社会经济地位、健康生活方式与高血压发病的前瞻性队列研究

  目的  探讨社会经济地位(socioeconomic status, SES)、健康生活方式与高血压发病的关系，为高血压的防控提供参考依据。  方法  采用分层整群随机抽样于2010年对抽取的贵州省12个县(市、区)≥18岁常住居民共9 280人进行基线调查，于2016—2020年对该队列所有人群进行随访；采用t检验、χ2检验进行单因素分析，使用Cox比例风险回归模型分析SES、健康生活方式对高血压发病的影响。  结果  研究有效样本量为3 401人，高血压发病765人，人群高血压发病密度为32.53/1 000人年。多因素Cox回归结果显示:与低SES(＜9分)人群相比，高SES(≥9分)人群高血压发病风险下降29.9%(HR=0.701, 95% CI: 0.584~0.842)；与≤2种健康生活方式的人群相比，4种、≥5种健康生活方式人群发病风险分别降低25.7%(HR=0.743, 95% CI: 0.581~0.950)、39.2%(HR=0.608, 95% CI: 0.455~0.812)。与SES低且健康生活方式≤2种的人群相比，SES低且具有3种、4种、≥5种健康生活方式人群高血压发病风险的差异均无统计学意义(均有P＞0.05)；SES高且具有3种、4种、≥5种健康生活方式的人群高血压发病风险分别降低36.3%(HR=0.637, 95% CI: 0.446~0.909)、44.0%(HR=0.560, 95% CI: 0.391~0.802)、55.8%(HR=0.442, 95% CI: 0.295~0.662)。  结论  SES较低人群是贵州省高血压防控的重点人群，应采取措施提高其SES，并有针对性地开展健康教育与健康促进工作。

A prospective cohort study of socioeconomic status,healthy lifestyle and the incidence of hypertension

  Objective   To explore the relationship between socioeconomic status (SES), healthy lifestyle, and the incidence of hypertension, and to provide reference basis for the prevention and control of hypertension.  Methods   A total of 9 280 permanent residents aged 18 and over in 12 counties (cities and districts) of Guizhou Province were investigated by stratified cluster random sampling in 2010. All populations in this cohort were followed up from 2016 to 2020. T-test and χ2 test were used for univariate analysis. And Cox proportional hazards regression was used in analyzing the impact of socioeconomic status and healthy lifestyle on the incidence of hypertension.  Results   The adequate sample size of the final cohort study was 3 401. Among them, 765 had hypertension, and the incidence density was 32.53/1 000 person-years. The results of multivariate Cox regression showed that compared with the population with low SES (< 9 points), the risk of hypertension in the people with high SES (≥9 points) decreased by 29.9% (HR=0.701, 95% CI: 0.584-0.842). Compared to the population with ≤2 healthy lifestyles, the incidence risk of people with 4, 5, and more healthy lifestyles decreased by 25.7% (HR=0.743, 95% CI: 0.581-0.950) and 39.2% (HR=0.608, 95% CI: 0.455-0.812), respectively. However, the difference in hypertension risk in the population with low SES and those with 3, 4, 5, or more healthy lifestyles was not statistically significant (all P>0.05) compared to those with low SES and ≤2 healthy lifestyles. The risk of hypertension in the population with high SES and have 3, 4, 5 or more healthy lifestyles was reduced by 36.3% (HR=0.637, 95% CI: 0.446-0.909), 44.0% (HR=0.560, 95% CI: 0.391-0.802) and 55.8% (HR=0.442, 95% CI: 0.295 -0.662), respectively.  Conclusions   The population with low SES is critical in preventing and controlling hypertension in Guizhou Province. Various measures should be taken to improve their socioeconomic status and simultaneously carry out health education and health promotion.