Article(id=1241329577063150112, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241329570129956900, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202406306, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1718553600000, receivedDateStr=2024-06-17, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773885633960, onlineDateStr=2026-03-19, pubDate=1752076800000, pubDateStr=2025-07-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773885633960, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773885633960, creator=13701087609, updateTime=1773885633960, updator=13701087609, issue=Issue{id=1241329570129956900, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='13', pageStart='2305', pageEnd='2496', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773885632307, creator=13701087609, updateTime=1773885763730, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241330121425080472, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241329570129956900, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241330121425080473, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241329570129956900, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2317, endPage=2322, ext={EN=ArticleExt(id=1241329579009307261, articleId=1241329577063150112, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Research on the impact of body mass index on chronic disease prevalence among adult residents: based on propensity score matching method, columnId=1240413921954295836, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the impact of BMI on the prevalence of chronic diseases among adult residents and provide theoretical reference for early prevention of chronic diseases.

Methods

A multi-stage stratified random sampling method was used to select residents in Shandong for questionnaire surveys. The questionnaire included basic information, quality of life, and chronic disease prevalence. The propensity score matching method was employed to examine the effect of BMI on chronic disease prevalence.

Results

A total of 2 451 adult residents in Shandong were surveyed. When BMI < 18.5 kg/m2, the impact of BMI on chronic disease prevalence was not statistically significant (P > 0.05). When BMI ≥ 24.0 kg/m2, the average treatment effects of BMI on chronic disease prevalence were -0.134, -0.110, and -0.113 (P < 0.05), increasing the probability of chronic diseases by 11.0%-13.4%. The balance test showed that the standard errors of all variables decreased, and no covariates were statistically significant after matching (P > 0.05). The common support test indicated that both the treatment and control groups were within the common range and relatively symmetric, with almost no systematic differences after matching, demonstrating good matching quality.

Conclusion

BMI ≥ 24.0 kg/m2 increases the probability of chronic diseases among residents. It is necessary to strengthen weight management and public awareness campaigns, expand coverage for key populations, clarify intergroup differences, and propose targeted health management strategies. The roles of the government, primary healthcare institutions, and family doctors should be fully utilized to improve chronic disease prevention and management, thereby enhancing residents’ quality of life.

, correspAuthors=null, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, authorCompany=null, fund=null, authors=null, authorsList=Ming-hui GENG, Jia-ying SUN, Jin-ping LUO, Yi-fan MU, Bao-xuan ZHANG, Wen-qiang YIN, Zhong-ming CHEN, Dong-ping MA), CN=ArticleExt(id=1241329582683517797, articleId=1241329577063150112, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=身体质量指数对成年居民慢性病患病的影响研究——基于倾向得分匹配法, columnId=1228016567632462653, journalTitle=现代预防医学, columnName=流行病与统计方法, runingTitle=null, highlight=null, articleAbstract=
目的

分析身体质量指数(body mass index, BMI)对成年居民慢性病患病的影响,为慢性病早期预防提供理论参考。

方法

采用多阶段分层随机抽样的方法抽取山东省居民进行问卷调查,问卷内容包括基本情况、生命质量、慢性病患病情况等,运用倾向得分匹配法检验BMI对慢性病患病的影响。

结果

共调查山东省成年居民2 451名,BMI<18.5 kg/m2时,BMI对成年居民慢性病患病影响无统计学意义(P>0.05);BMI≥24.0 kg/m2时,BMI对成年居民慢性病患病的平均处理效应分别为-0.134、-0.110、-0.113(P<0.05),会使居民患慢性病的概率增加11.0%~13.4%;平衡性检验结果显示所有变量的标准误差均变小,匹配后所有协变量均无统计学意义(P>0.05);共同支撑度检验结果显示处理组与非处理组均在共同取值范围内且较为对称,匹配后两组样本几乎不存在系统性差异,匹配效果良好。

结论

BMI≥24.0 kg/m2时会增加居民患慢性病的概率,需加强体重管理和宣传力度,扩大重点人群覆盖面,明确人群间差异,提出针对性健康管理对策建议;充分发挥政府、基层医疗卫生机构以及家庭医生的作用,做好慢性病预防与管理工作,提高居民生活质量。

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马东平,E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点,除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=+rH/0YxQnIIZdKvgCGUz0w==, magXml=foxDwq2WYVQSLrWrzAzLcw==, pdfUrl=null, pdf=AZOXvFoRhgV9fG9721uYWA==, pdfFileSize=932090, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=NMOjSHVcJlClhjHUGtFtEQ==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=Aug0/8I0dkqgU02dKzy7WQ==, mapNumber=null, authorCompany=null, fund=null, authors=

耿铭慧(2000—),女,硕士在读,研究方向:卫生管理与政策研究

, authorsList=耿铭慧, 孙嘉颖, 罗金萍, 牟艺帆, 张宝轩, 尹文强, 陈钟鸣, 马东平)}, authors=[Author(id=1241329761406996923, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329577063150112, orderNo=0, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=null, emailSecond=null, emailThird=null, correspondingAuthor=0, authorType=1, ext={EN=AuthorExt(id=1241329761578963402, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329577063150112, authorId=1241329761406996923, language=EN, stringName=Ming-hui GENG, firstName=Ming-hui, middleName=null, lastName=GENG, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=1, 2, 3, address=School of Management, Shandong Second Medical University, Weifang, Shandong 261053, China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1241329761763512786, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329577063150112, authorId=1241329761406996923, language=CN, stringName=耿铭慧, firstName=null, middleName=null, lastName=null, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=1, 2, 3, address=1.山东第二医科大学管理学院,山东 潍坊 261053
2.“健康山东”重大社会风险预测与治理协同创新中心,山东 潍坊 261053
3.健康风险预警治理协同创新中心,上海 200032, bio={"content":"

耿铭慧(2000—),女,硕士在读,研究方向:卫生管理与政策研究

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耿铭慧(2000—),女,硕士在读,研究方向:卫生管理与政策研究

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2.“健康山东”重大社会风险预测与治理协同创新中心,山东 潍坊 261053
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2.“健康山东”重大社会风险预测与治理协同创新中心,山东 潍坊 261053
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Medicine and Society, 2023, 36(11): 20-26.(In Chinese), articleTitle=Analysis on influencing factors of health guidance adherence among older adults in Xuzhou based on health belief model, refAbstract=null)], funds=[Fund(id=1241329766796677992, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329577063150112, awardId=72004164, language=CN, fundingSource=国家自然科学基金青年项目(72004164), fundOrder=null, country=null), Fund(id=1241329766918312812, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329577063150112, awardId=null, language=CN, fundingSource=2021年山东省高等学校“青创人才引育计划”(卫生管理与政策研究创新团队), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241329759087546780, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329577063150112, xref=1., ext=[AuthorCompanyExt(id=1241329759095935389, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329577063150112, companyId=1241329759087546780, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Management, Shandong Second Medical University, Weifang, Shandong 261053, China), AuthorCompanyExt(id=1241329759108518303, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329577063150112, companyId=1241329759087546780, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.山东第二医科大学管理学院,山东 潍坊 261053)]), AuthorCompany(id=1241329759259513255, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329577063150112, xref=2., ext=[AuthorCompanyExt(id=1241329759267901864, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329577063150112, companyId=1241329759259513255, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.“健康山东”重大社会风险预测与治理协同创新中心,山东 潍坊 261053)]), AuthorCompany(id=1241329761222447534, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329577063150112, xref=3., ext=[AuthorCompanyExt(id=1241329761235030448, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329577063150112, companyId=1241329761222447534, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.健康风险预警治理协同创新中心,上海 200032)])], figs=[ArticleFig(id=1241329765764879134, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329577063150112, language=EN, label=Figure 1, caption=The kernel density curves before and after matching, figureFileSmall=HObd6YrZNKrsALMBJ0v+MA==, figureFileBig=NMOjSHVcJlClhjHUGtFtEQ==, tableContent=null), ArticleFig(id=1241329765915874091, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329577063150112, language=CN, label=图1, caption=匹配前后核密度曲线图, figureFileSmall=HObd6YrZNKrsALMBJ0v+MA==, figureFileBig=NMOjSHVcJlClhjHUGtFtEQ==, tableContent=null), ArticleFig(id=1241329766083646263, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329577063150112, language=EN, label=Table 1, caption=

Variables of the influence of BMI on the prevalence of chronic diseases (n=2 451)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量类别变量名称变量人数(%)
协变量性别950(38.8)
1 501(61.2)
年龄实测值64.20±12.50
文化程度小学及以下1 422(58.0)
初中647(26.4)
高中/中专248(10.1)
大专94(3.8)
本科及以上40(1.6)
长期居住地城市地区306(12.5)
农村地区2 040(83.2)
城乡结合部39(1.6)
乡镇66(2.7)
户口性质城市217(8.9)
农村2 234(91.1)
婚姻状况在婚2 073(84.6)
非在婚378(15.4)
就业状况在业732(29.9)
未在业1 719(70.1)
参加医疗保险情况未参保69(2.8)
参保2 382(97.2)
参加养老保险情况未参保251(10.2)
参保2 200(89.8)
吸烟情况吸烟368(15.0)
以前吸,但现在不吸烟241(9.8)
从不吸烟1 842(75.2)
饮酒情况饮酒463(18.9)
以前饮,但现在不饮酒222(9.1)
从不饮酒1 766(72.1)
近30 d,有意识锻炼情况从不进行体育锻炼610(24.9)
1-2次/周455(18.6)
3-5次/周418(17.1)
5次以上/周968(39.5)
睡眠质量1 158(47.2)
790(32.2)
503(20.5)
生命质量实测值4.64±0.54
自变量BMI情况(kg/m2<18.565(2.7)
≥18.5~<24≥865(35.3)
≥≥241 521(62.1)
因变量患慢性病情况无慢性病653(26.6)
患慢性病1 798(73.4)
), ArticleFig(id=1241329766171726653, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329577063150112, language=CN, label=表1, caption=

BMI对慢性病患病影响的各变量情况(n=2 451)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量类别变量名称变量人数(%)
协变量性别950(38.8)
1 501(61.2)
年龄实测值64.20±12.50
文化程度小学及以下1 422(58.0)
初中647(26.4)
高中/中专248(10.1)
大专94(3.8)
本科及以上40(1.6)
长期居住地城市地区306(12.5)
农村地区2 040(83.2)
城乡结合部39(1.6)
乡镇66(2.7)
户口性质城市217(8.9)
农村2 234(91.1)
婚姻状况在婚2 073(84.6)
非在婚378(15.4)
就业状况在业732(29.9)
未在业1 719(70.1)
参加医疗保险情况未参保69(2.8)
参保2 382(97.2)
参加养老保险情况未参保251(10.2)
参保2 200(89.8)
吸烟情况吸烟368(15.0)
以前吸,但现在不吸烟241(9.8)
从不吸烟1 842(75.2)
饮酒情况饮酒463(18.9)
以前饮,但现在不饮酒222(9.1)
从不饮酒1 766(72.1)
近30 d,有意识锻炼情况从不进行体育锻炼610(24.9)
1-2次/周455(18.6)
3-5次/周418(17.1)
5次以上/周968(39.5)
睡眠质量1 158(47.2)
790(32.2)
503(20.5)
生命质量实测值4.64±0.54
自变量BMI情况(kg/m2<18.565(2.7)
≥18.5~<24≥865(35.3)
≥≥241 521(62.1)
因变量患慢性病情况无慢性病653(26.6)
患慢性病1 798(73.4)
), ArticleFig(id=1241329766268195652, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329577063150112, language=EN, label=Table 2, caption=

Regression analysis of the impact on the prevalence of chronic diseases with BMI≥24.0 kg/m2

, figureFileSmall=null, figureFileBig=null, tableContent=
变量名称β Wald χ2POR值(95%CI
BMI(kg/m2,≥24 为参照)
≥18.5~<24-0.7960.11048.740<0.0010.463(0.374~0.575)
性别(男性为参照)
女性0.0990.1420.7500.4871.104(0.836~1.459)
年龄(岁)0.0560.00697.227<0.0011.058(1.046~1.070)
文化程度(小学及下为参照)
初中-0.0550.1280.1810.6710.947(0.736~1.218)
高中/中专-0.2270.1801.5950.2070.797(0.560~1.133)
大专-0.6280.2994.4160.0360.534(0.297~0.959)
本科及上-1.1480.4815.6940.0170.317(0.124~0.815)
长期居住地(城市地区为参照)
农村地区-0.2760.2341.3930.2380.759(0.479~1.200)
城乡结合部0.3710.4330.7360.3911.450(0.621~3.387)
乡镇-0.3450.3850.8020.3710.708(0.333~1.507)
户口性质(城市为参照)
农村-0.2380.2780.7320.3920.788(0.457~1.360)
婚姻状况(在婚为参照)
非在婚-0.2470.1632.3000.1290.781(0.568~1.075)
就业状况(在业为参照)
未在业0.4530.12114.118<0.0011.574(1.242~1.994)
医疗保险(未参保为参照)
参保0.0330.3640.0080.9271.034(0.507~2.108)
养老保险(未参保为参照)
参保0.1440.1840.6080.4351.155(0.804~1.658)
吸烟情况(吸烟为参照)
前吸,但现在不吸烟-0.0950.2460.1500.6990.909(0.561~1.473)
从不吸烟-0.0010.1780.0000.9960.999(0.704~1.418)
饮酒情况(饮酒为参照)
前饮,但现在不饮酒0.7800.2599.0940.0032.183(1.314~3.625)
从不饮酒0.0540.1740.0950.7581.055(0.750~1.485)
近30 d,有意识锻炼情况0.1010.0445.2290.0221.107(1.015~1.207)
睡眠质量0.3500.07621.449<0.0011.419(1.224~1.646)
命质量0.7180.14125.937<0.0012.050(1.555~2.703)
常量-3.9970.59944.51<0.0010.018
), ArticleFig(id=1241329766402413387, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329577063150112, language=CN, label=表2, caption=

BMI≥24.0 kg/m2时对慢性病患病影响的回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量名称β Wald χ2POR值(95%CI
BMI(kg/m2,≥24 为参照)
≥18.5~<24-0.7960.11048.740<0.0010.463(0.374~0.575)
性别(男性为参照)
女性0.0990.1420.7500.4871.104(0.836~1.459)
年龄(岁)0.0560.00697.227<0.0011.058(1.046~1.070)
文化程度(小学及下为参照)
初中-0.0550.1280.1810.6710.947(0.736~1.218)
高中/中专-0.2270.1801.5950.2070.797(0.560~1.133)
大专-0.6280.2994.4160.0360.534(0.297~0.959)
本科及上-1.1480.4815.6940.0170.317(0.124~0.815)
长期居住地(城市地区为参照)
农村地区-0.2760.2341.3930.2380.759(0.479~1.200)
城乡结合部0.3710.4330.7360.3911.450(0.621~3.387)
乡镇-0.3450.3850.8020.3710.708(0.333~1.507)
户口性质(城市为参照)
农村-0.2380.2780.7320.3920.788(0.457~1.360)
婚姻状况(在婚为参照)
非在婚-0.2470.1632.3000.1290.781(0.568~1.075)
就业状况(在业为参照)
未在业0.4530.12114.118<0.0011.574(1.242~1.994)
医疗保险(未参保为参照)
参保0.0330.3640.0080.9271.034(0.507~2.108)
养老保险(未参保为参照)
参保0.1440.1840.6080.4351.155(0.804~1.658)
吸烟情况(吸烟为参照)
前吸,但现在不吸烟-0.0950.2460.1500.6990.909(0.561~1.473)
从不吸烟-0.0010.1780.0000.9960.999(0.704~1.418)
饮酒情况(饮酒为参照)
前饮,但现在不饮酒0.7800.2599.0940.0032.183(1.314~3.625)
从不饮酒0.0540.1740.0950.7581.055(0.750~1.485)
近30 d,有意识锻炼情况0.1010.0445.2290.0221.107(1.015~1.207)
睡眠质量0.3500.07621.449<0.0011.419(1.224~1.646)
命质量0.7180.14125.937<0.0012.050(1.555~2.703)
常量-3.9970.59944.51<0.0010.018
), ArticleFig(id=1241329766498882386, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329577063150112, language=EN, label=Table 3, caption=

Matching results of propensity scores for each variable

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BMI(kg/m2匹配方法匹配情况平均处理效应标准差T值
<18.5k近邻匹配匹配前-0.0080.061-0.12
匹配后-0.1090.090-1.21
半径匹配匹配前-0.0080.061-0.12
匹配后-0.1010.076-1.33
核匹配匹配前-0.0080.061-0.12
匹配后-0.0770.066-1.17
≥24.0k近邻匹配匹配前-0.1030.019-5.52**
匹配后-0.1340.026-5.21**
半径匹配匹配前-0.1030.019-5.52**
匹配后-0.1100.020-5.58**
核匹配匹配前-0.1030.019-5.52**
匹配后-0.1130.019-5.79**
), ArticleFig(id=1241329766616322905, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329577063150112, language=CN, label=表3, caption=

各变量倾向值得分匹配结果

, figureFileSmall=null, figureFileBig=null, tableContent=
BMI(kg/m2匹配方法匹配情况平均处理效应标准差T值
<18.5k近邻匹配匹配前-0.0080.061-0.12
匹配后-0.1090.090-1.21
半径匹配匹配前-0.0080.061-0.12
匹配后-0.1010.076-1.33
核匹配匹配前-0.0080.061-0.12
匹配后-0.0770.066-1.17
≥24.0k近邻匹配匹配前-0.1030.019-5.52**
匹配后-0.1340.026-5.21**
半径匹配匹配前-0.1030.019-5.52**
匹配后-0.1100.020-5.58**
核匹配匹配前-0.1030.019-5.52**
匹配后-0.1130.019-5.79**
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身体质量指数对成年居民慢性病患病的影响研究——基于倾向得分匹配法
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耿铭慧 1, 2, 3 , 孙嘉颖 1, 2, 3 , 罗金萍 1, 2, 3 , 牟艺帆 1, 2, 3 , 张宝轩 1, 2, 3 , 尹文强 1, 2, 3 , 陈钟鸣 1, 2, 3 , 马东平 1, 2, 3
现代预防医学 | 流行病与统计方法 2025,52(13): 2317-2322
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现代预防医学 | 流行病与统计方法 2025, 52(13): 2317-2322
身体质量指数对成年居民慢性病患病的影响研究——基于倾向得分匹配法
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耿铭慧1, 2, 3, 孙嘉颖1, 2, 3, 罗金萍1, 2, 3, 牟艺帆1, 2, 3, 张宝轩1, 2, 3, 尹文强1, 2, 3, 陈钟鸣1, 2, 3, 马东平1, 2, 3
作者信息
  • 1.山东第二医科大学管理学院,山东 潍坊 261053
  • 2.“健康山东”重大社会风险预测与治理协同创新中心,山东 潍坊 261053
  • 3.健康风险预警治理协同创新中心,上海 200032
  • 耿铭慧(2000—),女,硕士在读,研究方向:卫生管理与政策研究

通讯作者:

马东平,E-mail:
Research on the impact of body mass index on chronic disease prevalence among adult residents: based on propensity score matching method
Ming-hui GENG1, 2, 3, Jia-ying SUN1, 2, 3, Jin-ping LUO1, 2, 3, Yi-fan MU1, 2, 3, Bao-xuan ZHANG1, 2, 3, Wen-qiang YIN1, 2, 3, Zhong-ming CHEN1, 2, 3, Dong-ping MA1, 2, 3
Affiliations
  • School of Management, Shandong Second Medical University, Weifang, Shandong 261053, China
出版时间: 2025-07-10 doi: 10.20043/j.cnki.MPM.202406306
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目的

分析身体质量指数(body mass index, BMI)对成年居民慢性病患病的影响,为慢性病早期预防提供理论参考。

方法

采用多阶段分层随机抽样的方法抽取山东省居民进行问卷调查,问卷内容包括基本情况、生命质量、慢性病患病情况等,运用倾向得分匹配法检验BMI对慢性病患病的影响。

结果

共调查山东省成年居民2 451名,BMI<18.5 kg/m2时,BMI对成年居民慢性病患病影响无统计学意义(P>0.05);BMI≥24.0 kg/m2时,BMI对成年居民慢性病患病的平均处理效应分别为-0.134、-0.110、-0.113(P<0.05),会使居民患慢性病的概率增加11.0%~13.4%;平衡性检验结果显示所有变量的标准误差均变小,匹配后所有协变量均无统计学意义(P>0.05);共同支撑度检验结果显示处理组与非处理组均在共同取值范围内且较为对称,匹配后两组样本几乎不存在系统性差异,匹配效果良好。

结论

BMI≥24.0 kg/m2时会增加居民患慢性病的概率,需加强体重管理和宣传力度,扩大重点人群覆盖面,明确人群间差异,提出针对性健康管理对策建议;充分发挥政府、基层医疗卫生机构以及家庭医生的作用,做好慢性病预防与管理工作,提高居民生活质量。

体质指数  /  慢性病  /  倾向得分匹配法  /  居民
Objective

To analyze the impact of BMI on the prevalence of chronic diseases among adult residents and provide theoretical reference for early prevention of chronic diseases.

Methods

A multi-stage stratified random sampling method was used to select residents in Shandong for questionnaire surveys. The questionnaire included basic information, quality of life, and chronic disease prevalence. The propensity score matching method was employed to examine the effect of BMI on chronic disease prevalence.

Results

A total of 2 451 adult residents in Shandong were surveyed. When BMI < 18.5 kg/m2, the impact of BMI on chronic disease prevalence was not statistically significant (P > 0.05). When BMI ≥ 24.0 kg/m2, the average treatment effects of BMI on chronic disease prevalence were -0.134, -0.110, and -0.113 (P < 0.05), increasing the probability of chronic diseases by 11.0%-13.4%. The balance test showed that the standard errors of all variables decreased, and no covariates were statistically significant after matching (P > 0.05). The common support test indicated that both the treatment and control groups were within the common range and relatively symmetric, with almost no systematic differences after matching, demonstrating good matching quality.

Conclusion

BMI ≥ 24.0 kg/m2 increases the probability of chronic diseases among residents. It is necessary to strengthen weight management and public awareness campaigns, expand coverage for key populations, clarify intergroup differences, and propose targeted health management strategies. The roles of the government, primary healthcare institutions, and family doctors should be fully utilized to improve chronic disease prevention and management, thereby enhancing residents’ quality of life.

Body mass index  /  Chronic diseases  /  Propensity score matching  /  Residents
耿铭慧, 孙嘉颖, 罗金萍, 牟艺帆, 张宝轩, 尹文强, 陈钟鸣, 马东平. 身体质量指数对成年居民慢性病患病的影响研究——基于倾向得分匹配法. 现代预防医学, 2025 , 52 (13) : 2317 -2322 . DOI: 10.20043/j.cnki.MPM.202406306
Ming-hui GENG, Jia-ying SUN, Jin-ping LUO, Yi-fan MU, Bao-xuan ZHANG, Wen-qiang YIN, Zhong-ming CHEN, Dong-ping MA. Research on the impact of body mass index on chronic disease prevalence among adult residents: based on propensity score matching method[J]. Modern Preventive Medicine, 2025 , 52 (13) : 2317 -2322 . DOI: 10.20043/j.cnki.MPM.202406306
世界卫生组织数据显示,2016年全世界超过19亿18岁以上的人口超重,其中超过6.5亿人肥胖,世界上因超重或肥胖死亡人数超过了因体重不足死亡的人数[1],而目前我国居民对身体质量指数(body mass index,BMI)异常所带来的隐患并不了解[2]。《中国成人超重和肥胖症预防控制指南》中规定了成年人BMI正常范围为18.5 kg/m2≤BMI<24.0 kg/m2[3]。肥胖地图显示,在1 580万成年人受试者中超重(24.0 kg/m2≤BMI<28.0 kg/m2)与肥胖(BMI≥28.0 kg/m2)人群占48.9%[4],我国超重及肥胖问题较为严重。
已有研究多集中于老年人BMI或BMI对某一疾病的影响,但对成年居民这一群体以及BMI对慢性病总体患病率影响程度的研究较少,目前我国慢性病患病呈现年轻化趋势,成年居民BMI情况不容乐观。
由于BMI与慢性病患病的关系探讨研究会受到人口学特征、生活方式等混杂因素的干扰,若使用以往普通的回归模型分析,研究结果易产生系统性偏差,影响其准确性,本文运用倾向得分匹配法(propensity score matching,PSM)分析BMI是否会对慢性病患病产生影响以及影响程度的大小,使结果更加可靠合理,以期为慢性病的早期预防提供理论参考。
纳入标准:居民年龄≥18岁;无语言沟通障碍,自愿参加本次调查者。排除标准:患有严重听力和智力障碍,无法正常沟通的居民。
采用多阶段分层随机抽样的方法,在山东省根据经济发展状况(好、中、差)选取3个地市,每个地市随机选取3个县(市、区),每个县(市、区)随机选取4个乡镇(街道),每个乡镇(街道)抽6个村(社区)作为样本地区,每村(社区)抽取10~15名成年居民。
(1)本文选取BMI为自变量,根据《中国成人超重和肥胖症预防控制指南》界定的相关标准,BMI<18.5 kg/m2为低体重状态,18.5 kg/m2≤BMI<24.0 kg/m2为正常体重,BMI≥24.0 kg/m2为超重或肥胖。(2)本文选取是否患有慢性病为因变量,调查共包括14种慢性病:高血压、糖尿病、冠心病、中风(脑卒中)、脑梗塞(脑血栓)、颈椎病、肝硬化、类风湿病、恶性肿瘤、腰肌劳损、肩周炎、慢性胃肠炎、慢性支气管炎、高血脂症。(3)在进行PSM时所提供的协变量应最大程度满足外生性,因此本文尽可能选取与居民BMI和慢性病患病同时存在关联的协变量[5],结合文献回顾法最终确定性别、年龄、文化程度、长期居住地、户口性质、婚姻状况、就业状况、参加医疗保险状况、参加养老保险状况、吸烟情况、饮酒情况、30 d内有意识锻炼情况、睡眠质量、生命质量等14个变量为协变量。
运用Access 14.0软件建立数据库进行数据录入以及Stata 18.0对数据进行统计学分析。分类资料以百分比表示,计量资料用()表示。在分析居民BMI与慢性病患病之间的关系时容易受到人口学、行为习惯等因素的干扰,使用普通的回归模型容易产生偏差,而PSM法可以较好的控制混杂偏倚[6]。首先运用logistic回归计算各变量的倾向得分(propensity score),18.5 kg/m2≤BMI<24.0 kg/m2赋值为1,BMI<18.5 kg/m2或BMI≥24.0 kg/m2赋值为0;患有慢性病赋值为1,未患慢性病赋值为0。见公式(1):
倾向得分为在已知因素X1Xn后,个体选择接受处理行为的概率。计算得到倾向得分后,根据倾向得分将协变量相同或相似的个体进行匹配。分别进行两次PSM,第一次将BMI<18.5 kg/m2的数据与18.5 kg/m2≤BMI<24.0 kg/m2的数据进行匹配,第二次将BMI≥24.0 kg/m2的数据与18.5 kg/m2≤BMI<24.0 kg/m2的数据进行匹配。
分别计算BMI对慢性病患病的平均处理效应(average treatment effect of treated,ATT),见公式(2):
为了确保数据的稳定可靠,两次PSM中将依次进行k近邻匹配、卡钳值为0.01的半径匹配以及核匹配,检验水准α=0.05。
本次回收问卷2 498份,有效问卷2 451份,问卷有效率为98.12%。居民平均年龄为(64.20±12.50)岁;其中,女性1 501人(61.2%),男性950人(38.8%);文化程度为小学及以下最多,1 422人(58.0%),本科及以上最少,40人(1.6%);长期居住地主要为农村地区2 040人(83.2%),长期居住地为城乡结合部的最少39人(1.6%);1 158人(47.2%)睡眠质量较好,790人(32.2%)睡眠质量一般,503人(20.5%)睡眠质量较差;BMI<18.5 kg/m2的居民有65人(2.7%),BMI≥24 kg/m2的有1 521人(62.1%);患慢性病1 798人(73.4%),未患慢性病653人(26.6%)。见表1
回归结果显示,当BMI<18.5 kg/m2时,BMI对慢性病患病无显著影响(P>0.05);当BMI≥24.0 kg/m2时,超重或肥胖会增加成年居民慢性病患病的概率,BMI≥24.0 kg/m2的居民慢性病患病程度比BMI正常的居民高79.6%(P<0.05)。同时,年龄、文化程度、就业状况、饮酒情况、近30 d有意识锻炼情况、睡眠质量、生命质量均是慢性病患病的重要影响因素(P<0.05),在下一步进行匹配时需对这些因素加以控制。见表2
根据倾向得分进行匹配,使协变量相同或相似的样本匹配到一组,从而减少协变量对检验结果的干扰。为确保数据的稳定性,依次进行k近邻匹配、卡钳值为0.01的半径匹配和核匹配。PSM后,BMI<18.5 kg/m2时体质指数对居民慢性病患病的影响无统计学意义,即当居民BMI<18.5 kg/m2时,不会增加居民患慢性病的概率。而当居民BMI≥24.0 kg/m2时,BMI对居民慢性病患病的影响在三种匹配中均有统计学意义,ATT值分别为-0.134、-0.110、-0.113,ATT值相差较小,结果较为稳定可靠。当BMI≥24.0 kg/m2时ATT值为负,即可认为BMI≥24.0 kg/m2的居民患慢性病的概率高于18.5 kg/m2≤BMI<24.0 kg/m2的居民。见表3
BMI≥24.0 kg/m2时会增加居民患慢性病的概率,对此结果进行平衡性检验,确保结果的可靠性。一般情况下,匹配后标准误差越小,匹配效果越好,检验结果显示,所有变量的标准误差均变小,且匹配后各变量的标准化偏差绝对值都在10%以下。同时,匹配前年龄、户口性质、婚姻状况、参加医疗保险情况、睡眠质量、生命质量在18.5 kg/m2≤BMI<24.0 kg/m2组与BMI≥24.0 kg/m2组中的差异具有统计学意义(P<0.05),匹配后所有协变量均不具有统计学意义(P>0.05),说明匹配效果良好,能够有效地减少协变量对结果的影响。由匹配前后的核密度曲线图可知,匹配前18.5 kg/m2≤BMI<24.0 kg/m2组与BMI≥24.0 kg/m2组之间的差异较大,在倾向得分值为0.3~0.4之间差异最大,匹配后两者之间的差异明显减小,形态近似,匹配效果较好。见图1
共同支撑度检验结果显示,通过PSM,大部分变量在匹配后标准化偏差缩小,有效减少了对结果的干扰,结果更加可靠。处理组与非处理组均在共同取值范围内且较为对称,匹配后两组样本几乎不存在系统性差异,大多数观测值均在共同取值范围内,且分布较为均衡,匹配效果良好。
中国居民超重和肥胖患病率呈上升趋势,肥胖和相关疾病已经成为当今世界威胁人类健康的重大公共卫生问题[7]。本研究结果显示,BMI≥24.0 kg/m2的居民占62.1%,高于18.5kg/m2≤BMI<24.0 kg/m2的居民,超重或肥胖居民占比较大,提示我国居民对体重的管理意识不高且尚未意识到体重对身体健康的重要性。同时,本研究慢性病患者占比73.4%,可能与调查对象平均年龄偏大有关,年龄越大往往其患慢性病的概率越高,这也侧面反应出我国中老年人群慢性病患病趋势不容乐观。有研究表明,我国居民慢性病患病率持续上升且呈年轻化趋势[8],从1991年开始,中年人组的BMI均超过青年人组和老年人组[9],可能原因是中年人群更追求饮食的丰富性,较多脑力劳动者得不到充分的锻炼,居民对外卖以及快餐的需求也在不断上升,摄入过量的胆固醇和脂肪容易造成脂肪堆积[10],同时居民不了解有关预防慢性病的健康知识,或居民了解相关健康知识后并未将其转化为有效的行动,导致居民慢性病患病率上升。因此,需加强对居民BMI的管理,不应仅局限于老年人群或慢性病患者中,进一步识别高危人群,扩大重点人群覆盖范围[11],针对不同人群特点提出可行性对策建议,如年龄较高者,可以普及饮食方面相关知识,促进健康饮食;向脑力劳动者宣传每日合理运动量以及运动的重要性等等,明确各高危群体间的差异,找准每一高危人群的特点以及BMI升高的根本原因,从源头解决BMI过高问题。臧一腾等[12]指出BMI的长期变化与环境因素有关,因此在关注人群特征的同时也需要关注人群所处的环境,结合多方因素提出具有针对性、个性化的健康指导与建议。
超重和肥胖是慢性病患病的危险因素[13-14],研究结果显示,当BMI≥24.0 kg/m2时会使慢性病患病概率增加11.0%~13.4%,说明BMI≥24.0 kg/m2的居民更容易患慢性病。胡宜坦等[15]研究发现,超重和肥胖老年人患慢性病共病的风险分别是偏瘦老年人的2.434和4.014倍,BMI对我国居民慢性病患病起着重要作用。同时刘芹等[1]指出,BMI的增加会使得日常生活活动变差。因此,超重和肥胖不只在居民慢性病患病方面呈负向影响,在日常生活活动能力等方面也会产生不利影响。需加强对体重管理的宣传,提高居民体重管理意识,进一步拓宽健康知识宣传渠道,如宣传栏、广播、短视频、微信公众号等,针对不同人群进行不同形式的宣传,使每位居民都能获取所需要的健康知识。刘春光等人[16]指出家庭医生签约对农村老年人基本公共卫生服务的利用起正向促进作用进而改善老年人的健康,因此家庭医生在进行随访和诊疗时可以向居民进行宣传和指导,普及关于BMI的常识性知识以及慢性病预防的相关建议。
最后,需充分发挥政府的带头作用,健全全民健康政策,使各项健康政策能够被居民熟知,提升居民的健康意识。注重基层医疗卫生机构服务水平的提升以及家庭医生队伍建设[17],加强家庭医生对BMI和体重管理相关知识的学习和宣传,发挥基层医疗卫生机构以及家庭医生的优势。同时为了提升健康管理的效果,需减少老年人健康知识的盲区,提高老年人对健康知识的感知,从而使老年人意识到预防疾病的重要性[18],以通俗易懂的方式传授健康知识,并进行跟踪随访,确保健康知识的落实。
  • 国家自然科学基金青年项目(72004164)
  • 2021年山东省高等学校“青创人才引育计划”(卫生管理与政策研究创新团队)
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2025年第52卷第13期
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doi: 10.20043/j.cnki.MPM.202406306
  • 接收时间:2024-06-17
  • 首发时间:2026-03-19
  • 出版时间:2025-07-10
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  • 收稿日期:2024-06-17
基金
国家自然科学基金青年项目(72004164)
2021年山东省高等学校“青创人才引育计划”(卫生管理与政策研究创新团队)
作者信息
    1.山东第二医科大学管理学院,山东 潍坊 261053
    2.“健康山东”重大社会风险预测与治理协同创新中心,山东 潍坊 261053
    3.健康风险预警治理协同创新中心,上海 200032

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2种不同金属材料的力学参数

Family
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Number of
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种数
Number of
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占总种数比例
Percentage of
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种数
Number of
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占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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