| Objective:Obesity has been an increasingly serious global health problem,which is becoming more and more serious in China.A large number of epidemiological studies in the past have shown that obesity is closely related to a variety of metabolic diseases,cardiovascular and cerebrovascular diseases,as well as the risk of cancer and the increase of mental diseases.There are obvious contrasts in the dietary characteristics and living habits of different ethnic groups in Tacheng Prefecture,Xinjiang,a multi-ethnic gather area.It is essential to understand the obesity epidemic trends of different regional characteristics and the distribution characteristics of obesity epidemics in different subgroups of populations in the same area,in order to formulate corresponding health policies and interventions for the health management of different groups of people,contributing to improving the health of the local population.Through literature search,there are few studies on the phenomenon of overweight and obesity among the population in this area,and the sample size is small,lacking systematic and comprehensive epidemiological research and longitudinal trend analysis about obesity and cardiovascular metabolic indicators of populations in Tacheng Prefecture,Xinjiang.This study intends to systematically describe the epidemiological status and five-year trend about local adult obesity and cardiovascular metabolic indexes,such as blood pressure,blood sugar,and blood lipids by taking full advantage of the data of national health checkups in Tacheng Prefecture,Xinjiang,contributing to further analyzing the relationship between obesity and hypertension,diabetes and hyperlipidemia.It provides strong data support for the local government to accurately formulate the prevention and control strategies for chronic diseases such as overweight,obesity as well as cardiovascular and cerebrovascular diseases,to efficiently use limited health resources,and further to reduce the burden of cardiovascular diseases,which plays a vital role in effectively improving the health management level of local residents and implementing the strategy"Healthy China".Methods:This study was based on collection and in-depth analysis of population in Tacheng Prefecture,Xinjiang from 2016 to 2020.Firstly,it analyzed the data of the national medical examination population in 2020,using the data of 429,906 people who took free physical examination in 2020 and met the inclusion and exclusion criteria as the data source.The inclusion criteria included:1)Complete data on demographic characteristics such as gender,age,ethnicity,etc.;2)Complete data on height and weight;3)Age?18 years old;exclude malignant tumors and incomplete related data.Then,explore the five-year longitudinal trend about adult obesity and cardiovascular metabolic indicators in Tacheng Prefecture,Xinjiang from 2016 to 2020.This longitudinal physical examination cohort used the data of adult who had took the physical examination for five consecutive years as the analysis data source(the effective sample size was as follows:281029 people in 2016;607876 people in 2017;531446 people in 2018;508042 people in 2019;440749 people in 2020),the inclusion criteria included:1)complete data on demographic variables such as gender,age,ethnicity;2)complete data on height and weight;3)age?18 years old;4)complete participation of 5 national health check-ups in2016-2020;exclude malignant tumors and incomplete related data.The variables collected include continuous variables(age,BMI,SBP,DBP,total cholesterol and triglycerides)and classification variables(gender,ethnicity,obesity,high blood pressure,high total cholesterol and triglycerides).All relevant variable descriptions were standardized directly based on the population data composition of the entire population in Tacheng Prefecture,Xinjiang.Group description was mainly based on different gender(male/female),age(18-29 years old,30-44 years old,45-64 years old,?65 years old)and ethnicity(Han,Kazakh,Hui,Mongolian,Uyghur ,Dongxiang,Dahaner and other ethnic groups);the criteria for main metabolic indexes were as follows:obesity(BMI?28.0 kg/m~2),hypertension(average SBP?140mm Hg,and/or DBP?90mm Hg),diabetes(fasting blood glucose)?7.0 mmol/L),high total cholesterol(?5.2mmol/L),high triglycerides(?1.7mmol/L).In the longitudinal trend study,in order to analyze the relationship between weight change and cardiovascular metabolic indicators,we defined the population as 4 groups(group 1:normal in 2016 and normal in2020;group 2:obese in 2016 and normal in 2020;group 3:normal in 2016 and obese in2020;group 4:obese in 2016 and obese in 2020).Statistical continuous variables used the mean±standard deviation or median and interquartile range to describe while classification variables used frequency and percentage.The continuous variables of different groups used independent two-sample t-test or single factor analysis of variance while the comparison of prevalence between different groups used?~2 test;Use multiple unconditional logistic regression to analyze respectively whether obesity was the independent influencing factor of hypertension,diabetes,high total cholesterol and high triglycerides which was expressed by odds ratio(OR)and 95%confidence interval(CI)and included adjustment of possible confounding factors such as gender,age,ethnicity,etc.The five-year trend analysis will take BMI(obesity)and cardiovascular metabolic indicators as dependent variables,and the survey year as independent variables to perform Joinpoint regression analysis to calculate the average annual percent change(APC)(95%CI),and the comparison between APCs of different groups used Fisher Permutation Test(Permutation Test).All data were analyzed and sorted by SPSS 23.0(IBM Corp,Armonk,NY,USA).When P<0.05,it was considered statistically significant.Results:The results of this study show that the average BMI of adults in Tacheng Prefecture,Xinjiang in 2020 was 25.4±4.9kg/m~2 and the crude prevalence rate of obesity was 23.2%(standardized prevalence rate was 24.8%).The average SBP was127.4±17.1mm Hg;the average DBP was 78.8±10.7mm Hg,and the crude prevalence rate of hypertension was 28.5%(standardized prevalence rate was 28.7%);the average fasting blood glucose was 5.47±1.57mmol/L,and the crude prevalence of diabetes was8.7%(standardized prevalence rate was 8.7%).In addition,the average level of total cholesterol was 4.59±1.16 mmol/L and the high total cholesterol level was 27.4%(standardized prevalence was 28.6%);the average level of triglycerides is 1.45±1.11mmol/L and the high triglycerides level was 24.2%(standardized prevalence rate was25.1%).What's more,the abnormal rate of obesity and cardiovascular metabolic indicators differs among the various ethnic groups is as follows:1)the prevalence of obesity was the highest in Uyghur and the lowest in Han;2)the prevalence of hypertension was the highest in Dahaner (41.0%)and the lowest in Hui(22.3%)with a difference of more than 1.8 times;3)The prevalence of diabetes was higher in Han,Uyghur and Dahaner (>10%),while the Kazakh was the lowest(4.6%);4)The prevalence of high total cholesterol was higher in Uyghur (34.5%)and Dahaner (36.8%),while the lowest was in Hui(22.3%);5)The prevalence of high triglycerides was higher in the Han,Uyghur and Dahaner (>30%),while Kazakh was lowest group(15.3%).The prevalence of hypertension in the group<45,45-64,and?65 were 10.9%,37.9%,and 64.7%respectively.Hypertension increased significantly with age,having sudden increase after 45 years old,significantly higher than the group under 45 years old(P<0.001).Multivariate Logic regression analysis showed that after adjusting for sex,ethnicity and age,the risk of hypertension of obese people(OR=2.446,95%CI=2.404-2.487),diabetes(OR=1.872,95%CI=1.828-1.917),and high total cholesterol(OR=1.280,95%CI=1.258-1.302)was significantly higher than that of the normal population(all P<0.001).In the five-year trend analysis from 2016 to 2020,the prevalence of BMI and obesity of the population in Tacheng Prefecture,Xinjiang had increased year by year.BMI had increased from 25.0 kg/m~2 in 2016 by 25.6 kg/m~2 with an average annual increase of 0.12 kg/m~2.The APC was 0.7%(95%CI:0.3-1.1%).The average blood sugar level had increased from 5.19mmol/L in 2016 to 5.48mmol/L in 2020,and the APC was1.6%(0.7-2.5%).The prevalence of diabetes has increased from 5.4%in 2016 to 9.4%in2020,and the APC was 14.9%(7.2-23.2%),with relatively fast increase speed.The prevalence of obesity had risen from 20.7%in 2016 to 25.1%in 2020,and the APC is5.5%(2.8-8.2%).The prevalence of high triglycerides had increased from 22.7%in 2016to 24.6%in 2020 with an increase level in general while the Joinpoint regression analysis was not statistically significant(P=0.198).It was not obvious about the longitudinal trend of the average blood pressure and the prevalence of hypertension in 2016-2020.The prevalence of hypertension had increased from 30.4%in 2016 to 30.6%in 2020.In the study of the distribution of metabolic diseases in different weight subgroups,we found that individuals who were normal in 2016 and normal in 2020 had an APC of 0.2%(95%CI:0.1-0.4%)for systolic blood pressure,an APC of 1.4%(95%CI:0.4-2.4%)for fasting blood glucose and an APC of 13.4%(95%CI:5.7-21.6%)for diabetes in the past five years;that individuals who were obese in 2016 but normal in 2020 had an APC of-0.6%for systolic blood pressure,an APC of-3.0%for hypertension and an APC of-11.6%for high total cholesterol prevalence as well as an APC of-6.3%for triglycerides.Conclusion:1.The prevalence of adult obesity in Tacheng Prefecture,Xinjiang is high.There are significant differences in obesity and abnormal rates of cardiovascular metabolic indicators of different ethnic groups.2.There are differences in obesity and abnormal rates of cardiovascular metabolic indicators of different ethnic groups in different ages and genders among different ethnic groups and the prevalence of hypertension after the age of 45 has increased sharply.3.Obesity is closely related to hypertension,diabetes and dyslipidemia,which can increase the risk of cardiovascular disease.4.The prevalence of obesity,diabetes,and hyperlipidemia in the Tacheng Prefecture,Xinjiang showed an overall upward trend from 2016 to 2020 while hypertension showed the stable five-year trend of the prevalence.5.The five-year prevalence trend of obesity and cardiovascular metabolism indicators vary in different genders,age groups and ethnic groups in Tacheng Prefecture,Xinjiang,which reminds us that we need to formulate public health management policies for the different populations.6.It is possible to lose weight,conductive to reduce the occurrence of cardiovascular metabolic indicators.We should strengthen the health management and education of high-risk groups,intervene early to control the trend of weight gain,and restore obesity to normal weight which will effectively reduce the occurrence of chronic diseases and disease burden,and reduce long-term health resource consumption. |
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