基于健康生态学模型的老年慢性肾脏病危险因素分析

Risk of Chronic Kidney Disease in the Elderly Based on the Health Ecology Model

摘要: 目的：随着人口老龄化加剧，老年慢性肾脏病(chronic kidney diseases, CKD)已成为影响老年人生活质量的重要因素，如何更好地防治老年CKD将是社会面临的巨大挑战。基于健康生态学模型了解老年CKD现状和影响因素可为老年CKD防治提供参考。方法：本研究利用中国健康与养老追踪调查(China health and retirement longitudinal study, CHARLS) 2018年的追访调查数据，以是否发生CKD为因变量，基于健康生态模型逐级纳入自变量(模型1~5)，进行二分类logistics回归分析，进一步评估分析影响老年CKD发生的影响因素。结果：共计纳入有效样本6320例，其中老年CKD的患病率为7.0% (441/6320)。在患有CKD的老年人中，合并其他慢性疾病(包括但不限于心血管疾病、糖尿病、慢性呼吸疾病、肥胖症、某些类型的癌症等)135例(81.2%, 358/441)、抑郁症状281例(63.7%, 281/441)、低教育水平(79.8%, 352/441)、已婚状态(81.9%, 361/441)、拥有医疗保险(95.7%, 422/441)的占有较大比例。Logistics回归分析显示，男性(OR = 1.443, 95% CI: 1.099~1.896, P = 0.008)、当前吸烟(OR = 1.420, 95% CI: 1.100~1.834, P = 0.007)、合并其他慢性病(OR = 2.348, 95% CI: 1.832~3.010, P < 0.05)和抑郁症状(OR = 1.463, 95% CI: 1.158~1.849, P = 0.001)的老年人CKD的风险更高。结论：我国老年CKD发病率较高，影响因素是多层次、多维度的，包括性别、吸烟、慢性病、抑郁等。进一步防治需要从个体到环境多维度加强对CKD的干预和管理，提高老年人群肾脏健康水平。

Abstract: Objective: With the aging of the population, Chronic Kidney Disease (CKD) has become an important factor affecting the quality of life of the elderly. How to better prevent and treat CKD in the elderly will be a challenge for society. Understanding the current status and influencing factors of CKD in the elderly based on the health ecology model can provide a reference for the prevention and treatment of CKD in the elderly. Methods: Data were collected from the China health and Retirement Longitudinal Study (CHARLS) 2018 follow-up survey data, based on the occurrence of CKD as the dependent variable. The independent variables were included in the healthy ecological model step by step (model 1 to 5), and binary logistics regression analysis was performed to further evaluate and analyze the influence of aging Influencing factors of CKD. Results: A total of 6320 participants were included in the analysis. The prevalence of CKD in the elderly was 7.0% (441/6320). In older adults with CKD, the risk of comorbidity with other chronic diseases (including but not limited to cardiovascular disease, diabetes, chronic respiratory disease, obesity, some types of cancer, etc.) 135 cases (81.2%, 358/441), 281 cases (63.7%, 281/441) of depressive symptoms, low education level (79.8%, 281/441), and high risk of depression. 352/441), married status (81.9%, 361/441) and having medical insurance (95.7%, 422/441). Logistics regression analysis showed that being male (OR = 1.443, 95% CI: 1.099~1.896, P = 0.008), current smoking (OR = 1.420, 95% CI: 1.100~1.834, P = 0.007), and having chronic diseases (OR = 2.348, 95% CI: 1.832~3.010, P < 0.05) and depressive symptoms (OR = 1.463, 95% CI: 1.158~1.849, P = 0.001) had a higher risk of CKD (P < 0.05). Conclusion: The incidence of CKD in the elderly in China is high. The influencing factors of CKD are multi-level and multi-dimensional, and there are complex relationships among different influencing factors, including gender, smoking, chronic diseases, depression, and so on. It is recommended to strengthen the intervention and management of CKD from the individual to the environment to improve the kidney health of the elderly.