上海市社区老年高血压患者血压水平影响因素的多水平分析

目的 应用多水平分析模型分析社区老年高血压患者血压水平的影响因素.方法 通过多阶段随机抽样,抽取上海市23个社区的927例老年高血压患者作为研究对象,采用两水平线性多层模型分别分析社区老年高血压患者收缩压(SBP)和舒张压(DBP)的影响因素.结果 研究对象的平均血压水平为SBP(139.2±11.7)mm Hg、DBP(85.6±8.6)mm Hg(I mm Hg=0.133 kPa).在社区水平上,辖区高血压患者/站点医师数(医患比)"高"的社区较医患比"低"的社区患者的SBP低3.86 mm Hg、DBP低2.51 mm Hg.在个体水平上,年龄、性别、超重/肥胖是血压升高的危险因素;规律服药、限盐、疾病管理自我效能的提高可降低血压,特别是在控制其他影响因素后仅限盐1项就可降低SBP 2.44 mm Hg、DBP 2.03 mm Hg.结论 多水平分析模型可以灵活有效地处理具有层次结构的数据,社区因素和个体因素对老年高血压患者的血压水平均有影响.

Multilevel analysis on influencing factors regarding blood level among elderly hypertensive patients at the community level

Objective To explore the factors affecting blood level of elderly hypertensive patients, using a multilevel analysis model. Methods 927 elderly hypertensive patients from 23 communities were studied, through a multi-stage random sampling method. The influencing factors on systolic blood pressure (SBP) and diastolic blood pressure (DBP) were analyzed through a two-level linear multilevel model, respectively. Results The average blood pressure of subjects appeared as: SBP (139.2±11.7) mm Hg ( 1 mm Hg=0.133 kPa), DBP (85.6±8.6) mm Hg. Ratio of physician versus patients was the factor affecting blood level of subjects from the community level. SBP and DBP of the subjects from the higher physician/patient ratio communities were 3.86 mm Hg and 2.51 mm Hg, lower than the subjects in the lower ratio communities, after controlling the other related factors. Age, gender,overweight/obesity were the individual risk factors of hypertension, while factors as regularl medicine taking, reducing salt intake and related self-efficacy to manage disease could reduce the blood pressure.Reducing salt intake could lower the SBP for 2.44 mm Hg and DBP for 2.03 mm Hg, after controlling the other factors. Conclusion Multilevel analysis model could effectively analyze the hierarchically structured data while both factors from the community and individual levels could affect the blood level among elderly patients with hypertension.