广州厂企职工血压水平与心脑血管疾病死亡的关系

目的分析工人高血压与心脑血管疾病(CVD)死亡的相对危险度(RR),探讨减少工人CVD死亡危险性的预防办法.方法由广州399家工厂年龄35岁或以上的78 379名工人组成队列,进行前瞻性研究.资料处理采用分层和多因素调整统计分析方法(Cox模型).结果(1)队列中男48 705名、女29 674名,追踪8.0年,CVD死亡363人,男305人、女58人,粗死亡率分别为78.58/10万人年和24.55/10万人年,主要死于脑卒中、冠心病和高血压.(2)与理想或正常血压比,高血压CVD死亡的RR(95%)分别为男6.19(4.85～7.91)、女2.78(1.59～4.85);男性工人基线无患病者和非CVD患者Ⅰ级高血压CVD死亡的RR和CVD患者Ⅱ级高血压CVD死亡的RR明显增加,分别为3.98、3.25和3.15,理想或正常血压与Ⅰ级高血压和Ⅱ级高血压CVD死亡的RR增加趋势差异有显著性(P＜0.01).(3)按年龄、吸烟、饮酒、文化程度和职业接触有害因素分层后,年轻、吸烟、不饮酒、文化程度较高者以及职业接触有害因素者的高血压患者CVD死亡RR较高.结论血压水平与心脑血管疾病死亡率呈连续性相关,高血压对CVD死亡的影响在较年轻时已经出现;应采用综合预防办法减少CVD死亡危险性.

A cohort study on the relationship between blood pressure levels and the mortality of cerebro-cardiovascular diseases in Guangzhou workers

OBJECTIVE: To study the relative risk (RR) of mortalities of cerebro-cardiovascular diseases (CVD) in Guangzhou workers with hypertension. METHOD: Prospective cohort study was conducted in 78,379 workers, aged >or= 35, from 399 factories. Cox regression model were mainly used for data analysis. RESULTS: (1) There were 48,705 male and 29,674 female workers in the cohort. All workers were followed-up for 8 years. 363 CVD deaths (male 305, female 58) mainly died of stroke, coronary heart disease and hypertension. The crude mortalities were 78.58/100,000 person years in male and 24.55/100,000 person years in female. (2) Compared with the optimal or normal blood pressure (ONBP), the RR (95%) of CVD deaths with high blood pressure (HBP) were 6.19 (4.85 - 7.91) in male and 2.78 (1.59 - 4.85) in female. In male, compared with ONBP, the RR of CVD deaths without illness but with 1st-grade HBP at baseline, and of those suffered non-CVD but with 1st-grade HBP at baseline, and of those suffered CVD with 2nd-grade HBP at baseline were 3.98, 3.25 and 3.15 respectively (P < 0.01). (3) After stratifying of age, smoking, drinking, educational levels and occupational exposure, the RR of CVD deaths was higher in those who were younger, or ever-smoking, non-drinking, higher educational level, exposed to occupational hazards and with hypertension. CONCLUSION: There is relationship between BP levels and CVD mortality. High BP may affect CVD deaths at younger age. Comprehensive measures should be used to reduce the risk of CVD deaths.