我国成年人自评健康状况与脑卒中发病风险的前瞻性研究

从祥丰; 刘少博; 马吉祥; 王文绢; 陈波; 李剑虹

Abstract

从祥丰,刘少博,马吉祥,王文绢,陈波,李剑虹.我国成年人自评健康状况与脑卒中发病风险的前瞻性研究[J].Chinese journal of Epidemiology,2021,42(3):513-519

我国成年人自评健康状况与脑卒中发病风险的前瞻性研究

Association between self-rated health status and risk of stroke in Chinese adults: a prospective study

Received:January 03, 2020

DOI：10.3760/cma.j.cn112338-20200103-00006

KeyWord: 自评健康脑卒中缺血性卒中前瞻性研究

English Key Word: Self-rated health Stroke Ischemic stroke Prospective study

FundProject:国家重点研发计划（2018YFC1313900，2018YFC1313904）

Author Name	Affiliation	E-mail
Cong Xiangfeng	National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
Liu Shaobo	National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
Ma Jixiang	Office of Non-Communicable Diseases and Ageing Health Management, Chinese Center for Disease Control and Prevention, Beijing 102206, China
Wang Wenjuan	National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
Chen Bo	National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China
Li Jianhong	National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, China	lijianhong@ncncd.chinacdc.cn

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Abstract:

目的分析我国成年人自评健康状况与脑卒中发病风险的关联。方法将2010年中国慢性病及其危险因素监测数据作为基线数据，从2010年监测点中选取11个省60个监测点（城市监测点25个、农村监测点35个）作为随访点，排除基线心血管病者，共36 195人进入随访队列。2016-2017年进行随访调查，完成随访27 441人。采用Cox比例风险回归模型分析自评健康状况与脑卒中发病风险比（HR），并按年龄、性别等基线特征进行亚组分析，剔除死亡者和基线糖尿病者进行敏感性分析。结果共纳入26 699名研究对象进入分析，平均随访6.4年（共171 431.1人年），随访期间共观察到脑卒中1 332例（蛛网膜下腔出血32例，脑内出血197例，缺血性卒中1 149例），发病密度为7.77/1 000人年。多因素调整相关因素后，以自评健康非常好者为参照，自评健康差者脑卒中发病风险增加68%（HR=1.68，95%CI：1.22~2.32），缺血性卒中发病风险增加47%（HR=1.47，95%CI：1.05~2.05）。亚组分析发现年龄和BMI对自评健康与脑卒中发病风险间的关联存在效应修饰作用，年龄和血脂异常对自评健康与缺血性卒中发病存在修饰作用（交互P<0.05）。敏感性分析结果与全人群结果一致。结论自评健康状况差的人群发生脑卒中和缺血性卒中的风险增加，应将该人群，尤其是自评健康差的超重/肥胖、年龄<60岁或血脂异常人群作为重点干预对象。

English Abstract:

Objective To explore the relationship between self-rated health status and risk of stroke in Chinese adults. Methods Data was collected from the Chronic Disease Risk Factor Surveillance in China (2010) as baseline. A total of 60 follow-up monitors (25 urban and 35 rural) in 11 provinces were selected. A total of 36 195 participants without prior cardiovascular diseases were followed and investigated 27 441 people in 2016 and 2017. Cox proportional hazard regression model was used to analyze the self-assessed health status and stroke onset hazard ratio (HR), further conducted several subgroup analyses by demographic characteristics such as age and gender, and sensitivity analysis was performed by excluding death and baseline diabetes. Results A total of 26 699 study subjects were included according to the inclusion criteria. We identified 1 332 stroke cases (32 subarachnoid hemorrhage, 197 cerebral hemorrhage, and 1 149 cerebral infarction) during an average of 6.4 years (171 431.1 person-years) of follow-up, and the incidence density was 7.77/1 000 person-years. After adjusting the related factors, the risk of stroke in participants with poor self-related health increased by 68% (HR=1.68, 95%CI:1.22-2.32) and the risk of ischemic stroke increased by 47% (HR=1.47, 95%CI:1.05-2.05), with a reference of excellent ones. In subgroup analysis, only age and BMI had an effect-modifying effect on the association between self-rated health and risk of stroke. Only age and dyslipidemia had an effect-modifying effect on the association between self-rated health and ischemic stroke risk (interaction P<0.05). The results of the sensitivity analysis were consistent with the results of the total population. Conclusion People with poor self-assessed health, especially for those who were overweight/obesity with poor self-assessed health or age less than 60 or dyslipidemia are at increased risk of stroke and ischemic stroke and should be targeted for intervention.

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