Spatial Distribution Characteristics And Influencing Factors Of Management Effect Of Hypertension And Diabetes In Community

Objective In order to understand the management effect of hypertension and diabetes mellitus in the community of Chengguan District of Lanzhou City.The spatial analysis model was used to analyze the related indicators of hypertension and diabetes management in community health service institutions.To explore the distribution law of health management rate,standardized management rate and control rate,and to analyze the influence of different geographical distribution on the control effect of hypertension and diabetes mellitus,so as to provide new ideas for the management of chronic diseases in urban areas.Methods Based on the data of public health service management platform in Lanzhou,taking 25 streets in Chengguan district of Lanzhou city as the basic research unit,relevant data of community health management of hypertension and diabetes since the end of 2018 were collected.According to the stratified sampling method,814 patients with hypertension and 471 patients with diabetes were selected,and a total of 1285 population samples were collected for questionnaire survey.Research content: The spatial distribution rules of the health management rate,standard management rate and control rate of hypertension and diabetes in Chengguan district of Lanzhou city were obtained by spatial global autocorrelation analysis and spatial local autocorrelation analysis;the influencing factors of community hypertension and diabetes control rate were explored and the weight of the factors was ranked.Data processing: Arc GIS 10.2 software was used to analyze the spatial effect of community hypertension and diabetes management in Chengguan District of Lanzhou City;Logistic regression was used to analyze the influencing factors;Classification and regression trees(CART)were used to weigh the controlling factors of hypertension and diabetes in Chengguan District of Lanzhou City.Results 1.The health management rates of hypertension and diabetes mellitus in Chengguan District of Lanzhou City were 52.91% and 51.96% respectively;the standardized management rates were 75.92% and 76.40% respectively;and the control rates were 24.72% and 39.25% respectively(Moran's I>0,Z>1.96,P<0.001).From the global spatial autocorrelation analysis,the spatial distribution of hypertension,diabetes mellitus health management rate,standardized management rate and control rate in Chengguan District of Lanzhou City has spatial aggregation,which is reflected in the large area of high-value aggregation in the downtown streets and the low-value aggregation in the peripheral streets.From the spatial autocorrelation analysis,adjacent to a few streets for the center with Jiu Quan street is high control rate of hypertension and diabetes,named hot spots(G*= 3,Z(Gi*)>2.58,P<0.05),while the area adjacent to Dong Gang street is the cold point area of the control rate of hypertension and diabetes(G*=-1,-1.96?Z(Gi*)<-1.64,P<0.05).2.The factors influencing the control rate of hypertension and diabetes mellitus among cold and hot spots are as follows: basic characteristics,disease prevalence,utilization of health services,lifestyle and physiological and biochemical data.Univariate analysis and multivariate logistic regression model showed that the minorities,older people,higher income,higher education level,more energy consumption in exercise,better medication adherence,light diet and quit smoking were protective factors for hypertension and diabetes control(OR<1,P<0.05),However,the long course of disease,failure to sign up for a family doctor,high BMI,elevated TG,elevated LDL,failure to regularly measure blood pressure and blood glucose,and not receiving dietary guidance were the risk factors for hypertension and diabetes(OR>1,P<0.05).3.According to the importance ranking of predictors of the model constructed by CART algorithm,medication compliance is the most important factor affecting the control rate of hypertension and diabetes,followed by exercise energy consumption,increased TG,increased LDL-C and other factors.Whether to accept dietary guidance is the least important factor affecting the control rate of hypertension and diabetes.Conclusion 1.The management effect of hypertension and diabetes in Chengguan district is poor and the control rate is low.2.The spatial distribution of hypertension and diabetes among community residents in Chengguan district of Lanzhou city is different in health management rate,standardized management rate and control rate,which is shown as that the urban center area is higher than the urban fringe area.3.The primary factor affecting the control rate of hypertension and diabetes is the patient's medication compliance.Elderly people,ethnic minorities,high education level and high family monthly income are protective factors affecting the control effect of hypertension and diabetes mellitus;with complications and long course of disease are risk factors affecting the control effect of hypertension and diabetes mellitus;poor drug compliance,salty diet,smoking and low energy consumption of exercise can increase the risk of uncontrolled blood sugar and blood pressure in patients with hypertension and diabetes mellitus.Suggestions: According to the weight of factors influencing the control rate of hypertension and diabetes mellitus,all regions should implement the management and evaluation system of hypertension and diabetes,and carry out the management of chronic diseases at different stages and levels.