| Objective The aim of this study is to understand the basic characteristics of hypertensive and diabetic patients and their control status aged 60 years and older living in Zhejiang Province through a longitudinal study of hypertension and diabetes,based on which health ecology models were combined to analyze the influencing factors associated with the control of hypertension and diabetes,and this study will also investigate the mediating role of lifestyle between the factors of the health ecology model and the control of hypertension and diabetes mellitus,in order to provide a scientific and theoretical basis for improving the control level of hypertension and diabetes mellitus patients.Methods In this study,an observational research design was adopted.15752 elderly patients with hypertension and diabetes aged 60 years and above from 21 counties(cities and districts)in Zhejiang Province were selected as the research subjects.In 2020 and 2021,demographic information,major chronic disease history and diagnosis and treatment,behavior and lifestyle,physical measurement indicators,and laboratory test indicators of the research subjects were collected through questionnaires,physical examinations,and laboratory tests.Based on the health ecology model,this paper explores the influencing factors of hypertension and diabetes control among the elderly in Zhejiang Province.The database was established using EpiData 3.1 software,and data were double entered.Statistical analysis of data using R3.5.1 and SAS 9.4 software.Measurement data that conformed to normal distribution were expressed by X±S,and comparisons between groups were tested by t test;Measurements that did not follow a normal distribution were expressed by M(P25,P75),and comparisons between groups were performed by the rank sum test;The count data were expressed as frequent(percentage),and comparisons between groups were performed using the χ2 test,and the influencing factors of hypertension and diabetes control were analyzed using multivariate logistic regression analysis,and differences with P<0.05 were considered statistically significant,and mediating effect method was used to assess the mediating effect between lifestyle on the factors of health ecology model and the control of hypertension and diabetes.Results A total of 11644 hypertensive and diabetic patients 60 years old and above were included in the study.(1)There were 4632(45.7%)hypertensive patients with good blood pressure control in 2020,and a total of 5070(50.0%)hypertensive patients had good blood pressure control in 2021,and a total of 3117(30.8%)hypertensive patients had good blood pressure control in 2020 and 2021.There were 2174(51.4%)patients with diabetes had good glycemic control in 2020,and a total of 2203(52.1%)patients with diabetes had good glycemic control in 2021,and a total of 1628(38.5%)patients with diabetes had good glycemic control in 2020 and 2021.(2)Analysis of influencing factors of hypertension and diabetes control:Age≥70 years(OR=1.237,P<0.001),other ethnic groups(OR=1.901,P=0.005),high BMI level(OR=1.031,P<0.001),long duration of hypertension(OR=1.149,P<0.001),residing in counties(OR=1.183,P=0.016),and not receiving follow-up management of hypertension(OR=1.741,P=0.013)were the risk factors for good blood pressure control in elderly hypertension patients.In contrast,high education level(OR=0.834,P<0.001),retirees,as well as managers/professional technicians from government agencies,enterprises,and institutions(OR=0.733,P=0.004;OR=0.302,P=0.031)and high satisfaction with local medical services(OR=0.747,P<0.001)were the protective factors for good blood pressure control in elderly hypertension patients.High BMI level(OR=1.034,P=0.003),no hypertension(OR=1.264,P=0.003)and long duration of diabetes(OR=1.543,P<0.001)were the risk factors for good glycemic control in elderly diabetes patients.In contrast,age≥70 years(OR=0.806,P=0.010),normal diabetes foot and skin examination(OR=0.620,P=0.031),high education level(OR=0.785,P<0.001),unemployed or unemployed/domestic workers(OR=0.650,P<0.001)were the protective factors for good glycemic control in elderly diabetes patients.(3)Mediating effect analysis:There was a mediating effects of lifestyle among hypertensive patients between gender,ethnicity,duration of hypertension,residence,marital status,education,type of occupation,and blood pressure control(all P<0.05).There was a mediating effect of lifestyle among diabetic patients between marital status,educational level and glycemic control(all P<0.05).Conclusion The control rate of elderly patients with hypertension and diabetes in Zhejiang Province needs to be improved,and the control level is affected by many factors.Lifestyle was found to mediate the association between certain factors in the health ecology model and the control of hypertension and diabetes.It is suggested that the elderly should be helped to abandon their unhealthy lifestyle behaviors and cultivate a healthy life style so as to improve the control level of hypertension and diabetes. |
PDF Full Text Request