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国家基本公共卫生服务老年人健康体检的异常检出率分析

泰然健康网
2024-12-03 02:37

摘要： 背景基本公共卫生服务项目中的老年健康体检服务对老年健康异常状况检出的贡献及老年人对体检结果的获悉情况相关研究报道较少。目的了解≥65岁老年人健康体检中发现的血压异常、血糖异常、超重肥胖、贫血、脂肪肝、胆结石或胆囊炎几种常见病的异常检出情况。方法 2019年11—12月，采用多阶段分层抽样法从我国东、中、西部的3省5市20所基层医疗卫生机构选择前来就诊的≥65岁老年人作为调查对象（排除本年度体检结果不详者），根据基本公共卫生服务对象人群划分标准，将研究对象分为一般老年人（不患有高血压或糖尿病）、高血压老年人、糖尿病老年人3类，对所有调查对象进行"一对一"问卷调查（问卷内容包括被调查者一般人口学特征、老年人健康体检异常检出情况）。结果 3 018例老年人中，2 033例（67.36%）自报健康体检异常。不同居住地类型、人群类型、所在地区、户口类型老年人自报健康体检异常率比较，差异有统计学意义（P<0.05）。3 018例老年人中，1 174例（38.90%）自报检出血压异常，747例（24.75%）自报检出血糖异常，719例（23.82%）自报检出血脂异常，445例（14.74%）自报检出脂肪肝，393例（13.02%）自报检出超重肥胖，238例（7.89%）自报检出胆结石或胆囊炎，60例（1.99%）自报检出贫血。49.13%的已被诊断为高血压的老年人在年度体检中的血压值异常，高血压老年人的血压控制率为50.87%；糖尿病老年人在体检中血糖异常率为60.48%，糖尿病老年人的血糖控制率为39.52%。多因素Logistic回归分析结果显示，糖尿病老年人血压异常检出率是一般老年人的2.57倍〔95%CI（2.01，3.29）〕，高血压、糖尿病老年人血脂异常检出率分别是一般老年人的1.64倍〔95%CI（1.29，2.08）〕、1.42倍〔95%CI（1.10，1.84）〕，高血压、糖尿病老年人超重肥胖检出率分别是一般老年人的2.79倍〔95%CI（1.94，4.00）〕、2.64倍〔95%CI（1.80，3.87）〕，高血压老年人脂肪肝检出率分别是一般老年人的2.10倍〔95%CI（1.55，2.85）〕，而高血压、糖尿病老年人贫血检出率则是一般老年人的0.25倍〔95%CI（0.13，0.47）〕、0.47倍〔95%CI（0.25，0.86）〕；农村老年人的血脂异常、胆结石或胆囊炎检出率分别是城市老年人的0.76倍〔95%CI（0.64，0.90）〕、1.32倍〔95%CI（1.01，1.73）〕（P<0.05）。结论基本公共卫生服务的老年人体检项目对老年人早发现、早知晓健康问题具有重要的作用。

关键词: 老年人, 老年人身心健康评价, 体格检查, 国家基本公共卫生服务, 健康促进

Abstract:

Background

The contribution of geriatric health examination services of national essential public health services to the detection of abnormal health conditions in the elderly and the awareness of examination results of the elderly has been rarely reported in the current studies.

Objective

To investigate the abnormal detection of several common diseases including abnormal blood pressure, abnormal blood glucose, overweight and obesity, anemia, fatty liver disease, gallstones or cholecystitis in the health examination of the older adults aged 65 years and above.

Methods

The older adults aged 65 years and above who visited 20 primary care institutions in 5 cities of 3 provinces in eastern, central and western China were selected as study subjects (excluding those with unclear health examination results in this year) from November to December 2019 by using a multi-stage stratified sampling method, and divided into the general older adults (without hypertension or diabetes), older adults with hypertension, older adults with diabetes. A one-on-one questionnaire survey was conducted on all respondents (The questionnaire included the general demographic characteristics of the respondents and the abnormal detection in the health examination of the elderly) .

Results

Among 3 018 older adults, 2 033 (67.36%) reported abnormalities in the health examination. There were statistically significant differences in the abnormal detection rates of health examination for the older adults with different types of residence, population, and household registration (P<0.05). Among 3 018 older adults, 1 174 (38.90%) self-reported abnormal blood pressure detection, 747 (24.75%) self-reported abnormal blood glucose detection, 719 (23.82%) self-reported dyslipidemia detection, 445 (14.74%) self-reported fatty liver detection, 393 (13.02%) reported overweight and obesity detection, 238 (7.89%) reported gallstones or cholecystitis detection, and 60 (1.99%) reported anemia detection. Abnormal blood pressure was detected in 49.13% of the older adults diagnosed with hypertension during the annual health examination, with the blood pressure control rate of 50.87%. Abnormal blood glucose was detected in 60.48% of the older adults diagnosed with diabetes during health examination with the control rate of blood glucose of 39.52%. Multivariate Logistic regression analysis showed that the detection rate of abnormal blood pressure was 2.57 times〔95%CI (2.01, 3.29) 〕 higher in the older adults with diabetes than in the general older adults; the detection rate of dyslipidemia was 1.64 times〔95%CI (1.29, 2.08) 〕 and 1.42 times〔95%CI (1.10, 1.84) 〕 higher in the older adults with hypertension and diabetes than in the general older adults, respectively; the detection rate of overweight and obesity was 2.79 times〔95%CI (1.94, 4.00) 〕 and 2.64 times〔95%CI (1.80, 3.87) 〕 higher in the older adults with hypertension and diabetes than in the general older adults, respectively; the detection rate of fatty liver was 2.10 times〔95%CI (1.55, 2.85) 〕 higher in the the older adults with hypertension than the general older adults; while the detection rate of anemia was 0.25 times〔95%CI (0.13, 0.47) 〕 and 0.47 times〔95%CI (0.25, 0.86) 〕 higher in the older adults with hypertension and diabetes than in the general older adults; the detection rate of dyslipidemia, gallstones or cholecystitis was 0.76〔95%CI (0.64, 0.90) 〕and 1.32〔95%CI (1.01, 1.73) 〕 times higher in the rural older adults than the urban older adults, respectively (P<0.05) .

Conclusion

The physical examination program for the elderly in the national essential public health services plays an important role in early detection and wareness of health problems.

Key words: Aged, Geriatric assessment, Physical examination, National essential public health services, Health promotion