عوامل خطر بيماري هاي قلبي عروقي با رويكرد آناليز چند سطحي در جمعيت كاركنان دانشگاه علوم پزشكي مشهد

Assessment of Cardiovascular Diseases Risk Factors in the Staff of Mashhad University of Medical Sciences Using on a Multilevel Analysis Approach

ﺑﯿﻤﺎريﻫﺎي ﻗﻠﺒﯽ ﻋﺮوﻗﯽ)CVD( ﻋﺎﻣﻞ ﺑﯿﺸﺘﺮﯾﻦ ﻣﺮگوﻣﯿﺮ در ﺟﻬﺎن اﺳﺖ و در ﺳﺎل 17/3ﻣﯿﻠﯿﻮن ﻧﻔﺮ در اﺛﺮ اﺑﺘﻼ ﺑﻪ اﯾﻦ ﺑﯿﻤﺎري ﺟﺎن ﺧﻮد را از دﺳﺖ ﻣﯽدﻫﻨﺪ ﮐﻪ ﺑﯿﺶ از 75% از اﯾﻦ ﻣﺮگﻫﺎ در ﮐﺸﻮرﻫﺎي ﮐﻢ و ﻣﺘﻮﺳﻂ درآﻣﺪ رخ ﻣﯽدﻫﺪ. ﮔﺮﭼﻪ ﻣﻄﺎﻟﻌﺎت ﮔﺴﺘﺮدهاي در ﺗﻌﯿﯿﻦ ﻋﻮاﻣﻞ ﺧﻄﺮ اﯾﻦ ﺑﯿﻤﺎريﻫﺎ ﺻﻮرت ﮔﺮﻓﺘﻪ اﻣﺎ ﻣﻄﺎﻟﻌﺎت ﻣﺤﺪودي ﺟﻬﺖ ﺑﺮرﺳﯽ اﯾﻦ ﻋﻮاﻣﻞ ﺑﺎ روش ﭼﻨﺪ ﺳﻄﺤﯽ ﺻﻮرت ﮔﺮﻓﺘﻪ اﺳﺖ. ﻫﺪف از اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﺗﻌﯿﯿﻦ ﻋﻮاﻣﻞ ﺧﻄﺮ ﺑﯿﻤﺎري ﻗﻠﺒﯽ ﻋﺮوﻗﯽ ﺑﺎ اﺳﺘﻔﺎده از روﯾﮑﺮد ﭼﻨﺪﺳﻄﺤﯽ و ﻣﻘﺎﯾﺴﻪ ﻋﻤﻠﮑﺮد رﮔﺮﺳﯿﻮن ﻟﺠﺴﺘﯿﮏ ﭼﻨﺪ ﺳﻄﺤﯽ و ﻣﻌﻤﻮﻟﯽ در ﺗﻌﯿﯿﻦ ﻋﻮاﻣﻞ ﺧﻄﺮ ﺑﯿﻤﺎري ﻗﻠﺒﯽ ﻋﺮوﻗﯽ در ﮐﺎرﮐﻨﺎن داﻧﺸﮕﺎه ﻋﻠﻮم ﭘﺰﺷﮑﯽ ﻣﺸﻬﺪ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﺳﺎﺧﺘﺎر ﺳﻠﺴﻠﻪ ﻣﺮاﺗﺒﯽ داده ﻫﺎ ﻣﯽ ﺑﺎﺷﺪ. روش ﮐﺎر: ﻣﻄﺎﻟﻌﻪ ﺣﺎﺿــﺮ ﺑﻪ ﺻــﻮرت ﻣﻮردي- ﺷــﺎﻫﺪي ﺑﺎ 1091ﻧﻤﻮﻧﻪ از ﻣﻄﺎﻟﻌﻪ ﻫﻤﮕﺮوﻫﯽ آﯾﻨﺪه ﻧﮕﺮ" PERSIAN cohort study in Mashhad University of Medical Sciences" در ﺳﺎل 1397 ﻃﺮاﺣﯽ ﺷﺪ. ﮔﺮوه ﻣﻮرد152 ﻧﻔﺮ از اﻓﺮاد ﻣﺒﺘﻼ ﺑﻪ ﺑﯿﻤﺎري ﻗﻠﺒﯽ ﻋﺮوﻗﯽ ﺑﺎ ﺗﺸــﺨﯿﺺ ﻗﻄﻌﯽ ﻣﯽ ﺑﺎﺷــﻨﺪ و 939 ﻧﻔﺮ از ﻣﯿﺎن ﮐﺎرﮐﻨﺎن، اﻓﺮادي ﮐﻪ ﺗﺎ آن زﻣﺎن ﻫﻢ ﭼﻨﺎن ﺑﻪ ﺑﯿﻤﺎري ﻗﻠﺒﯽ ﻋﺮوﻗﯽ دﭼﺎر ﻧﺸــﺪهاﻧﺪ ﺑﻪ ﻋﻨﻮان ﺷــﺎﻫﺪ )Control( وارد ﻣﻄﺎﻟﻌﻪ ﺷﺪه اﻧﺪ ﮐﻪ ﻫﺮ دو ﮔﺮوه ﺑﻪ ﺻﻮرت ﻧﻤﻮﻧﻪ ﮔﯿﺮي ﺗ ﺼﺎدﻓﯽ ﺳﺎده اﻧﺘﺨﺎب ﺷﺪه اﻧﺪ. ﺑﻌﺪ از ﺟﻤﻊآوري اﻃﻼﻋﺎت، دادهﻫﺎ وارد ﻧﺮماﻓﺰار Stata ﺷﺪ و ﻣﻮرد ﺗﺠﺰﯾﻪ و ﺗﺤﻠﯿﻞ آﻣﺎري ﻗﺮار ﮔﺮﻓﺖ. ﺟﻬﺖ ﺗﻮﺻﯿﻒ ﻣﺘﻐﯿﺮﻫﺎ از ﻓﺮاواﻧﯽ و درﺻﺪ و در ﺗﺤﻠﯿﻞ از آﻧﺎﻟﯿﺰ رﮔﺮﺳﯿﻮن ﻟﺠﺴﺘﯿﮏ ﺗﮏ ﺳﻄﺤﯽ و دو ﺳﻄﺤﯽ در ﺳﻄــﺢ 0/05= α اﺳﺘﻔﺎده ﺷﺪه اﺳﺖ. ﻧﺘﺎﯾﺞ: آﻧﺎﻟﯿﺰ ﭼﻨﺪﮔﺎﻧﻪ ﻧﺸﺎن داد ﮐﻪ ﻣﺘﻐﯿﺮﻫﺎي ﭘﺮﻓﺸﺎري ﺧﻮن، ﻣﺼﺮف ﺳﯿﮕﺎر، ﻗﻨﺪ ﺧﻮن ﻧﺎﺷﺘﺎ و ﮐﻠﺴﺘﺮول ﺟﺰو ﻋﻮاﻣﻞ ﺧﻄﺮ ﺑﯿﻤﺎري ﻫﺎي ﻗﻠﺒﯽ ﻋﺮوﻗﯽ ﻣﺤﺴﻮب ﺷﺪه و ارﺗﺒﺎط ﻣﻌﻨﯽ داري ﺑﺎ اﯾﻦ ﺑﯿﻤﺎري دارﻧﺪ. در ﻣﺪل رﮔﺮﺳﯿﻮن ﻟﺠﺴﺘﯿﮏ دو ﺳﻄﺤﯽ، ﻧﺴﺒﺖ ﺷﺎﻧﺲ اﺑﺘﻼ ﺑﻪ ﺑﯿﻤﺎري ﻗﻠﺒﯽ ﻋﺮوﻗﯽ در اﻓﺮاد ﻣﺒﺘﻼ ﺑﻪ ﭘﺮﻓﺸﺎري ﺧﻮن 3/93 ﺑﺮاﺑﺮ اﻓﺮاد ﺑﺎ ﻓﺸﺎر ﺧﻮن ﻧﺮﻣﺎل ﺑﺎ ﻓﺎﺻﻠﻪ اﻃﻤﯿﻨﺎن )6/28- 2/64( ﺑﻪ دﺳﺖ آﻣﺪ. ﺧﻄﺮ ﻣﺬﮐﻮر در اﻓﺮاد ﻣﺼﺮف ﮐﻨﻨﺪه ﺳﯿﮕﺎر1/85(1/11-3/09)ﺑﺮاﺑﺮ ﻏﯿﺮﺳﯿﮕﺎري ﻫﺎ ﺑﻮد. ﻫﻤﭽﻨﯿﻦ، در اﻓﺮادي ﮐﻪ ﻗﻨﺪﺧﻮن ﻧﺎﺷﺘﺎ آﻧﻬﺎ ﺑﺎﻻﺑﻮد )دﯾﺎﺑﺖ ﻧﺎﺷﻨﺎﺧﺘﻪ/دﯾﺎﺑﺖ ﮐﻨﺘﺮل ﻧﺸﺪه( ﻧﺴﺒﺖ ﺷﺎﻧﺲ اﺑﺘﻼ ﺑﻪ ﺑﯿﻤﺎرﯾﻬﺎي ﻗﻠﺒﯽ-ﻋﺮوﻗﯽ (6/18- 1/18) 2/7 ﺑﺮاﺑﺮ اﻓﺮاد ﻧﺮﻣﺎل ﺑﻪ دﺳﺖ آﻣﺪ. ﻣﺘﻐﯿﺮﻫﺎي ﻧﻤﺎﯾﻪ ﺗﻮده ﺑﺪﻧﯽ، اﺑﺘﻼ ﺑﻪ دﯾﺎﺑﺖ ﮐﻨﺘﺮل ﺷﺪه ﯾﺎ ﻧﺸﺪه(، ﺗﺮي ﮔﻠﯿﺴﯿﺮﯾﺪ از ﻧﻈﺮ آﻣﺎري ﻣﻌﻨﯽدار ﻧﺒﻮدﻧﺪ. ﻧﺘﯿﺠﻪ ﮔﯿﺮي: در اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﻧﺸﺎن داده ﺷﺪ ﮐﻪ اﻧﺘﺨﺎب ﻣﺪل آﻣﺎري ﻣﯽﺗﻮاﻧﺪ ﺑﺮ ﻧﺘﺎﯾﺞ ﺑﻪ دﺳﺖ آﻣﺪه از ﯾﮏ ﻣﺠﻤﻮﻋﻪ داده ﺗﺎﺛﯿﺮﮔﺬار ﺑﺎﺷﺪ. ﻫﻤﭽﻨﯿﻦ ﻧﺘﺎﯾﺞ اﯾﻦ ﻣﻄﺎﻟﻌﻪ ﻧﺸﺎن دﻫﻨﺪه ﺷﯿﻮع ﺑﺎﻻي ﺑﺮﺧﯽ ﻋﻮاﻣﻞ ﺧﻄﺮﺳﺎز ﺑﯿﻤﺎري ﻗﻠﺒﯽ ﻋﺮوﻗﯽ در ﮐﺎرﮐﻨﺎن ﻣﯽ ﺑﺎﺷﺪ. ﻧﮑﺘﻪ ﺑﺴﯿﺎر ﻣﻬﻢ در ﻣﻄﺎﻟﻌﻪ ﻓﻮق ﭘﺎﯾﯿﻦ ﺑﻮدن ﻓﻌﺎﻟﯿﺖ ﻓﯿﺰﯾﮑﯽ ﮐﺎرﮐﻨﺎن و ﺑﺎﻟﺘﺒﻊ آن اﻓﺰاﯾﺶ اﺿﺎﻓﻪ وزن و ﭼﺎﻗﯽ ﺧﻮاﻫﺪ ﺑﻮد.

Cardiovascular diseases (CVD) are the leading cause of death globally, causing annually 17.3 million deaths, more than 75% of these deaths occurring in the low- and middle-income countries. Although extensive studies have been conducted to determine the risk factors for these diseases, limited studies have been performed to investigate these factors using a multilevel analysis method. The aim of this study was to determine the CVD risk factors in the staff of Mashhad University of Medical Sciences using a multilevel analysis approach, as well as compare the application of the conventional and multilevel logistic regressions in doing this according to the hierarchical structure of the data. Materials and Methods: This was a case-control study including a total of 1091 randomly selected individuals from among the people in a prospective cohort study, namely, the “PERSIAN Cohort Study in Mashhad University of Medical Sciences” in 2018. The case group included 152 patients with a definite diagnosis of CVD and the control group 939 staff members not suffering at the time from CVD. Data analysis was done using the STATA software. Data analysis (based on frequencies and percentages) was done using one-way and two-level logistic regression analysis at α = 0.05. Results: Multivariate analysis showed that hypertension, smoking, fasting blood sugar and cholesterol were among the cardiovascular risk factors with a significant relationship with the disease. Based on the two-tier logistic regression model, the odds ratio for CVD in the hypertensive patients was 3.93 times that in individuals with a normal blood pressure with a confidence interval of 2.64-6.28. The risk in smokers was 1.85 (1.11-3.09) times that in nonsmokers. The CVD odds ratio in individuals with a high fasting blood glucose level (undiagnosed/uncontrolled diabetes) was 2.7 (1.18-6.18) times that in those with a normal blood pressure. There were no statistically differences between the case and control groups as regards the other variables ─ body mass index, diabetes (controlled or uncontrolled), or blood triglyceride level. Conclusion: The findings show that statistical model selection can influence the results of data analysis in a dataset. It should be noted that the results of this study indicate a high prevalence of some cardiovascular risk factors among the staff. Another crucial point in this study is that the level of physical activity of the staff was found to be low, which would result in increased risk of overweight and obesity.