贵州省社区女性人群高血压基线调查与社区综合防治效果评价

摘要

背景:女性高血压患者有其自身流行病学特点,其主要于预措施也有所不同.目的:调查贵州省心脑血管病社区综合防治示范点女性人群高血压危险因素并观察康复预防干预效果.设计:采用整群随机设计,13个行政村每个村根据总人口数随机抽取一定比例样本量.单位:贵州省心血管病研究所,贵阳市云岩区人民医院,贵州省临床检验中心.对象:1996年以来,在贵州省心脑血管病社区开展心脑血管病社区综合防治的一系列工作,社区内有13个行政村,112个村民组,主要为在城郊结合部村民26 604人,多数村民的社会自然条件、生活行为方式等可以反映贵州省城乡人民的一般状况.调查范围为本社区15岁以上人群3 934人,均对调查项目知情同意.对数据不完整的样本剔除.方法:①于2001-04-01/05-15按照中国科学院预防医学研究所设计对示范点基线调查的要求对15岁以上人群进行调查(基线调查).②对纳人人群进行健康教育,并开展健康促进活动.③2002-07/2003-06按照中国科学院预防医学研究所设计的监测项目对女性人群进行调查(干预后监测调查).④以体质量指数18.5～23.9 kg/m2为正常,体质量指数24～27.9 kg/m2为超重,体质量指数≥28 kg/m为肥胖.⑤对两次调查结果作体质量指数、腰臀围比、平均血压、高血压患病率、知晓率、治疗率、高盐高脂饮食率对比分析.⑥两样本均数比较采用t检验,率的比较采用x2检验.主要观察指标:①贵州省社区基线调查不同年龄女性高血压患病率、知晓率、治疗率、控制率比较.②不同年龄社区基线调查女性人群体质量指数、腰臀比、血压比较.③不同体质量指数基线调查女性人群高血压患病率比较.④基线调查与干预后调查女性人群体质量指数、腰臀比、血压、吸烟、饮酒、高盐高脂饮食率、患病率、知晓率、治疗率、控制率比较.结果:基线调查获填写准确、完整的表格6 361份,合格率为99.84%.其中女性3 934人;干预后获合格资料1 141份.社区基线调查显示:①社区女性人群高血压患病率、知晓率、治疗率均随年龄增加而增加(P＜0.05);而控制率随年龄增加而降低(P＜0.05).②社区基线调查女性人群的体质量指数、腰臀围比、收缩压、舒张压及脉压均随年龄增加而显著增高(P＜0.01).女性人群体质量指数随年龄增加而升高,但在≥60岁下降.③体质量正常、超重、肥胖人群的高血压患病率分别为15.05%,23.87%,39.37%.即随体质量指数增加,高血压患病率显著增加(两两比较,P＜0.05).干预后结果与基线调查比较:①基线调查与干预后结果比较,同年龄者的体质量指数、腰臀比、血压均值多数有所降低,大部分显示差异明显(P＜0.05).②干预后女性吸烟率显著增高,高盐高脂率有所降低(P＜0.05).③本社区女性人群健康干预后患病率显著低于干预前(P＜0.05),知晓率、治疗率、控制率有显著增高(P＜0.05).结论:①贵州省社区女性人群高血压患病率、知晓率、治疗率、控制率存在年龄差异.②随着年龄增长,贵州省社区女性人群高血压危险因素严重程度也增高.③体质量的增加是影响高血压患病率的重要因素.④健康教育可降低高血压危险因素程度、提高知晓率、治疗率、控制率.%BACKGROUND: Female hypertension has its own epidemicologic character and the chief interventions on it are various.OBJECTIVE: To investigate the risk factors of female hypertension and observe the effects on rehabilitative and preventive intervention in demonstrative community for comprehensive prevention and treatment of cardiac cerebral vascular disease in Guizhou.DESIGN: Group randomization was designed. The samples of certain percentage were randomized according to total population from each village of 13 administrative areas.SETTING: Guizhou Institute of Cardiovascular Disease, Renmin Hospital of Yunyan District in Guiyang, Guizhou Clinical Examination Center.PARTICIPANTS: Since 1996, a series of comprehensive prevention and treatment had been carried in the communities for cardiac cerebral vascular disease in Guizhou, involved 13 administrative areas and 112 villagecitizen groups, in which, 26 604 people were employed, living in the regions between town and country. Social natural condition and life behavior of majority citizen reflected the common state of people in town and country. Totally 3 934 people aged over 15 years were investigated in the communities, and were all in the known of investigation. The samples without complete data were excluded.METHODS: ① Base-line investigation was carried on for the groups over 15 years old according to the requirement for administrative region designed by Institute of Preventive Medicine of China Academy of Sciences from April 1st 2001 to May 15th . ② Health education and health promotion activity were carried on for the included groups. ③ Survey after intervention was given for females according to the survey items designed by Institute of Preventive Medicine of China Academy of Sciences from July 2002to June 2003. ④ Normal body-mass index (BMI) was 18.5-23.9 kg/m2,overweight was indicated if BMI was 24-27.9 kg/m2 and obesity was diagnosed if BMI ≥28 kg/m2. ⑤ Analysis was applied on comparison of BMI,waist to hip ratio (WHR), average blood pressure, the rates of incidence,awareness and treatment of hypertension and rate of high-salty and lipid diet. ⑥ t test was adopted for comparison of means between two samples and x2 test was used for rate comparison.MAIN OUTCOME MEASURES: ① Comparison of the rates of incidence, awareness, treatment and control of hypertension for females of different ages in community base-line investigation in Guizhou. ② Comparison of BMI, WHR and BP of females of various ages in baseline investigation.③ Comparison of incident rate of hypertension for females with various BMI in baseline investigation. ④ Comparison of BMI, WHR, BP, smoke, alcohol, rate of high-salty and lipid diet, the rates of incidence, awareness,treatment and control of hypertension for females between baseline investigation and post-intervention survey.RESULTS: In baseline investigation, 6 361 correct and complete forms were collected, with 99.84% qualified rate, of which, there were 3 934females. 1 141 data were qualified after intervention. It was indicated in community baseline investigation: ① Rates of incidence, awareness and treatment of hypertension for females were improved with increased age (P ＜ 0.05), and the control rate was decreased with increased age (P ＜ 0.05). ② BMI, WHR, SBP (systolic blood pressure) and DBP (diastolic blood pressure) and PP (pulse pressure) were improved significantly with in creased age (P ＜ 0.01). BMI for females was increased with ages, but was declined with age ≥60 years. ③ The incident rates of hypertension for groups of normal body mass, overweight and obesity were 15.05%, 23.87% and 39.37% successively, indicating that the hypertension inci dent rate was increased significantly with improved BMI (paired compari son, P ＜ 0.05). Comparison between post-intervention survey and base-line investigation: ① In the comparison, the results of BMI, WHR and BP means were reduced for most cases at same age and significant difference was displayed in majority (P ＜ 0.05). ② After intervention, smoke rate of females was increased significantly and rate of high-salty and lipid diet was decreased (P ＜ 0.05). ③ Incident rate after health intervention was decreased significantly compared with that before intervention (P ＜ 0.05),and the rates of awareness, treatment and control of hypertension were enhanced significantly (P ＜ 0.05).CONCLUSION: ① The rates of incidence, awareness, treatment and control of female hypertension are different in ages in community of Guizhou. ② The severity of risk factor of female hypertension is enhanced with increased age in community of Guizhou. ③ The increased body mass is the important factor of incident rate of hypertension. ④ Health education probably decreases the severity of risk factor of hypertension and increases the rates of awareness, treatment and control.