广州市社区老年人慢性病共病与营养状况相关性研究

林伟权; 孙敏英; 刘览; 王畅; 利耀辉; 杨韵鸥; 吴迪; 刘慧; 林国桢

doi:10.16766/j.cnki.issn.1674-4152.002723

广州市社区老年人慢性病共病与营养状况相关性研究

doi: 10.16766/j.cnki.issn.1674-4152.002723

林伟权^{1, 2},
孙敏英^{1, 2},
刘览³,
王畅¹,
利耀辉¹,
杨韵鸥¹,
吴迪^{2, 4},
刘慧¹,
林国桢^1, ,

1.
广州市疾病预防控制中心基本公共卫生部，广东广州 510440
2.
广州市疾病预防控制中心广州医科大学公共卫生研究院
3.
广州市疾病预防控制中心食源性疾病和食品安全风险监测部
4.
广州市疾病预防控制中心慢性非传染性疾病预防控制部

基金项目:

国家自然科学基金青年项目 72104061

广州市科技计划项目 202201010022

广州市卫生健康科技计划项目 20201A011058

广州市卫生健康科技计划项目 20201A011064

广州市医学重点学科建设项目 2021-2023-12

广州市重点实验室基础研究计划项目 202102100001

详细信息

通讯作者:
林国桢, E-mail: xwkgzcdc@126.com

中图分类号: R459.3 R161.7
计量
- 文章访问数: 178
- HTML全文浏览量: 20
- PDF下载量: 15
- 被引次数: 0
出版历程
- 收稿日期: 2021-09-11
- 网络出版日期: 2022-12-30

Study on the relationship between multimorbidity and nutritional status among the community-dwelling elderly people in Guangzhou

LIN Wei-quan^{1, 2},
SUN Min-ying^{1, 2},
LIU Lan³,
WANG Chang¹,
LI Yao-hui¹,
YANG Yun-ou¹,
WU Di^{2, 4},
LIU Hui¹,
LIN Guo-zhen^{1
, ,}

1.
Department of Primary Public Health, Center for Disease Control and Prevention of Guangzhou, Guangzhou, Guangdong 510440, China

摘要

摘要: 目的探索广州市社区老年人慢性病共病与营养状况相关性及其影响因素。方法采用便利抽样方法，选择广州市某社区卫生服务中心参加2019年度健康体检的2 127名65岁及以上老年人为研究对象。营养状况包括营养不良和超重/肥胖。采用Spearman相关分析研究慢性病共病现状、营养状况的相关性；采用多因素logistic回归分析研究老年人营养状况的影响因素。结果老年人慢性病共病患病率为38.08%(810/2 127)，营养不良患病率为10.81%(230/2 127)，超重/肥胖率为46.26%(984/2 127)。老年人慢性病共病与超重/肥胖存在正相关关系(r=0.144，P＜0.05)。Logistic回归分析显示，年龄每增加5岁，患营养不良的风险增加(OR=1.369，95% CI：1.205~1.555)，超重/肥胖的风险降低(OR=0.885，95% CI：0.813~0.965)。未婚、离婚和丧偶是老年人营养不良的危险因素(OR=1.791，95% CI：1.164~2.754)。吸烟是老年人超重/肥胖的保护因素(OR=0.558，95% CI：0.408~0.764)。在校正一般资料及健康相关因素后，缺齿的老年人营养不良发生风险是不缺齿的1.337倍，慢性病共病的老年人超重/肥胖发生风险是未患共病的1.849倍。结论广州市社区老年人慢性病共病、营养不良、超重/肥胖检出率较高。缺齿与营养不良之间，共病与超重/肥胖之间存在关联。
- 老年人 /
- 慢性病共病 /
- 缺齿 /
- 营养不良 /
- 超重/肥胖
Abstract: Objective To explore the relationship between multimorbidity and nutritional status, as well as its influence factors among community-dwelling elderly people in Guangzhou. Methods A total of 2 127 residents aged ≥ 65 years who participated in a physical examination in the community health service centre in Guangzhou from January to December 2019 were selected as subjects. Nutritional status included malnutrition and overweight/obesity. The Spearman correlation analysis was used to analyse the relationship between multimorbidity and nutritional status. The multivariate logistic regression analysis was used to explore the influence factors of nutritional status among elderly people. Results The prevalence of multimorbidity, malnutrition and overweight/obesity was 38.08% (810/2 127), 10.81% (230/2 127) and 46.26% (984/2 127), respectively. There was a positive correlation between multimorbidity and overweight/obesity among elderly people (r=0.144, P < 0.05). Logistic regression analysis showed that per 5 years of age increasing, the risk of malnutrition increased (OR=1.369, 95% CI: 1.205-1.555), whereas the risk of overweight/obese decreased (OR=0.885, 95% CI: 0.813-0.965). Meanwhile, unmarried, divorced and widowed were risk factors for malnutrition (OR=1.791, 95% CI: 1.164-2.754). In addition, smoking was a protective factor against overweight or obesity (OR=0.558, 95% CI: 0.408-0.764). After adjusting the general data and health related factors, the risk of malnutrition in the elderly with missing teeth was 1.337 times as that without missing teeth, and the risk of overweight/obesity in the elderly with multimorbidity was 1.849 times as that without multimorbidity. Conclusion The prevalence of multimorbidity, malnutrition and overweight/obesity are high among community-dwelling elderly people in Guangzhou. There is an association between tooth loss and malnutrition, as well as between multimorbidity and overweight/obesity.
- The aged /
- Multimorbidity /
- Tooth loss /
- Malnutrition /
- Overweight/obese

HTML全文

表 1 广州市2 127名社区老年人一般资料与慢性病共病及营养状况的单因素分析[例(%)]

Table 1. Univariate analysis of socio-demographic characteristics, multimorbidity and nutritional status among 2 127 community elderly in Guangzhou [cases(%)]

项目	人数(%)	慢性病共病	χ²值	P值	营养不良	χ²值	P值	超重/肥胖	χ²值	P值
性别			0.206	0.650		0.599	0.439		2.550	0.110
男性	856(40.24)	321(37.50)			98(11.45)			378(44.16)
女性	1 271(59.76)	489(38.47)			132(10.39)			606(47.68)
年龄(岁)			16.501	0.001		30.013	0.001		10.565	0.014
65~69	945(44.43)	321(33.97)			71(7.51)			442(46.77)
70~74	605(28.44)	233(38.51)			64(10.58)			294(48.60)
75~79	344(16.17)	153(44.48)			55(15.99)			163(47.38)
80~94	233(10.95)	103(44.21)			40(17.17)			85(36.48)
户籍			51.805	0.001		4.257	0.039		3.807	0.051
广州户籍	1 348(63.38)	591(43.84)			160(11.87)			602(44.66)
非广州户籍	779(36.62)	219(28.11)			70(8.99)			382(49.04)
文化程度			0.069	0.995		4.594	0.204		7.036	0.071
初中及以下	189(8.89)	73(38.62)			18(9.52)			82(43.39)
高中与中专	462(21.72)	174(37.66)			44(9.52)			193(41.77)
大专	661(31.08)	253(38.28)			65(9.83)			309(46.75)
本科及以上	815(38.32)	310(38.04)			103(12.64)			400(49.08)
婚姻			0.003	0.958		11.045	0.001		0.543	0.461
已婚	1 966(92.43)	749(38.10)			200(10.17)			914(46.49)
丧偶等^a	161(7.57)	61(37.89)			30(18.63)			70(43.48)
医疗保险			8.248	0.004		0.300	0.584		0.006	0.940
有	1 940(91.21)	757(39.02)			212(10.93)			897(46.24)
自费	187(8.79)	53(28.34)			18(9.63)			87(46.52)
合计	2 127(100.00)	810(38.08)			230(10.81)			984(46.26)
注：^a表示未婚、离婚和丧偶。

下载: 导出CSV

表 2 广州市2 127名社区老年人健康相关因素与慢性病共病及营养状况的单因素分析[例(%)]

Table 2. Univariate analysis of health-related factors, multimorbidity and nutritional status among 2127 community elderly in Guangzhou [cases(%)]

健康相关因素	人数(%)	慢性病共病	χ²值	P值	营养不良	χ²值	P值	超重/肥胖	χ²值	P值
不适症状			0.743	0.389		2.848	0.091		0.432	0.511
是	989(46.50)	367(37.11)			119(12.03)			450(45.50)
否	1 138(53.50)	443(38.93)			111(9.75)			534(46.92)
体育锻炼			0.272	0.873		3.075	0.215		4.982	0.083
每天	1 312(61.68)	504(38.41)			130(9.91)			625(47.64)
偶尔	250(11.75)	96(38.40)			29(11.60)			100(40.00)
不锻炼	565(26.56)	210(37.17)			71(12.57)			259(45.84)
吸烟			2.215	0.137		1.964	0.161		13.763	0.001
是	196(9.21)	65(33.16)			27(13.78)			66(33.67)
否	1 931(90.79)	745(38.58)			203(10.51)			918(47.54)
饮酒			0.681	0.409		0.881	0.348		1.462	0.227
是	322(15.14)	116(36.02)			30(9.32)			139(43.17)
否	1 805(84.86)	694(38.45)			200(11.08)			845(46.81)
缺齿情况			0.279	0.598		5.747	0.017		0.057	0.811
是	684(32.16)	266(38.89)			90(13.16)			319(46.64)
否	1 443(67.84)	544(37.70)			140(9.70)			665(46.08)
慢性病共病						1.901	0.168		44.246	0.001
是	810(38.08)				78(9.63)			449(55.43)
否	1 317(61.92)				152(11.54)			535(40.62)

下载: 导出CSV

表 3 变量赋值表

Table 3. Assignment List

变量	赋值方法
年龄	65~69岁=0；70~74岁=1；75~79岁=2；80~94岁=3
户籍	广州=0；非广州=1
婚姻	已婚=0；丧偶等^a=1
吸烟	否=0；是=1
缺齿情况	否=0；是=1
慢性病共病	否=0；是=1
注：^a表示未婚、离婚和丧偶。

下载: 导出CSV

表 4 广州市2 127名社区老年人营养不良的多因素logistic回归分析

Table 4. Logistic regression analysis of malnutrition among 2 127 community elderly in Guangzhou

变量	B	SE	Wald χ²	P值	OR值	95% CI
年龄(每增加5岁)	0.314	0.065	23.201	0.001	1.369	1.205~1.555
丧偶等^a	0.583	0.220	7.030	0.008	1.791	1.164~2.754
缺齿	0.291	0.146	3.983	0.046	1.337	1.005~1.779
注：^a表示未婚、离婚和丧偶。

下载: 导出CSV

表 5 广州市2 127名社区老年人超重/肥胖的多因素logistic回归分析

Table 5. Logistic regression analysis of overweight or obese among 2 127 community elderly in Guangzhou

变量	B	SE	Wald χ²	P值	OR值	95% CI
年龄(每增加5岁)	-0.122	0.044	7.735	0.005	0.885	0.813~0.965
吸烟	-0.583	0.160	13.289	0.001	0.558	0.408~0.764
慢性病共病	0.614	0.091	45.431	0.001	1.849	1.546~2.210

下载: 导出CSV

参考文献(28)

[1]	SALIVE M E. Multimorbidity in older adults[J]. Epidemiol Rev, 2013, 35: 75-83. doi: 10.1093/epirev/mxs009
[2]	罗瑶, 邓学学, 徐晓茹, 等. 基于大数据老年多重慢性病风险预测模型构建探究[J]. 中华全科医学, 2021, 19(12): 1979-1982. doi: 10.16766/j.cnki.issn.1674-4152.002216 LUO Y, DENG X X, XU X R, et al. Research on the establishment of a risk prediction model for multiple chronic diseases in the elderly based on big data[J]. Chinese Journal of General Practice, 2021, 19(12): 1979-1982. doi: 10.16766/j.cnki.issn.1674-4152.002216
[3]	孙至佳, 樊俊宁, 余灿清, 等. 中国10个地区成年人共病流行特征分析[J]. 中华流行病学杂志, 2021, 42(5): 755-762. UN Z J, FAN J N, YU C Q, et al. Prevalence, patterns and long-term changes of multimorbidity in adults from 10 regions of China[J]. Chinese Journal of Epidemiology, 2021, 42(5): 755-762.
[4]	LIN W Q, WANG H H X, YUAN L X, et al. The unhealthy lifestyle factors associated with an increased risk of poor nutrition among the elderly population in China[J]. J Nutr Health Aging, 2017, 21(9): 943-953. doi: 10.1007/s12603-017-0881-8
[5]	康军仁, 邱月, 李海龙, 等. 3 885例中国社区老年人营养风险的多中心横断面调查[J]. 中国医学科学院学报, 2018, 40(5): 637-641. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYKX201805011.htm KANG J R, QIU Y, LI H L, et al. Multicenter cross-sectional community-based nutrition risk screening in 3 885 chinese elderly adults[J]. Acta Academiae Medicinae Sinicae, 2018, 40(5): 637-641. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYKX201805011.htm
[6]	柴培培, 张毓辉, 万泉, 等. 我国老年营养不良的疾病经济负担研究[J]. 中国卫生经济, 2016, 35(3): 13-16. https://www.cnki.com.cn/Article/CJFDTOTAL-WEIJ201603004.htm CHAI P P, ZHANG Y H, WEI Q, et al. Study on economic burden of malnutrition of the elderly in China[J]. Chinese Health Economics, 2016, 35(3): 13-16. https://www.cnki.com.cn/Article/CJFDTOTAL-WEIJ201603004.htm
[7]	DONINI L M, STEPHAN B C M, ROSANO A, et al. What are the risk factors for malnutrition in older-aged institutionalized adults?[J]. Nutrients, 2020, 12(9): 2857. doi: 10.3390/nu12092857
[8]	WANG X X, LIN W Q, CHEN X J, et al. Multimorbidity associated with functional independence among community-dwelling older people: A cross-sectional study in Southern China[J]. Health Qual Life Outcomes, 2017, 15(1): 73. doi: 10.1186/s12955-017-0635-7
[9]	NUNES B P, FLORES T R, MIELKE G I, et al. Multimorbidity and mortality in older adults: A systematic review and meta-analysis[J]. Arch Gerontol Geriatr, 2016, 67: 130-138. doi: 10.1016/j.archger.2016.07.008
[10]	孔亚, 卢宗亮, 刘洁, 等. 342例老年住院患者营养状况调查分析[J]. 重庆医学, 2014, 43(30): 4056-4058. https://www.cnki.com.cn/Article/CJFDTOTAL-CQYX201430026.htm KONG Y, LU Z L, LIU J, et al. Nutritional status investigation and analysis of 342 cases of elderly hospitalized patients[J]. Chongqing Medicine, 2014, 43(30): 4056-4058. https://www.cnki.com.cn/Article/CJFDTOTAL-CQYX201430026.htm
[11]	李嘉琛, 吕筠, 高萌, 等. 中国成年人体质指数和腰围与主要慢性病风险的关联研究[J]. 中华流行病学杂志, 2019, 40(12): 1541-1542, 1547. LI J C, LYU J, GAO M, et al. Association of body mass index and waist circumference with major chronic diseases in Chinese[J]. Chinese Journal of Epidemiology, 2019, 40(12): 1541-1547.
[12]	李林, 朱小霞, 戴宇翔, 等. 中国高尿酸血症相关疾病诊疗多学科专家共识[J]. 中华内科杂志, 2017, 56(3): 235-248. LI L, ZHU X X, DAI Y X, et al. Multidisciplinary expert consensus on diagnosis and treatment of hyperuricemia related diseases in China[J]. China Medical News, 2017, 56(3): 235-248.
[13]	高杨, 平智广, 裴晓婷, 等. 2009年中国中老年人群慢性病共病现状及相关因素的多重对应分析[J]. 卫生研究, 2020, 49(5): 844-849. https://www.cnki.com.cn/Article/CJFDTOTAL-WSYJ202005030.htm GAO Y, PING Z G, PEI X T, et al. Multi-correspondence analysis of the status and related factors of chronic diseases multimorbidity in middle-aged and elderly people in China in 2009[J]. Journal of Hygiene Research, 2020, 49(5): 844-849. https://www.cnki.com.cn/Article/CJFDTOTAL-WSYJ202005030.htm
[14]	中华人民共和国. 国民经济和社会发展第十四个五年规划和2035年远景目标纲要[EB/OL]. (2021-03-13)[2021-06-20]. http://www.gov.cn/xinwen/2021-03/13/content_5592681.htm. The People's Republic of China. The fourteenth five year plan for national economic and social development and the outline of long-term goals for 2035[EB/OL]. (2021-03-13)[2021-06-20]. http://www.gov.cn/xinwen/2021-03/13/content_5592681.htm.
[15]	ZHANG R, LU Y, SHI L Y, et al. Prevalence and patterns of multimorbidity among the elderly in China: A cross-sectional study using national survey data[J]. BMJ Open, 2019, 9(8): e024268. DOI: 10.1136/bmjopen-2018-024268.
[16]	YAO S S, CAO G Y, HAN L, et al. Prevalence and patterns of multimorbidity in a nationally representative sample of older Chinese: Results from the china health and retirement longitudinal study[J]. J Gerontol A Biol Sci Med Sci, 2020, 75(10): 1974-1980.
[17]	WEI J M, LI S, CLAYTOR L, et al. Prevalence and predictors of malnutrition in elderly Chinese adults: Results from the China Health and Retirement Longitudinal Study[J]. Public Health Nutr, 2018, 21(17): 3129-3134.
[18]	VISVANATHAN R. Anorexia of aging[J]. Clin Geriatr Med, 2015, 31(3): 417-427.
[19]	王凡, 贺圣文, 刘红杨, 等. 潍坊市养老机构老年人营养状况影响因素[J]. 中国老年学杂志, 2018, 38(13): 3244-3247. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLXZ201813070.htm WANG F, HE S W, LIU H Y, et al. Influencing factors of nutritional status of the elderly in Weifang elderly care institutions[J]. Chinese Journal of Gerontology, 2018, 38(13): 3244-3247. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLXZ201813070.htm
[20]	NAKA O, ANASTASSIADOU V, PISSIOTIS A. Association between functional tooth units and chewing ability in older adults: A systematic review[J]. Gerodontology, 2014, 31(3): 166-177.
[21]	DION N, COTART J L, RABILLOUD M. Correction of nutrition test errors for more accurate quantification of the link between dental health and malnutrition[J]. Nutrition, 2007, 23(4): 301-307.
[22]	ADIATMAN M, UENO M, OHNUKI M, et al. Functional tooth units and nutritional status of older people in care homes in Indonesia[J]. Gerodontology, 2013, 30(4): 262-269.
[23]	于亮, 王宗站. 青岛市市南区老年人高尿酸血症与代谢综合征的关系分析[J]. 中华老年心脑血管病杂志, 2019, 21(10): 1092-1093. https://www.cnki.com.cn/Article/CJFDTOTAL-LNXG201910023.htm YU L, WANG Z Z. Relationship between hyperuricemia and metabolic syndrome in the elderly in Shinan of Qingdao[J]. Chinese Journal of Geriatric Heart Brain and Vessel Diseases, 2019, 21(10): 1092-1093. https://www.cnki.com.cn/Article/CJFDTOTAL-LNXG201910023.htm
[24]	鞠香丽, 裴冬梅. 健康体检人群超重、肥胖流行特点与相关因素分析[J]. 中国基层医药, 2020, 27(13): 1628-1633. JU X L, PEI D M. The epidemiological characteristics and correlation factors analysis of overweight and obesity in physical examination population[J]. Chinese Journal of Primary Medicine and Pharmacy, 2020, 27(13): 1628-1633.
[25]	刘览, 刘华章, 冯颖青, 等. 广州市35~75岁社区居民心血管病主要危险因素聚集情况分析[J]. 现代预防医学, 2020, 47(4): 635-639, 647. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF202004014.htm LIU L, LIU H Z, FENG Y Q, et al. Clustering of cardiovascular disease risk factors in population aged 35 to 75 in Guangzhou[J]. Modern Preventive Medicine, 2020, 47(4): 635-639, 647. https://www.cnki.com.cn/Article/CJFDTOTAL-XDYF202004014.htm
[26]	宋孟娜, 程潇, 孔静霞, 等. 我国中老年人超重、肥胖变化情况及影响因素分析[J]. 中华疾病控制杂志, 2018, 22(8): 804-808. https://www.cnki.com.cn/Article/CJFDTOTAL-JBKZ201808011.htm SONG M N, CHENG X, KONG J X, et al. Prevalence and influencing factors of overweight and obesity among middle-aged and elderly people in China[J]. Chinese Journal of Disease Control & Prevention, 2018, 22(8): 804-808. https://www.cnki.com.cn/Article/CJFDTOTAL-JBKZ201808011.htm
[27]	朱明胜, 陈莲芬. 2012—2017年三亚市健康管理老年人超重和肥胖流行趋势分析[J]. 中国慢性病预防与控制, 2019, 27(9): 676-679. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMXB201909010.htm ZHU M S, CHEN L F. Epidemiological analysis of overweight and obesity among the elderly in Sanya city from 2012 to 2017[J]. Chinese Journal of Prevention and Control of Chronic Diseases, 2019, 27(9): 676-679. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMXB201909010.htm
[28]	卢露, 景翔, 王亚丽, 等. 山东省≥60岁老年人超重、肥胖和腹型肥胖流行现状及其影响因素分析[J]. 中国公共卫生, 2020, 36(4): 566-569. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGW202004022.htm LU L, JING X, WANG Y L, et al. Prevalence and influence factors of overweight, obesity and abdominal obesity among residents aged 60 years and over in Shandong province[J]. Chinese Journal of Public Health, 2020, 36(4): 566-569. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGGW202004022.htm