糖尿病前期老年人社会因素与心血管疾病风险因素的纵向关系：健康与退休研究（2006 - 2016年）
Longitudinal relationship between social and CVD risk factors in older adults with prediabetes: the HRS 2006-2016.
作者信息
Ekwunife Obinna, Xu Yilin, Fraser Raphael, Campbell Jennifer, Walker Rebekah J, Jacobs David, Egede Leonard E
机构信息
Division of Population Health, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, NY 14203, USA.
Division of Outcomes and Practice Advancement, Department of Pharmacy Practice, School of Pharmacy, University at Buffalo, Buffalo, NY 14214, USA.
出版信息
Aging (Albany NY). 2025 Aug 26;17(8):2152-2166. doi: 10.18632/aging.206308.
BACKGROUND
This study examines how multiple social risk factors influence cardiovascular disease (CVD) risk control over time in older adults with prediabetes using a nationally representative cohort.
METHODS
Data from the Health and Retirement Study (HRS) included 5,086 U.S. adults aged 50+ with prediabetes. Five social risk domains (economic stability, environment, education, healthcare, and social context) were examined as independent variables, while CVD risk factors included glycemic control (HbA1c), systolic blood pressure (SBP), and cholesterol ratio (total cholesterol/high-density lipoprotein). Mixed-effects models assessed relationships between social risk factors and CVD outcomes, adjusting for age, gender, race, and marital status.
RESULTS
The sample had an average age of 68.6 years, with 60.2% female, and 70.97% identifying as non-Hispanic Black. Average HbA1c was 5.7, SBP 129.4, and cholesterol ratio 3.85. Limited education was consistently associated with increased CVD risk-HbA1c (β = 0.03, 95% CI: 0.01-0.06, p < 0.001), SBP (β = 4.34, 95% CI: 2.96-5.71, p < 0.001), and cholesterol ratio (β = 0.08, 95% CI: 0.01-0.16, p < 0.05) -in the fully adjusted model. Medication cost-related non-adherence was significantly associated with higher HbA1c levels (β = 0.03, 95% CI: 0.002-0.06, p < 0.05). Difficulty paying bills and lack of health insurance were both significantly associated with higher cholesterol levels (β = 0.03, 95% CI: 0.002-0.06, p < 0.05) and (β = 0.22, 95% CI: 0.15-0.30, p < 0.001), respectively.
CONCLUSIONS
Social risk factors, particularly limited education, significantly impact CVD risk in older adults with prediabetes.
背景
本研究使用全国代表性队列，考察了多种社会风险因素如何随时间影响患有糖尿病前期的老年人的心血管疾病（CVD）风险控制情况。
方法
健康与退休研究（HRS）的数据包括5086名年龄在50岁及以上的患有糖尿病前期的美国成年人。五个社会风险领域（经济稳定性、环境、教育、医疗保健和社会环境）作为自变量进行考察，而心血管疾病风险因素包括血糖控制（糖化血红蛋白）、收缩压（SBP）和胆固醇比率（总胆固醇/高密度脂蛋白）。混合效应模型评估了社会风险因素与心血管疾病结果之间的关系，并对年龄、性别、种族和婚姻状况进行了调整。
结果
样本的平均年龄为68.6岁，女性占60.2%，70.97%的人认定为非西班牙裔黑人。平均糖化血红蛋白为5.7，收缩压为129.4，胆固醇比率为3.85。在完全调整模型中，受教育程度有限始终与心血管疾病风险增加相关——糖化血红蛋白（β = 0.03，95%置信区间：0.01 - 0.06，p < 0.001）、收缩压（β = 4.34，95%置信区间：2.96 - 5.71，p < 0.001）和胆固醇比率（β = 0.08, 95%置信区间：0.01 - 0.16，p < 0.05）。与药物成本相关的不依从与较高的糖化血红蛋白水平显著相关（β = 0.03，95%置信区间：0.002 - 0.06，p < 0.05）。支付账单困难和缺乏医疗保险分别与较高的胆固醇水平显著相关（β = 0.03，95%置信区间：0.002 - 0.06，p < 0.05）和（β = 0.22，95%置信区间：0.15 - 0.30，p < 0.001）。
结论
社会风险因素，尤其是受教育程度有限，对患有糖尿病前期的老年人的心血管疾病风险有显著影响。
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