- 學位論文
"自報高血壓"對隨後罹患慢性疾病及死亡風險之長期預測功能
Usefulness of self-reports of hypertension as an indicator for predicting the risk of long-term mortality or chronic diseases
摘要
背景--高血壓是老年人最普遍的慢性疾病，國健局2002年的調查中台灣65歲以上中老年人高血壓盛行率高達56.6%，高血壓同時也是引起心臟血管疾病、糖尿病和腎臟疾病等慢性疾病的主要原因之ㄧ，而上述慢性疾病在台灣十大死因中又常居高位，高血壓的高盛行率及其與死亡和罹患慢性疾病的高度關聯性，是值得重視的公共衛生議題。 目的--本研究目的為縱貫分析國健局之「台灣中老年身心社會狀況長期追蹤調查系列研究」資料庫找出高血壓與心臟血管疾病、糖尿病、腎病等各項慢性疾病以及死亡風險之間的關聯性，了解自報高血壓是否為可有效預測隨後存活與慢性病罹病率之因子。 方法--本研究以1989年「台灣地區老人保健與生活問題調查」之4049名調查對象為主要分析樣本。取用1989年問卷健康狀況中疾病自報部份，分為自報有無高血壓兩組，再分別與1999年第四波調查資料庫以及1999年存活檔資料庫進行樣本串檔分析；以描述性統計分析基本社會人口學、健康狀況等百分比分佈情形，以卡方分析兩組十年後存活情形及慢性病新增罹病率、自認健康狀況及ADL分佈差異，以邏輯迴歸縱貫分析1989年樣本健康狀況與隨後十年間存活率及主要慢性病罹病率之關聯性，以Kaplan Meier生存分析自報有無高血壓兩組十年間的存活差異。 結果--自報有無高血壓兩組之1999年存活情形及糖尿病、心臟病、中風罹病率、ADL功能均有顯著差異。1989年自報有高血壓者十年之總死亡率比自報無高血壓者顯著增加25%，心臟病罹病率增加92%，中風率加倍(p<0.001)，糖尿病罹病率為自報無高血壓者之1.32倍(p<0.05)，慢性腎臟病罹病率為1.29倍，但未達統計顯著意義。邏輯回歸分析顯示，在控制性別、年齡、社經因素、生活方式、行動功能等變項下，自報高血壓為影響存活與隨後中風及心臟病罹病率之顯著因子。 結論--本研究發現自報高血壓者其隨後死亡風險及慢性病罹病率顯著增加，自報高血壓確實可做為一推測長期死亡與慢性疾病罹病率之有效指標，可提供台灣日後推動慢性病防治以及相關慢性病研究之參考。
並列摘要
Background: Hypertension is common among the elderly. A recent study suggests that 56.6% of elderly Taiwanese are hypertensive. Hypertension has also been shown to be a risk factor of a number of chronic diseases such as heart disease, diabetes mellitus and chronic kidney disease. These chronic diseases are also among the top leading causes of death in Taiwan. Hypertension is a major public health issue and deserves further investigation. Objective: The objective of this study was to determine the prevalence of hypertension and the associated risk factors as well as the impact of hypertension on the incidences of subsequent chronic diseases. Methods: Data used for this study were from the “Survey of Health and Living Status of the Elderly in Taiwan, SHLSET” conducted by the Bureau of Health Promotion of Taiwan. Chi-square and regression analyses were performed cross-sectional and longitudinal analyses of SHLSET 1989 and 1999 data and mortality data during the period to determine the prevalence of self-reports of hypertension and its associations with the chronic diseases, health statuses and the potential causal factors. Kaplan- Meier survival analysis was performed to the significance of difference in follow-up survivability between the hypertensives and non-hypertensives. Results: Cross-sectional analyses showed that self-reports of hypertension was associated with increased follow-up mortality. Hypertension was also associated with higher rates of diabetes, heart disease and stroke, and poorer ADL. Logistic regression analysis indicated that self-reports of hypertension significantly increased follow-up 10-year mortality by 38%. Conclusion: Results indicate that elderly who self-reported hypertension have significantly increased chronic disease and mortality risks. These results suggest that self-report is probably a useful measure for identifying individuals who have greater needs for preventive interventions.
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