1993—2018年中国15个省（自治区、直辖市）18~35岁成人中心型肥胖变化趋势及其人口学和社会经济学影响因素
Secular trends in central obesity prevalence and demographic and socioeconomic factors of adults aged 18-35 years in 15 provinces (autonomous regions and municipalities) of China from 1993 to 2018
-
摘要:
背景 近年来，我国居民饮食习惯和生活行为方式发生了深刻变化，中心型肥胖患病率的不断攀升成为了主要的公共卫生难题之一。
目的 分析1993—2018年中国15个省（自治区、直辖市）18~35岁成年人腰围分布变化及中心型肥胖流行趋势，并探讨其人口学和社会经济学因素差异，为进一步探索病因和采取控制措施提供依据。
方法 以“中国健康与营养调查”1993—2018年共9轮随访调查数据为基础，选择其中18~35岁成年人作为研究对象，剔除人口学信息缺失及体格测量数据异常的观测后，共纳入16008个观测对象。采用中华人民共和国卫生行业标准WS/T 428—2013《成人体重判定》的中心型肥胖诊断标准。采用Spearman秩相关分析腰围水平的变化；采用Cochran-Armitage趋势检验分析中心型肥胖患病率的变化趋势；应用多因素logistic回归分析全人群中心型肥胖的影响因素；分别对2018年不同人群的腰围水平和中心型肥胖患病率进行差异性比较。
结果 1993—2018年间中国15省（自治区、直辖市）18~35岁成人腰围及中心型肥胖患病率均呈上升趋势（P<0.05），中心型肥胖率男性从4.40%增至35.49%（P趋势<0.001），女性从6.33%增至18.31%（P趋势<0.001），年均增长率分别为8.14%、2.58%。多因素分析结果显示：25~35岁男性（OR=1.285，95%CI：1.066~1.550）和女性（OR=1.558，95%CI：1.234~1.967）患中心型肥胖的危险性高于对照组18~24岁人群；城乡、地理位置和经济地带与男性中心型肥胖间具有统计学意义的关联：城市男性患中心型肥胖的危险性较农村男性高39.5%（OR=1.395，95%CI：1.169~1.165）,南方男性患中心型肥胖的危险性较北方男性低37.9%（OR=0.621，95%CI：0.519~0.744），西部经济地带男性患中心型肥胖的危险性较中部低27.1%（OR=0.729，95%CI：0.567~0.937），而东部经济地带男性患中心型肥胖的危险性较中部高21.8%（OR=1.218，95%CI：1.017~1.459）。女性中未发现城乡、地理位置与中心型肥胖存在关联，仅西部经济地带女性患中心型肥胖的危险性较中部低32.4%（OR=0.676，95%CI：0.515~0.886）；随着家庭人均年收入水平增高，女性患中心型肥胖的危险性降低，中（OR=0.749，95% CI：0.600~0.934）、高收入（OR=0.684，95% CI：0.542~0.864）女性患中心型肥胖的危险性低于对照组低收入女性。在全人群中，体重指数（BMI）水平越高伴随中心型肥胖的危险性越高，男性中超重、肥胖人群伴随中心型肥胖的可能性分别为体重正常人群的12.207（95%CI：10.228~14.568）和150.418（95%CI：111.186~203.492）倍；女性中分别为9.014（95%CI：7.446~10.912）和88.215（95%CI：61.411~126.717）倍。
结论 1993—2018年中国15省（自治区、直辖市）18~35岁成人腰围水平和中心型肥胖患病率逐年上升，其中男性的中心型肥胖形式更为严峻。性别、年龄、经济地带及BMI水平是中心型肥胖率的主要影响因素。建议加强青年人群中心型肥胖的早期筛查和干预，降低人群健康风险。
Abstract:Background In recent years, Chinese residents have undergone profound changes in dietary habits and lifestyle, and the increasing prevalence rate of central obesity has become one of the major public health problems.
Objective To analyze the changes in waist circumference distribution and central obesity prevalence, and the differences by demographic and socioeconomic factors among Chinese adults aged 18-35 in 15 provinces (autonomous regions and municipalities) from 1993 to 2018, and to provide evidence for further exploration of etiology and control measures.
Methods Based on the data of nine follow-up rounds of the China Health and Nutrition Survey from 1993 to 2018, adults aged 18 to 35 were selected as study subjects. After excluding the records of missing demographic information or abnormal physical measurement data, a total of 16008 subjects were included in this study. Central obesity was diagnosed by WS/T 428—2013 Criteria of weight for adults. Spearman rank test was used to analyze the changes of waist circumference; Cochran-Armitage trend test was used to analyze the trends of central obesity prevalence rate; multiple logistic regression analysis was used to analyze the influencing factors of central obesity in the whole population; subgroup analysis on waist circumference and central obesity prevalence rate was also conducted among participants from the 2018 follow-up survey. survey.
Results From 1993 to 2018, the waist circumference and prevalence rate of central obesity of adults aged 18-35 in 15 provinces (autonomous regions and municipalities) significantly increased by year (P<0.05). In males, the prevalence rate increased from 4.40% to 35.49% (Ptrend<0.05), while in females, it increased from 6.33% to 18.31% (Ptrend<0.05), and the average growth rates were 8.14% and 2.58% per annum, respectively. The results of multiple model analysis showed that subjects aged 25 to 35 years were more likely to have central obesity than the control group with age 18 to 24 years in both males (OR=1.285, 95%CI: 1.066-1.550) and females (OR=1.558, 95%CI: 1.234-1.967). There were significant associations of central obesity in males with residence, geographical location, and economic zones: urban males were 39.5% (OR=1.395, 95%CI: 1.169-1.165) more likely to suffer from central obesity than rural males; males living in southern China were 37.9% (OR=0.621, 95%CI: 0.519-0.744) less likely to suffer from central obesity than those living in northern China; compared with males living in central economic zone, males living in western economic zone were 27.1% (OR=0.729, 95%CI: 0.567-0.937) less likely and males living in eastern economic zone were 21.8% (OR=1.218, 95%CI: 1.017-1.459) more likely to suffer from central obesity. No significant correlation was found of residence and geographical location with central obesity in females, only in the western economic zone, females were 32.4% (OR=0.676, 95%CI: 0.515-0.886) less likely to suffer from central obesity than those in the central economic zone. With increase of income levels, females were less likely to be central obese, and females of middle income level (OR=0.749, 95%CI: 0.600-0.934) and high income level (OR=0.684, 95%CI: 0.542-0.864) were less likely to suffer from central obesity than those of low income level. In the total population, a higher body mass index (BMI) level was significantly associated with having central obesity; overweight and obese males were found to be 12.207 (95%CI: 10.228-14.568) and 150.418 (95%CI: 111.186-203.492) times more likely to have central obesity, respectively, and the odds ratios for females were 9.014 (95%CI: 7.446-10.912) and 88.215 (95%CI: 61.411-126.717), respectively.
Conclusion From 1993 to 2018, waist circumference and the prevalence rate of central obesity in adults aged 18-35 in selected 15 provinces (autonomous regions and municipalities) of China have been increased year by year, the condition of central obesity is more severe in males. Gender, age, economic zones, and BMI are the major influencing factors. It is necessary to take effective early screening and intervention measures targeting central obesity in youth population to reduce health risks.
下载:
