥胖”。结论 湖南省中小学生常见病多病共患现象较为普遍，且呈随年龄增长而增加的趋势。学段、性别、城乡、身体活动、睡眠时间和屏幕时间是常见病多病共患的重要关联因素。近视、血压偏高及超重/肥胖构成了主要的多病共患模式。针对相关因素的早期干预与综合防控措施亟需加强，以降低多病负担并促进青少年健康发展。 |
| 英文摘要: |
| Objective To investigate the prevalence, related factors, and multimorbidity patterns of common diseases among primary and secondary school students in Hunan Province, providing a scientific basis for developing targeted interventions. Methods From September to November 2023, a stratified random cluster sampling method was employed to select 255 107 children and adolescents aged 7-18 years in Hunan Province for physical examinations and questionnaire surveys. Data on height, weight, surveillance of common diseases (including the five common diseases of overweight/obesity, myopia, elevated blood pressure, dental caries, and spinal curvature abnor malities), as well as dietary behaviours, physical activity, and health-related behaviors were collected. Multimorbidity was defined as having ≥2 of the above common diseases concurrently. Inter-group comparisons were conducted using Chi-square tests, while ArcGIS software was used to map the spatial distribution and to perform spatial autocorrelation analysis of the multimorbidity detection rates of common diseases. The log-binomial model was used to analyze factors associated with multiple common diseases, and association rules based on the Apriori algorithm were applied to identify the multimorbidity patterns of common diseases in primary and secondary school students. Results The overall prevalence of common disease multimorbidities among primary and secondary school students in Hunan Province was 47.23%. The prevalence was highest among high school students (62.30%), followed by middle school (51.08%) and primary school students (38.21%). The prevalence was lower in boys (45.44%) than in girls (49.18%) and higher among urban students (50.77%) than among suburban and rural students (45.33%) (all P<0.001). Multimorbidity prevalence increased with age, rising from 27.88% at age 7 to 60.12% at age 18 (P for trend <0.001). Spatial analysis revealed that the top three being Changsha (55.43%), Yiyang (50.77%), and Yueyang (50.20%), and the lowest being Xiangtan (41.57%). school stage, gender, urban/rural status physical activity, sleep duration, and screen time were identified as significant factors associated with common disease multimorbidities. The patterns with the top three support degrees were "overweight/obesity → myopia", "myopia → overweight/obesity", and "elevated blood pressure → myopia". Multimorbidity patterns demonstrating both high confidence and elevation degrees included "spinal curvature abnormalities → myopia", along with the association rules "myopia + elevated blood pressure → overweight/obesity" and "elevated blood pressure → overweight/obesity". Conclusions Common disease multimorbidities are prevalent among primary and secondary school students in Hunan Province, with an increasing trend as age advances. school stage, gender, urban/rural status physical activity, sleep duration, and screen time are key associated factors. Myopia, elevated blood pressure, and overweight/obesity constitute the primary multimorbidity patterns. Early intervention and comprehensive prevention strategies targeting these factors are urgently needed to reduce disease burden and promote adolescent health. |
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