Zhongguo quanke yixue (Jan 2024)
The 5-year Survival of Elderly Hypertension and Diabetes Patients Combined with Dyslipidemia
Abstract
Background With the aging of the Chinese population, the prevalence of chronic comorbidity among the elderly has been increasing by year. Hypertension, diabetes or hyperglycemia, and dyslipidemia are the most common patterns of chronic comorbidity among the elderly in China. However, the survival and influencing factors of this most common pattern of chronic comorbidity remain unclear. Objective To investigate 5-year survival of elderly hypertension and diabetes patients combined with dyslipidemia, and analyze the common risk factors. Methods Retrospective cohort analysis was used in this study. Elderly residents (≥60 years old) who underwent health examination in the West Campus of the Second Affiliated Hospital of Guangzhou Medical University in 2016 were selected as the study subjects, their relevant information was collected through the Resident Health Record Information System, Health Insurance Information Network, Resident Death Information Network, Resident Health Management Information Registry Platform and telephone interviews, mainly including baseline information such as demographic characteristics, disease-related conditions, medical records, as well as follow-up and death information. According to the survival of the study subjects, they were divided into survival and death groups; according to the presence of hypertension and diabetes, they were divided into no hypertension and diabetes group, hypertension group, diabetes group, hypertension combined with diabetes group; according to the presence of dyslipidemia, they were divided into normal dyslipidemia group, mixed hyperlipidemia group, hypertriglyceridemia group, hypercholesterolemia group, and simple lipoprotein disorder group; according to the presence of hypertension and diabetes mellitus and the presence or absence of combined dyslipidemia were categorized as normal group, hypertension and/or diabetes mellitus group, non-simple dyslipidemia group, non-simple dyslipidemia+hypertension and/or diabetes mellitus group, simple dyslipidemia group, and simple dyslipidemia+hypertension and/or diabetes mellitus group. Log-rank test was used to compare the difference in 5-year crude survival rate between different groups. Multivariate Cox proportional hazards regression analysis was used to explore the influencing factors of 5-year crude survival rate of elderly residents with hypertension and diabetes combined with dyslipidemia. Results A total of 3 463 elderly residents with complete data and clear diagnosis were collected, including 1 486 males (42.91%) and 1 977 females (57.09%), and a total of 287 (8.29%) died by the end of follow-up. There were significant differences in gender, physical exercise, prevalence of hypertension and diabetes, dyslipidemia, BMI, waist circumference, fasting blood glucose level, red blood cell count level, hemoglobin level, white blood cell count level, platelet level, serum alanine aminotransferase level, serum creatinine level, blood and urine nitrogen level between the survival group and death group (P<0.05). There was significant difference in 5-year crude survival rate of elderly physical examination residents among the no hypertension and diabetes group, hypertension group, diabetes group, and hypertension combined with diabetes group (χ2=15.730, P=0.001). There was statistically significant difference in 5-year crude survival rates among the normal blood lipid group, mixed hyperlipidemia group, hypertriglyceridemia group, hypercholesterolemia group and simple lipoprotein disorder group (χ2=29.290, P<0.001). In addition, there was significant difference in the 5-year crude survival rates among the normal group, hypertension and/or diabetes group, non-simple lipoprotein disorder group, non-simple lipoprotein disorder + hypertension and/or diabetes group, simple lipoprotein disorder group, simple lipoprotein disorder + hypertension and/or diabetes group (χ2=42.400, P<0.001). Multivariate Cox proportional hazards regression analysis showed that daily physical exercise, BMI, waist circumference, fasting blood glucose level, red blood cell count level, hemoglobin level, serum aspartate aminotransferase level and serum creatinine level were the influencing factors of 5-year crude survival rate of elderly residents with hypertension and diabetes combined with dyslipidemia (P<0.05) . Conclusion Compared with the general population, the 5-year crude survival rate of people with hypertension and diabetes combined with dyslipidemia is lower, especially those with lipoprotein disorders. At the same time, lifestyle, nutritional status, liver and kidney function also have a significant impact on the 5-year crude survival rate. In the management of chronic diseases such as hypertension, diabetes and dyslipidemia, it is necessary to pay attention to the improvement of lipoprotein level, nutritional status, liver and kidney function and lifestyle in addition to actively lowering blood pressure, blood glucose, cholesterol and triglyceride levels.
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