Carss-sectional Study On Chronic Disease And Risk Factors Among Adult Residents In Jilin Province

Chronic disease is the general term for the diseases with complex etiology, insidiousonset, long duration and generally slow progression and for which complete remission is notpossible. The main types of chronic diseases are cardiovascular disease (such as heartattacks and stroke), cancers, diabetes, chronic obstructed pulmonary disease, chronicdigestive diseases and mental disorders. In China with rapid urbanization and aging of thepopulation, the morbidity and mortality from chronic diseases are increasing steadily. JilinProvince is situated in the northeastern China. Prior to the2012survey there has been nocomprehensive survey on the prevalence of chronic disease in Jilin Province.ObjectiveTo examine the prevalence of a wide spectrum of chronic diseases and associatedrelated risk factors in Jilin Province. To explore the risk factors associated with a widespectrum of chronic diseases. The results of this study will produce scientific evidence tosupport strategies and policies for the prevention and control of chronic disease, and a morerational allocation of health resources.MethodsThe Jilin Provincial Chronic Disease Survey was a face-to-face health interview andphysical examination survey conducted from June2012to August2012among arepresentative sample of individuals aged18to79years. A multistage stratified clustersampling was used. The final target sample size was established at23050. A detailedstructured interview was used to collect information on demographic characteristics,chronic disease related behavioral factors, diagnosed chronic disease history in the past12months, family history of chronic diseases, and general mental health. A companionphysical examination which measured blood pressure, blood glucose, blood lipids, height,weight, and waist circumference was also conducted at field survey sites throughout theprovince. The complex sampling design of the survey necessitated post-stratification adjustment involving sample weights to make the completed sample more representative ofthe provincial population. The adjustment was made according to the gender, age groupsand place of residence (rural or urban) distribution of the provincial population found in thecensus of the adult population of Jilin Province2010. Prevalence rates were used todescribe the distribution of chronic diseases and related risk factors. The prevalence rates ofchronic diseases were described in terms of system and disease categories. Geographic heatmaps were used to describe the distribution of highly prevalent chronic diseases amongdifferent regions of the province. The prevalence of multimorbidity among chronic diseaseswas also examined. To explore the differences in results arising form using complex sampleweights and not doing so, two logistic regression models (one using a weighted sample, theother a non-weighted sample) were used for analyzing the association between risk factorsand hypertension, diabetes and dyslipidemia, respectively. After identifying the advantageof using weighted data, the associations between related risk factors and ischemic heartdisease, cerebrovascular diseases, arthritis, intervertebral disk disease, chronicgastroenteritis/peptic ulcer, cholecystitis/gallstones, and chronic obstructed pulmonarydisease were then explored. Logistic regression and association rule analysis (apriorialgorithm) were also used.to explore the patterns of co-and multi-morbidity.All the analyses were designed to provide evidentiary support for the development ofstrategies for the prevention and control of chronic diseases.Results1. The overall prevalence rate of self-reported chronic diseases was51.6%in adultresidents aged18~79years in Jilin Province. The top8self-reported prevalent systemicchronic diseases were diseases of the circulatory system (23.5%), diseases of the digestivesystem (19.1%), diseases of the musculoskeletal system and connective tissue (18.1%),diseases of the genitourinary system (12.3%), endocrine, nutritional and metabolic diseases(7.6%), diseases of respiratory system (5.9%), diseases of the blood and hematologicalsystem and immune system (4.6%), and diseases of the eye and adnexa (2.1%). The top10most prevalent self-reported chronic diseases were hypertension (13.3%), chronicgastroenteritis/peptic ulcer (11.4%), intervertebral disk disease (11.4%), ischemic heartdisease (7.7%), arthritis (7.0%), cholecystitis/gallstones (6.9%), cerebrovascular disease (5.2%), diabetes (5.0%), chronic obstructive pulmonary disease (3.1%), and anaemia (3.0%).Biological measurement from the companion physical examination revealed much higherprevalence rates in hypertension, diabetes and dyslipidemia at30.5%,8.2%and37.4%,respectively. Disparity in the prevalence of chronic diseases existed among different regions,between male and female, and among different age groups. The population prevalence ofmultimorbidity was estimated as42.9%.2. The prevalence rates of current cigarette smoking and former cigarette smokingwere estimated as31.8%and7.3%, respectively. The prevalence of drinking and frequentdrinking (3days per week) were33.8%and15.6%, respectively. The prevalence rates ofirregular diets (22.4%), skipping breakfast (20.3%), excessive salt intake (38.2%),inadequate intake of fruit and vegetables (49.6%), inadequate intake of egg and beanproducts (9.1%), and inadequate intake of milk products (56.9%) were also estimated byage, gender and place of residence. The prevalence rates of overweight, obesity and centralobesity were32.3%,14.6%and44.0%, respectively. The prevalence of high risk, mediumrisk and low risk of mental disorders were23.8%,53.0%and23.1%, respectively.3. Comparing the results of the logistic regression models using weighted data, andnon-weighted data showed the estimates of the standard errors of the coefficient increased,and the estimated effect was more conservative in non-weighted data analysis.4. The risk factors individually associated with hypertension include older age (18~44years as reference,45~59years OR=3.087,60~79years OR=6.440, both P<0.001), male(OR=1.414, P<0.001), married (OR=1.244, P=0.048), divorced or widowed (OR=1.449,P=0.006), lower education (primary school or below as reference, college and aboveOR=0.823, P=0.013), overweight (OR=1.510, P<0.001), obesity (OR=2.640, P<0.001),central obesity (OR=1.857, P<0.001), frequent alcohol drinking (OR=1.749, P<0.001),regular breakfast (regular breakfast as reference, no breakfast OR=0.860, P=0.012),inadequate intake of fruit or vegetables (OR=1.254, P<0.001), inadequate intake of milkproducts (OR=1.228, P<0.001), frequent exercises (frequent exercises as reference, seldomexercise (OR=0.806, never exercise OR=0.751, both P<0.001), and family history ofcirculatory system diseases (OR=1.535, P<0.001).The risk factors individually associated with diabetes include older age (18~44years as reference,45~59years OR=2.817,60~79years OR=3.204, both P<0.001), male (OR=1.627,P<0.001), married (OR=2.131, P=0.008), divorced or widowed (OR=2.131, P=0.013),lower education (primary school or below as reference, junior high school OR=0.724,P<0.001, senior high school OR=0.719, P=0.002, college and above OR=0.564, P<0.001),retirement (OR=1.444, P=0.003), overweight (OR=1.383, P<0.001), obesity (OR=1.518,P<0.001), central obesity (OR=1.835, P<0.001), inadequate intake of fruit or vegetables(OR=1.895, P<0.001), inadequate intake of milk products (OR=1.239, P<0.007),(frequentexercises as reference, seldom exercise OR=0.647, never exercise OR=0.513, both P<0.001),high risk of mental disorder (OR=1.227, P=0.007), and family history of diabetes(OR=2.981, P<0.001).The risk factors individually associated with ischemic heart disease include older age(18~44years as reference,45~59years OR=0.532,60~79years OR=14.589, both P<0.001),female (male OR=0.536, P<0.001), lower family income per head (<500yuan asreference,>3000yuan OR=0.636, P=0.003), overweight (OR=1.234, P=0.008), obesity(OR=1.499, P<0.001), central obesity (OR=1.377, P<0.001), current cigarette smoking(OR=1.471, P<0.001), inadequate intake of fruit or vegetables (OR=1.200, P=0.005),frequent exercises (frequent exercises as reference, seldom exercise OR=0.679, neverexercise OR=0.762, both P<0.001), high risk of mental disorder (OR=1.435, P<0.001), andfamily history of circulatory system diseases (OR=1.785, P<0.001).In addition to these three chronic diseases, this study also explored the risk factorsindividually associated with dyslipidemia, cerebrovascular disease, arthritis, intervertebraldisk disease, gastroenteritis/peptic ulcer, cholecystitis/gallstones, and chronic obstructedpulmonary disease.5. There were wide associations (co-and multi-morbidity) among chronic diseases.Strong associations were observed between: a) cerebrovascular disease and ischemic heartdisease; b) cerebrovascular disease and hypertension; c) diabetes and dyslipidemia; d)ischemic heart disease and hypertension; e) anemia and chronic gastroenteritis/peptic ulcer;f) cholecystitis/gallstones and chronic gastroenteritis/peptic ulcer; g) arthritis andintervertebral disk disease; h) diabetes and hypertension. Conclusion1. The overall prevalence of chronic diseases in Jilin Province is high. Hypertension,chronic gastroenteritis/peptic ulcer, intervertebral disk disease, ischemic heart disease,arthritis, cholecystitis/gallstones, cerebrovascular disease, diabetes and COPD were themost prevalent chronic diseases.2. Cigarette smoking, frequent alcohol drinking and lacking physical exercise, knownas risk factors for chronic diseases, were very prevalent in Jilin Province. Irregular diets,skipping breakfast, excessive salt intake, inadequate intake of fruit or vegetables andinadequate intake of milk products were significant unhealthy dietary behaviors presentedin Jilin Province.3. With complex sampling designs, weighted data should be used in the surveyanalyses.4. Chronic diseases were associated with a wide range of demographic characteristics,socio-economic factors, behavioral factors, family history of related chronic diseases, andmental health. Differences existed among their specific associations with specific chronicdiseases.5. Application of both the logistic regression model and association rule analysis toexplore the association between chronic diseases produced multi-dimensional informationto support the strategy of prevention of multimorbidity, which is prevalent in patients withchronic diseases.