Analysis of Trend in Prevalence of Hypertension and Its Relationship with Different Obesity Indices among Rural Adults in Fumin County of Yunnan Province
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摘要:
目的 分析云南省富民县农村居民高血压的变化趋势及与不同肥胖指标的关系。 方法 采用重复横断面调查设计，分别于2009年和2019年在富民县采用多阶段分层随机抽样方法，分别抽取2544名和2502名≥35岁农村居民进行面对面问卷调查和体格检查。 结果 在2009年至2019年期间，调查人群的高血压标化患病率、男性和女性的标化患病率分别从32.8%、31.2%、33.9%上升到了44.1%、43.5%、44.6%（χ2 = 68.122，χ2 = 39.626，χ2 = 31.456，P < 0.001）；2次调查人群的高血压标化患病率均随年龄的增加而呈上升趋势，随文化程度和家庭年人均收入的增加而呈下降趋势（P < 0.05）；居民肥胖指标体重指数（BMI）从22.90 kg/m2上升到了23.62 kg/m2（t = −7.326，P < 0.001），而腰围（WC）、腰臀比（WHR）、身体圆润指数（BRI）和人体肥胖指数（BAI）无明显变化趋势（P > 0.05）。多因素Logistic回归分析结果显示，男性和女性WC、WHR、BMI、BRI和BAI值的升高均会增加高血压患病风险（P < 0.001），其中，WHR与高血压患病的关联强度最高（男：OR = 7.446，女：OR = 2.223，P < 0.001）；各肥胖指标与高血压患病的关联强度均是男性高于女性。ROC曲线分析发现，男性和女性的WC、WHR、BMI、BRI和BAI值对高血压患病风险均有预测价值（P < 0.001）。 结论 云南富民县农村居民的高血压患病率呈上升趋势，肥胖指标WC、WHR、BMI、BRI和BAI与高血压患病呈正相关，将其保持在正常范围内有利于控制高血压的发生。 Abstract:Objective To analyze the trend of hypertension prevalence and its relationship with different obesity indices among rural adults in Fumin county of Yunnan province. Methods A repeated cross-sectional surveys was employed. A total of 2544 individuals aged ≥35 years in 2009 and 2502 in 2019 were selected by multistage stratified random sampling method. Each participant received face to face questionnaire interview and physical examination. Results From 2009 to 2019, the overall age-standardized prevalence of hypertension increased from 32.8% to 44.1%, while prevalence of hypertension increased from 31.2% to 43.5% among males, and increased from 33.9% to 44.6% among females, respectively （χ2 = 68.122, χ2 = 39.626, χ2 = 31.456, P < 0.001）. Both in 2009 and 2019, the age-standardized prevalence of hypertension increased with age, whereas decreased with level of education and annual per capita household income （P < 0.05）. The mean of body mass index （BMI） increased from 22.90 kg/m2 to 23.62 kg/m2 （t = -7.326, P < 0.001）, while there were no significant difference of waist circumference （WC）, waist-to-hip ratio （WHR）, body roundness index （BRI） and body adiposity index （BAI） between two survey years （P > 0.05）. The result of multiple logistic regression indicated that both males and females with higher values of WC, WHR, BMI, BRI and BAI had higher risk of suffering from hypertension （P < 0.001）. WHR showed strongest association with hypertension （males: OR = 7.446, females: OR = 2.223, P < 0.001）. The correlation between obesity indices and hypertension prevalence was stronger in males than in females. The result of ROC curve analysis showed that WC, WHR, BMI, BRI and BAI were significant predictors of risk of hypertension in both males and females （P < 0.001）. Conclusion Prevalence of hypertension increased substantially in Fumin county of Yunnan province. WC, WHR, BMI, BRI and BAI were positively correlated with prevalence of hypertension, keep people’ s values of obesity indices within normal interval is beneficial to control of hypertension. -
Key words:
- Hypertension /
- Obesity indices /
- Temporal trend /
- Rural area
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表 1 云南富民县农村居民高血压患病率的变化情况
Table 1. Changes in the prevalence of hypertension among rural residents in Fumin County，Yunnan Province
变量 2009年 2019年 高血压例数（n） 粗率（%） 标化率（%） 高血压例数（n） 粗率（%） 标化率（%） 性别 男性 367 29.8 31.2 550 45.2 43.5b 女性 434 33.1 33.9 581 45.2 44.6b 年龄（岁） 35～44 64 17.4 17.4a 57 21.1 21.1a 45～54 138 21.6 21.6 220 37.3 37.3b 55～64 217 30.3 30.3 258 43.7 43.7b 65～74 240 46.8 46.8 388 55.4 55.4b ≥75 142 47.5 47.5 208 59.1 59.1b 文化程度 小学及以下 577 34.5 35.3a 810 47.6 46.8ab 初中及以上 224 25.7 26.6 321 40.1 38.7b 家庭年人均收入（元） 低 489 35.1 35.9a 577 47.5 46.2ab 高 312 27.1 28.8 554 43.0 41.9b 合计 801 31.5 32.8 1131 45.2 44.1b 同一年率的比较，aP < 0.05；与2009年比较，bP < 0.05。 
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表 2 云南富民县农村居民不同性别各肥胖指标的变化情况（
$\bar x \pm s $ ）Table 2. Changes of different obesity indexes of rural residents in Fumin County，Yunnan Province （
$\bar x \pm s $ ）变量 2009年 2019年 男性 女性 合计 男性 女性 合计 WC（cm） 83.75 ± 9.53 82.80 ± 10.23a 83.26 ± 9.91 83.71 ± 9.32 82.51 ± 10.19a 83.09 ± 9.79 WHR（cm/cm） 0.90 ± 0.07 0.89 ± 0.07a 0.90 ± 0.07 0.91 ± 0.06 0.89 ± 0.06a 0.90 ± 0.06 BMI（kg/m2） 22.82 ± 3.21 22.99 ± 3.75 22.90 ± 3.49 23.57 ± 3.28b 23.68 ± 3.61b 23.62 ± 3.46b BRI 3.56 ± 1.15 4.20 ± 1.47a 3.89 ± 1.36 3.60 ± 1.11 4.16 ± 1.42a 3.89 ± 1.30 BAI 25.73 ± 4.79 30.54 ± 5.46a 28.21 ± 5.68 25.92 ± 3.68 30.83 ± 4.68a 28.44 ± 4.88 注：WC：腰围，WHR：腰臀比，BMI：体重指数，BRI：身体圆润指数，BAI：人体肥胖指数。同一年内均数的比较，aP < 0.05；与2009年比较，bP < 0.001。
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表 3 云南富民县农村居民各年龄段不同肥胖指标的变化情况（
$\bar x \pm s $ ）Table 3. Changes of different obesity indices by age groups of rural residents in Fumin County，Yunnan Province （
$\bar x \pm s $ ）年龄 WC（cm） WHR（cm/cm） BMI（kg/m2） BRI BAI 2009年（岁） 35～44 83.07 ± 9.29 0.90 ± 0.06a 23.40 ± 2.94a 3.55 ± 1.12a 26.35 ± 5.10a 45～54 83.55 ± 10.14 0.90 ± 0.08 23.36 ± 3.25 3.83 ± 1.36 27.94 ± 5.38 55～64 83.30 ± 9.91 0.90 ± 0.07 23.11 ± 3.63 3.89 ± 1.35 28.35 ± 5.94 65～74 83.19 ± 10.01 0.90 ± 0.07 22.34 ± 3.40 4.02 ± 1.39 28.85 ± 5.42 ≥75 82.92 ± 10.01 0.91 ± 0.07 21.80 ± 4.05 4.19 ± 1.53 29.69 ± 6.14 2019年（岁） 35～44 81.93 ± 10.15 0.87 ± 0.06ab 24.17 ± 3.77ab 3.52 ± 1.18a 27.34 ± 4.45ab 45～54 83.29 ± 10.06 0.89 ± 0.06b 24.45 ± 3.52b 3.77 ± 1.29 27.92 ± 4.67 55～64 83.59 ± 10.03 0.90 ± 0.06 23.82 ± 3.43b 3.91 ± 1.31 28.38 ± 4.81 65～74 82.86 ± 9.14 0.90 ± 0.06 23.15 ± 3.14b 3.96 ± 1.22 28.73 ± 4.82 ≥75 83.29 ± 9.87 0.92 ± 0.07 22.44 ± 3.28b 4.26 ± 1.46 29.69 ± 5.46 注：WC：腰围，WHR：腰臀比，BMI：体重指数，BRI：身体圆润指数，BAI：人体肥胖指数。同一年内均数的比较，aP < 0.05；与2009年比较，bP < 0.05。
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表 4 2019年调查人群肥胖指标与高血压的Logistic回归分析
Table 4. Logistic regression of the correlation between obesity indices and hypertension prevalence of participants in 2019
变量 B S.E. Wald X2 P OR 95%CI 男性 WC 0.056 0.007 65.064 < 0.001 1.057 1.043～1.072 WHR 5.589 1.068 27.366 < 0.001 7.446 2.948～70.904 BMI 0.159 0.020 62.775 < 0.001 1.173 1.127～1.220 BRI 0.449 0.058 59.152 < 0.001 1.567 1.397～1.757 BAI 0.103 0.017 36.168 < 0.001 1.108 1.072～1.146 女性 WC 0.042 0.006 46.407 < 0.001 1.042 1.030～1.055 WHR 4.409 0.971 20.618 < 0.001 2.223 2.257～5.565 BMI 0.110 0.017 39.940 < 0.001 1.116 1.078～1.154 BRI 0.298 0.045 43.954 < 0.001 1.347 1.233～1.471 BAI 0.077 0.013 32.825 < 0.001 1.080 1.052～1.109
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表 5 不同性别各肥胖指标预测高血压的ROC曲线分析
Table 5. Analysis of ROC curve of hypertension predicted by different gender
变量 AUC 95%CI P 切点值 灵敏度 特异度 约登指数 男性 WC 0.638 0.607～0.670 < 0.001 84.50 0.462 0.725 0.213 WHR 0.609 0.578～0.641 < 0.001 0.90 0.567 0.646 0.187 BMI 0.607 0.575～0.639 < 0.001 24.51 0.649 0.538 0.187 BRI 0.647 0.616～0.678 < 0.001 3.70 0.551 0.680 0.231 BAI 0.615 0.583～0.647 < 0.001 26.52 0.538 0.640 0.178 女性 WC 0.626 0.596～0.657 < 0.001 77.50 0.466 0.665 0.185 WHR 0.610 0.580～0.641 < 0.001 0.89 0.776 0.409 0.181 BMI 0.575 0.543～0.606 < 0.001 24.25 0.575 0.606 0.132 BRI 0.644 0.614～0.674 < 0.001 3.84 0.647 0.559 0.206 BAI 0.632 0.602～0.662 < 0.001 29.82 0.685 0.519 0.204
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