2006—2020年开滦18~44岁青年人群心血管疾病流行趋势

Trends in the epidemiology of cardiovascular diseases in the Kailuan young adults aged 18 to 44 years from 2006 to 2020

    摘要
  • 摘要: 目的 分析2006—2020年开滦18~44岁青年人群心血管疾病(CVD)及其亚类(脑卒中、心肌梗死、心力衰竭)的患病趋势。方法 基于开滦研究每2年一次的健康体检数据,纳入2006—2020年期间参加开滦健康体检且体检年龄在18~44岁的青年人群。采用Clopper-Pearson法估算粗率及95%置信区间(CI),采用广义线性模型估算调整年龄和性别后的患病率及95% CI;以2020年我国人口普查的不同性别和年龄为基准,采用直接标化法计算标准化患病率及95% CI,采用Joinpoint回归方法估算CVD标准化患病率的平均年度变化百分比(AAPC)及95% CI,采用Cochran-Armitage法进行趋势性检验。结果 在2006—2007、2008—2009、2010—2011、2012—2013、2014—2015、2016—2017和2018—2020年的调查中,分别纳入27 278、29 915、28 378、34 919、30 671、30 683和30 496名青年人。CVD及其亚类脑卒中的标准化患病率在2006—2020年期间整体呈先上升后下降趋势,分别从2006—2007年的0.22%及0.11%上升至2008—2009年的0.32%及0.21%,2018—2020年下降至0.27%及0.15%,AAPC分别为-0.99%及-2.53%(Z值分别为1.17及0.93,Ptrend值分别为0.24及0.35)。不同特征青年人群CVD标准化患病率趋势存在差异,其中:男性、吸烟及肥胖人群CVD标准化患病率分别先从2006—2007年的0.35%、0.24%及0.36%上升至2008—2009年的0.46%、0.46%及0.93%,后下降至2018—2020年的0.29%、0.12%和0.29%,AAPC分别为-3.42%、-6.04%及-3.42%(Z值分别为3.00、4.49、3.20,均Ptrend<0.01);糖尿病人群CVD标准化患病率从2006—2008年的0.27%上升至2018—2020年的1.66%,AAPC=9.56%(Z=-2.54,Ptrend=0.01)。而高血压和血脂异常人群CVD标准化患病率在2006—2020年期间整体变化趋势不明显,AAPC分别为2.74%和-2.36%(Z值分别为-0.93、1.83,Ptrend值分别为0.35和0.07)。结论 2006—2020年期间,18~44岁开滦青年人群CVD及其亚类脑卒中的标准化患病率整体呈先上升后下降的趋势。其中男性、吸烟和肥胖人群CVD标准化患病率与总人群趋势一致,糖尿病人群CVD标准化患病率呈上升趋势,而高血压及血脂异常人群CVD标准化患病率整体线性变化趋势不明显。该变化趋势可能与开滦职工定期参加健康体检、健康宣教及高血压管理等一系列健康促进活动有关。

     

    Abstract: Objective To analyze the trends in the prevalence of cardiovascular disease (CVD) and its major subclasses (stroke, myocardial infarction, heart failure) among young adults aged 18 to 44 years in the Kailuan study from 2006 to 2020. Methods Young adults aged 18 to 44 years who participated in the Kailuan health examination every 2 years from 2006 to 2020 were included. The Clopper-Pearson method was used to estimate the crude rate and 95% confidence interval (CI). The age and sex-adjusted rates and 95% CI were estimated using generalized linear models, the standardized rate and 95% CI were calculated by direct standardization method based on the 2020 Chinese census data, a Joinpoint regression analysis was used to estimate the mean annual percentage change (AAPC) and 95% CI of standardized prevalence of CVD. The trend tests were performed using the Cochran-Armitage method. Results A total of 27 278, 29 915, 28 378, 34 919, 30 671, 30 683 and 30 496 young adults were included in surveys from 2006 to 2007, 2008 to 2009, 2010 to 2011, 2012 to 2013, 2014 to 2015, 2016 to 2017 and 2018 to 2020, respectively. The standardized prevalence of CVD and its subtypes of stroke showed an overall increasing and then decreasing trend during the period of 2006-2020, from 0.22% and 0.11% in 2006-2007 to 0.32% and 0.21% in 2008-2009, respectively; in 2018-2020, it decreased to 0.27% and 0.15%, with an AAPC of -0.99% and -2.53% (Z was 1.17 and 0.93, and Ptrendwas 0.24 and 0.35, respectively). There were significant differences in the standardized prevalence of CVD among different groups. The standardized prevalence of CVD in male, smoking and obesity populations increased from 0.35%, 0.24% and 0.36% in 2006-2007 to 0.46%, 0.46% and 0.93% in 2008-2009, and then decreased to 0.29%, 0.12% and 0.29% in 2018-2020, respectively (AAPC=-3.42%, -6.04% and -3.42%, and Z=3.00, 4.49 and 3.20, respectively; both Ptrend<0.01). The standardized prevalence of CVD in diabetic patients increased from 0.27% in 2006-2008 to 1.66% in 2018-2020 (AAPC=9.56%, Z=-2.54, Ptrend=0.01). However, the standardized prevalence of CVD in hypertensive and dyslipidemic populations showed no significant trend during 2006-2020 (AAPC=2.74% and -2.36%, Z=-0.93 and 1.83, Ptrend=0.35 and 0.07). Conclusions The standardized prevalences of CVD and its subtypes of stroke in young adults aged 18 to 44 in Kailuan study show an overall increasing and then decreasing trend from 2006 to 2020. The standardized prevalence of CVD in the male, smoking and obese populations is consistent with the trend of the overall population. The standardized prevalence of CVD in diabetic population shows an increasing trend, while the standardized prevalences of CVD in hypertensive and dyslipidemic populations do not show a significant trend. These trends may be related to the regular participation in a series of health promotion activities, such as health check-ups, health education and hypertension management, among Kailuan employees.

     

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