Tsai Alan Chung-Hong, Liou Jenn-Chang, Chang Ming-Cheng
Human Nutrition Program, Dept. of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA.
Asia Pac J Clin Nutr. 2007;16(2):338-45.
The aim of the study was to assess the association of socioeconomic, anthropometric and lifestyle factors with self-reported hypertension in older adults in Taiwan. The data were part of the "1999 Survey of Health and Living Status of the Elderly in Taiwan". The survey was conducted in-home, face-to-face, by interviews of 4440 men and women, 53 years or older, in a population-based cross-sectional study. The prevalence of self-reported hypertension was 31.1% for men and 38.0% for women. A logistic regression model showed a higher probability of self-reported hypertension for female gender, older age, and greater BMI, and lower probability for increased consumption of leguminous foods. No association was observed with cigarette smoking, alcohol consumption or physical activity. Current cigarette smokers and alcohol-drinkers underreported their hypertension status. Compared to the medically measured hypertension of a sub-sample study of the same cohort, only about 60% of medically-substantiated hypertensive patients self-reported their hypertensive status, indicating that the interview survey underestimated the prevalence of hypertension in this Taiwanese elderly population. The interview survey appears to identify associations of hypertension with age, gender, BMI and some food patterns, but does not recognize the likely associations with the candidate risk factors of physical inactivity, cigarette smoking, alcohol consumption and limited education, at least in this Taiwanese population. Thus caution must be applied where interview alone categorises individual older Taiwanese as hypertensive or not. A survey which has validation or cross-checking questions about the medical diagnosis of hypertension and the likelihood of its memory and appreciation by the patient (such as method, definition, communication with patient, recall and follow-up, lifestyle advice or pharmaco-therapy, presence of cognitive impairment) may clarify the significance of the discrepancy between self-reporting and medical record. In turn, this would allow a more robust evaluation of blood pressure determinants in such populations. Nevertheless, there is a role for community-based surveys that utilise self-reporting in the identification, prioritization and surveillance of putative contributors to hypertension; this is the case where, as in the Taiwanese elderly, it assumes major importance in the burden of disease and premature mortality.
本研究的目的是评估台湾老年人社会经济、人体测量和生活方式因素与自我报告的高血压之间的关联。这些数据是“1999年台湾老年人健康与生活状况调查”的一部分。该调查是在一项基于人群的横断面研究中，通过对4440名53岁及以上的男性和女性进行上门面对面访谈进行的。自我报告的高血压患病率男性为31.1%，女性为38.0%。逻辑回归模型显示，女性、年龄较大和体重指数较高者自我报告高血压的可能性较高，而豆类食物摄入量增加者可能性较低。未观察到与吸烟、饮酒或身体活动有关联。目前的吸烟者和饮酒者少报了他们的高血压状况。与同一队列的子样本研究中通过医学测量的高血压相比，只有约60%经医学证实的高血压患者自我报告了他们的高血压状况，这表明访谈调查低估了台湾老年人群中高血压的患病率。访谈调查似乎确定了高血压与年龄、性别、体重指数和一些食物模式之间的关联，但至少在台湾人群中，未认识到与身体活动不足、吸烟、饮酒和教育程度有限等候选风险因素可能存在的关联。因此，在仅通过访谈将台湾老年个体分类为是否患有高血压时必须谨慎。一项对高血压的医学诊断以及患者对其记忆和认知可能性（如方法、定义、与患者的沟通、回忆和随访、生活方式建议或药物治疗、是否存在认知障碍）有验证或交叉检查问题的调查，可能会阐明自我报告与病历之间差异的意义。反过来，这将允许对这类人群中的血压决定因素进行更有力的评估。尽管如此，在高血压潜在影响因素的识别、排序和监测中利用自我报告的社区调查仍有作用；就像在台湾老年人中一样，在疾病负担和过早死亡方面它具有重要意义。
