Associations between age, cohort, and urbanization with systolic and diastolic blood pressure in China: a population-based study across 18 years-猫眼课题宝

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2015

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作者：

Samantha M. Attard;A. Herring;Bing Zhang;Du Shufa;B. Popkin;P. Gordon-Larsen

目的——人们对大规模的环境变化（例如城市化带来的变化）是否与收缩压和舒张压有不同的相关性，以及这些变化是否因出生队列而异，知之甚少。方法——我们使用了中国健康与营养调查的数据，这是一项针对中国成年人（n=18,976；年龄 18-70 岁）的人群队列研究，在 1991 年至 2009 年期间最多观察到 7 次。我们使用分层多变量线性模型来同时估计收缩压和舒张压作为随时间变化的相关结果，解释它们的生理学、时变相关性。主要暴露变量是城市化程度、年龄和出生队列。经过 18 年的现代化改造，中位收缩压和舒张压分别增加了 10 毫米汞柱和 7 毫米汞柱。结果——我们的分层模型结果表明，与较高城市化程度相比，较低城市化程度下收缩压、尤其是舒张压在时间上增加幅度更大。在相同年龄下，对于 10 年差异的出生队列（即 1980 年代与 1970 年代出生），较晚出生队列的调整后平均舒张压高出约 3mm Hg (p<0.001)。与高城市化相比，低城市化的脉搏压（计算为模型预测的收缩压减去舒张压）也更高。结论——这些结果表明舒张压（以及外周血管阻力）对环境变化的敏感性增加，特别是在中国年轻人中。由于舒张压更能预测年轻时的心血管疾病风险，因此中国高血压相关的健康负担可能会随着时间的推移而增加。城市化的决定因素使用一个尺度来捕捉随着时间的推移而发生的变化，改善城乡二分法

Objective— Little is known about whether large-scale environmental changes, such as those seen with urbanization, are differentially associated with systolic versus diastolic blood pressure, and whether those changes vary by birth cohort. Methods— We used data from the China Health and Nutrition Survey, a population-based cohort study of Chinese adults (n=18,976; ages 18–70y) seen a maximum of 7 times over 1991–2009. We used hierarchical multivariable linear models to simultaneously estimate systolic and diastolic blood pressure as correlated outcomes over time, accounting for their physiologic, time-varying correlation. Main exposure variables were urbanicity, age, and birth cohort. Over 18 years of modernization, median systolic and diastolic blood pressure increased by 10 and 7 mm Hg, respectively. Results— Our hierarchical model results suggest greater temporal increases in systolic and particularly diastolic blood pressure at lower versus higher urbanicity. At the same chronological age, for a 10-year difference in birth cohort (i.e., born in 1980s versus 1970s) the adjusted mean diastolic blood pressure was ~3mm Hg higher for the later birth cohort (p<0.001). Pulse pressure (calculated as model-predicted systolic minus diastolic blood pressure) was also higher at low versus high urbanicity. Conclusions— These results suggest increased susceptibility of diastolic blood pressure (and thus peripheral vascular resistance) to environmental change, particularly in younger Chinese adults. Because diastolic blood pressure more strongly predicts cardiovascular disease risk in younger adulthood, hypertension-related health burden in China may increase over time. determinants urbanization using a scale that captures changes across and and health over time, improving upon urban-rural dichotomous

Associations between age, cohort, and urbanization with systolic and diastolic blood pressure in China: a population-based study across 18 years

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