Multimorbidity status and risk factors among adults aged 45-64 years in 15 provinces of China in 2018: Based on association rule analysis

WANG Zhiru; JIA Xiaofang; LIU Mengran; JIANG Hongru; WANG Huijun; ZHANG Bing; LI Weiyi; WANG Zhihong

doi:10.11836/JEOM24001

Volume 41 Issue 7

Jul. 2024

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Journal of Environmental and Occupational Medicine > 2024 > 41(7): 768-773. > DOI: 10.11836/JEOM24001

WANG Zhiru, JIA Xiaofang, LIU Mengran, JIANG Hongru, WANG Huijun, ZHANG Bing, LI Weiyi, WANG Zhihong. Multimorbidity status and risk factors among adults aged 45-64 years in 15 provinces of China in 2018: Based on association rule analysis[J]. Journal of Environmental and Occupational Medicine, 2024, 41(7): 768-773. DOI: 10.11836/JEOM24001

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Multimorbidity status and risk factors among adults aged 45-64 years in 15 provinces of China in 2018: Based on association rule analysis

a.
National Institute for Nutrition and Heath/Key Laboratory of Trace Elements and Nutrition, National Health Commission
b.
Department of Education and Training, Chinese Center for Disease Control and Prevention, Beijing 100050, China

Funds: This study was funded.

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Corresponding author:
LI Weiyi, E-mail：liwy@ninh.chinacdc.cn

WANG Zhihong, E-mail: wangzh@ninh.chinacdc.cn
Received Date: January 02, 2024
Accepted Date: May 12, 2024
Available Online: July 23, 2024

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Abstract

Abstract

Background
Multimorbidity imposes a heavy burden on individuals, families, and society. There are relatively few studies exploring patterns of multimorbidity among middle-aged adults in China.
Objective
To explore the current status of multimorbidity, associated risk factors, and multimorbidity patterns among adults aged 45-64 years in China, so as to provide a scientific basis to prevent and control multimorbidity in China.
Methods
A total of 5494 adults aged 45-64 years from the Chinese Health and Nutrition Survey (CHNS) in 2018 were selected. Of these, 2494 (45.39%) were men and 3000 (54.61%) were women. The nine diseases included were hypertension, diabetes, dyslipidaemia, obesity, mild cognitive impairment (MCI), myocardial infarction, stroke, asthma, and tumor. The prevalence of each disease or multimorbidity was expressed as N (%). Comparisons of multimorbidity prevalence between different groups were performed using the χ²test or Cochran-Armitage trend test. Association rule with the Apriori algorithm was used to explore the pattern of multimorbidity, with parameters set at a minimum conditional support of 3.00%, a minimum rule confidence of 50.00%, and a lift of >1.20. Logistic regression was used to evaluate the associations between selected risk factors and multimorbidity.
Results
In 2018, 37.44% of participants reported multimorbidity in 15 provinces of China. The prevalence of diseases in descending order was dyslipidaemia (39.99%), hypertension (39.48%), obesity (16.42%), MCI (14.47%), diabetes (14.16%), tumor (1.09%), stroke (1.04%), myocardial infarction (0.71%), and asthma (0.64%). A total of seven multimorbidity patterns were identified in this group. Obesity paired with hypertension, and diabetes paired with dyslipidemia were the two major patterns of multimorbidity in the general population and age or sex subgroups. The multimorbidity patterns of different populations were concentrated in the combination of obesity, hypertension, diabetes, and dyslipidemia. The risk of multimorbidity was lower in females than in males (OR=0.85, 95%CI: 0.75, 0.97). The multimorbidity risk was 1.56 times higher in the 55-64 years group than in the 45-54 years group (OR=1.56, 95%CI: 1.40, 1.75). Drinking in the past year increased the risk of multimorbidity by 25% (OR=1.25, 95%CI: 1.08, 1.45) compared to no alcohol comsumption in the past year. High and medium levels of physical activity were associated with a decreased OR (high: OR=0.74, 95%CI: 0.65, 0.85; medium: OR=0.81, 95%CI: 0.70, 0.93) with low level of physical activity as reference.
Conclusion
In 2018, there was a high prevalence rate of multimorbidity among middle-aged adults in China. The main multimorbidity patterns were obesity-hypertension and diabetes-dyslipidemia. Surveillance and interventions should be strengthened particularly for men, individuals with alcohol consumption or insufficient physical activity, and those with major multimorbidity patterns.
- nutrition survey,
- middle-aged adult,
- multimorbidity,
- multimorbidity pattern,
- association rule

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References

[1]	GBD 2019 Risk Factors Collaborators. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019[J]. Lancet, 2020, 396(10258): 1223-1249. doi: 10.1016/S0140-6736(20)30752-2
[2]	CHOWDHURY S R, CHANDRA DAS D, SUNNA T C, et al. Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta-analysis[J]. eClinicalMedicine, 2023, 57: 101860. doi: 10.1016/j.eclinm.2023.101860
[3]	HU Y, WANG Z, HE H, et al. Prevalence and patterns of multimorbidity in China during 2002-2022: a systematic review and meta-analysis[J]. Ageing Res Rev, 2024, 93: 102165. doi: 10.1016/j.arr.2023.102165
[4]	BUSIJA L, LIM K, SZOEKE C, et al. Do replicable profiles of multimorbidity exist? Systematic review and synthesis[J]. Eur J Epidemiol, 2019, 34(11): 1025-1053. doi: 10.1007/s10654-019-00568-5
[5]	POPKIN B M, DU S, ZHAI F, et al. Cohort Profile: the China Health and Nutrition Survey-monitoring and understanding socio-economic and health change in China, 1989-2011[J]. Int J Epidemiol, 2010, 39(6): 1435-1440. doi: 10.1093/ije/dyp322
[6]	ZHANG B, ZHAI F Y, DU S F, et al. The China health and nutrition survey, 1989-2011[J]. Obes Rev, 2014, 15(S1): 2-7. doi: 10.1111/obr.12119
[7]	张思婷, 张继国, 贾小芳, 等. 2018年中国15省份18~65岁居民肥胖与2型糖尿病患病的关联研究[J]. 中华流行病学杂志, 2022, 43(10): 1596-1602. doi: 10.3760/cma.j.cn112338-20211115-00884 ZHANG S T, ZHANG J G, JIA X F, et al. Association between obesity and the prevalence of type 2 diabetes mellitus among Chinese adults aged 18-65 years in 15 provinces in 2018[J]. Chin J Epidemiol, 2022, 43(10): 1596-1602. doi: 10.3760/cma.j.cn112338-20211115-00884
[8]	中国高血压防治指南修订委员会, 高血压联盟(中国), 中华医学会心血管病学分会, 等. 中国高血压防治指南(2018年修订版)[J]. 中国心血管杂志, 2019, 24(1): 24-56. doi: 10.3969/j.issn.1007-5410.2019.01.002 Writing Group of 2018 Chinese Guidelines for the Management of Hypertension, Chinese Hypertension League, Chinese Society of Cardiology, et al. 2018 Chinese guidelines for the management of hypertension[J]. Chin J Cardiovasc Med, 2019, 24(1): 24-56. doi: 10.3969/j.issn.1007-5410.2019.01.002
[9]	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)[J]. 中华糖尿病杂志, 2021, 13(4): 315-409. Chinese Diabetes Society. Guideline for the prevention and treatment of type 2 diabetes mellitus in China (2020 edition)[J]. Chin J Diabetes Mellitus, 2021, 13(4): 315-409.
[10]	中国成人血脂异常防治指南修订联合委员会. 中国成人血脂异常防治指南(2016年修订版)[J]. 中华心血管病杂志, 2016, 44(10): 833-853. Joint Committee Issued Chinese Guideline for the Management of Dyslipidemia in Adults. 2016 Chinese guideline for the management of dyslipidemia in adults[J]. Chin J Cardiol, 2016, 44(10): 833-853.
[11]	成人体重判定: WS/T 428—2013[S]. 北京: 中国标准出版社, 2013. Criteria of weight for adults: WS/T 428—2013[S]. Beijing: Standards Press of China, 2013.
[12]	O'BRYANT S E, HUMPHREYS J D, SMITH G E, et al. Detecting dementia with the mini-mental state examination in highly educated individuals[J]. Arch Neurol, 2008, 65(7): 963-967.
[13]	张振馨, 洪霞, 李辉, 等. 北京城乡55岁或以上居民简易智能状态检查测试结果的分布特征[J]. 中华神经科杂志, 1999, 32(3): 149-153. doi: 10.3760/j.issn:1006-7876.1999.03.006 ZHANG Z X, HONG X, LI H, et al. The mini-mental state examination in the Chinese residents population aged 55 years and over in the urban and rural areas of Beijing[J]. Chin J Neurol, 1999, 32(3): 149-153. doi: 10.3760/j.issn:1006-7876.1999.03.006
[14]	程杨杨, 曹志, 侯洁, 等. 中国中老年人群慢性病现状调查与共病关联分析[J]. 中华疾病控制杂志, 2019, 23(6): 625-629. CHENG Y Y, CAO Z, HOU J, et al. Investigation and association analysis of multimorbidity in middle-aged and elderly population in China[J]. Chin J Dis Control Prev, 2019, 23(6): 625-629.
[15]	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. doi: 10.1093/gerona/glz185
[16]	GENG Y, JIE W, HE Y, et al. Prevalence and patterns of multimorbidity among adults aged 18 years and older - China, 2018[J]. China CDC Wkly, 2023, 5(2): 35-39. doi: 10.46234/ccdcw2023.007
[17]	HAN S, MO G, GAO T, et al. Age, sex, residence, and region-specific differences in prevalence and patterns of multimorbidity among older Chinese: evidence from Chinese Longitudinal Healthy Longevity Survey[J]. BMC Public Health, 2022, 22(1): 1116. doi: 10.1186/s12889-022-13506-0
[18]	刘贝贝, 田庆丰, 郭金玲. 我国中老年人群慢性病患病现状及共病模式分析[J]. 医学与社会, 2022, 35(8): 58-61,66. LIU B B, TIAN Q F, GUO J L. Analysis of chronic diseases and comorbidities in middle-aged and elderly population in China[J]. Med Soc, 2022, 35(8): 58-61,66.
[19]	李泽亚, 黄榕翀. 高血压与代谢综合征的研究进展[J]. 中华全科医师杂志, 2023, 22(3): 239-244. doi: 10.3760/cma.j.cn114798-20230106-00036 LI Z Y, HUANG R C. Research progress on the relationship between hypertension and metabolic syndrome[J]. Chin J Gen Pract, 2023, 22(3): 239-244. doi: 10.3760/cma.j.cn114798-20230106-00036
[20]	BURKI T. European Commission classifies obesity as a chronic disease[J]. Lancet Diabetes Endocrinol, 2021, 9(7): 418. doi: 10.1016/S2213-8587(21)00145-5
[21]	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. doi: 10.3760/cma.j.cn112338-20200305-00259 SUN 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]. Chin J Epidemiol, 2021, 42(5): 755-762. doi: 10.3760/cma.j.cn112338-20200305-00259
[22]	李新华, 马吉祥, 吴静, 等. 联合国慢性病防控高级别会议对中国公共卫生事业发展的启示[J]. 中华预防医学杂志, 2019, 53(6): 545-548. doi: 10.3760/cma.j.issn.0253-9624.2019.06.001 LI X H, MA J X, WU J, et al. Enlightenment of the United Nations high-level summit on non-communicable disease prevention and control on the development of public health system in China[J]. Chin J Prev Med, 2019, 53(6): 545-548. doi: 10.3760/cma.j.issn.0253-9624.2019.06.001
[23]	PETERSEN R C, LOPEZ O, ARMSTRONG M J, et al. Practice guideline update summary: mild cognitive impairment: report of the guideline development, dissemination, and implementation subcommittee of the American academy of neurology[J]. Neurology, 2018, 90(3): 126-135. doi: 10.1212/WNL.0000000000004826
[24]	WANG R, YAN Z, LIANG Y, et al. Prevalence and patterns of chronic disease pairs and multimorbidity among older Chinese adults living in a rural area[J]. PLoS One, 2015, 10(9): e0138521. doi: 10.1371/journal.pone.0138521
[25]	杨馥霞, 魏文石. 老年人常见慢性疾病与认知功能障碍的关系[J]. 中华老年医学杂志, 2020, 39(10): 1227-1230. doi: 10.3760/cma.j.issn.0254-9026.2020.10.028 YANG F X, WEI W S. Latest research progress: the relationship between cognitive dysfunction and common chronic diseases in the elderly[J]. Chin J Geriatr, 2020, 39(10): 1227-1230. doi: 10.3760/cma.j.issn.0254-9026.2020.10.028
[26]	中国老年医学学会, 中国老年医学学会高血压分会, 中国老年医学学会认知障碍分会, 等. 老年高血压合并认知障碍诊疗中国专家共识(2021版)[J]. 中国心血管杂志, 2021, 26(2): 101-111. doi: 10.3969/j.issn.1007-5410.2021.02.001 Chinese Geriatrics Society, Hypertension Branch of Chinese Geriatrics Society, Academy of Cognitive Disorder of China, et al. Chinese expert consensus on diagnosis and treatment of senile hypertension complicated with cognitive impairment (2021 version)[J]. Chin J Cardiovasc Med, 2021, 26(2): 101-111. doi: 10.3969/j.issn.1007-5410.2021.02.001
[27]	中华医学会内分泌学分会, 中国成人2型糖尿病降压治疗目标研究工作组. 2型糖尿病患者认知功能障碍防治的中国专家共识[J]. 中华内分泌代谢杂志, 2022, 38(6): 453-464. doi: 10.3760/cma.j.cn311282-20220518-00320 Chinese Society of Endocrinology, The Blood Pressure Control Target in Diabetes (BPROAD) Research Group. Chinese expert consensus on the prevention and management of cognitive impairment in patients with type 2 diabetes mellitus[J]. Chin J Endocrinol Metab, 2022, 38(6): 453-464. doi: 10.3760/cma.j.cn311282-20220518-00320
[28]	AMINISANI N, STEPHENS C, ALLEN J, et al. Socio-demographic and lifestyle factors associated with multimorbidity in New Zealand[J]. Epidemiol Health, 2020, 42: e2020001.
[29]	WETTERLING T. Pathogenesis of multimorbidity-what is known?[J]. Z Gerontol Geriatr, 2021, 54(6): 590-596. doi: 10.1007/s00391-020-01752-z
[30]	ZOU S, WANG Z, BHURA M, et al. Prevalence and associated socioeconomic factors of multimorbidity in 10 regions of China: an analysis of 0.5 million adults[J]. J Public Health (Oxf), 2022, 44(1): 36-50. doi: 10.1093/pubmed/fdaa204
[31]	LEE T W, CHUNG J, SONG K, et al. Incidence and predictors of multimorbidity among older adults in Korea: a 10-year cohort study[J]. BMC Geriatr, 2022, 22(1): 565. doi: 10.1186/s12877-022-03250-w

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Multimorbidity status and risk factors among adults aged 45-64 years in 15 provinces of China in 2018: Based on association rule analysis

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