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Article(id=1241329575729361405, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241329570129956900, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202502031, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1738512000000, receivedDateStr=2025-02-03, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773885633641, onlineDateStr=2026-03-19, pubDate=1752076800000, pubDateStr=2025-07-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773885633641, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773885633641, creator=13701087609, updateTime=1773885633641, 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=2395, endPage=2400, ext={EN=ArticleExt(id=1241329576564027932, articleId=1241329575729361405, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Prevalence and influencing factors of overweight/obesity and elevated blood pressure comorbidity among primary and secondary school students from the perspective of health ecology, columnId=1228016568949474136, journalTitle=Modern Preventive Medicine, columnName=Child and Adolescent Health, Maternal and Child Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the comorbidity status and influencing factors of overweight/obesity and elevated blood pressure among primary and secondary school students based on the health ecological model, providing evidence for integrated prevention of common student health issues.

Methods

Using stratified cluster random sampling, 140 784 children and adolescents aged 7-18 years in Hubei Province were selected in 2022 for questionnaire surveys, physical examinations, and blood pressure measurements. Independent variables were determined according to five dimensions of the health ecological model, and multivariate logistic regression was used to analyze influencing factors.

Results

The detection rates were 28.52% for overweight/obesity, 20.52% for elevated blood pressure, and 7.95%for comorbidity. Logistic regression showed that junior/senior high school students (OR=1.25), insufficient sleep (OR=1.31), large family structure (OR=1.05), school bullying (OR=1.07), and lack of health records (OR=1.10) were positively associated with comorbidity risk (all P<0.05). Female gender (OR=0.69), moderate-to-vigorous exercise ≥4 days/week (OR=0.92), suburban residence (OR=0.87), skip-generation family (OR=0.88), and boarding (OR=0.76) were protective factors (all P<0.05).

Conclusion

The comorbidity of overweight/obesity and elevated blood pressure is prevalent among Hubei students, with influencing factors spanning multiple dimensions of the health ecological model. Comprehensive interventions addressing individual, behavioral, environmental, and policy aspects are recommended for integrated disease prevention.

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目的

基于健康生态学模型探究中小学生超重肥胖与血压偏高共患现状及其影响因素，为我国学生常见病多病共防提供依据。

方法

采用分层整群随机抽样的方法，于2022年选取湖北省140 784名7～18岁儿童青少年作为研究对象，对其进行问卷调查、体格检查和血压测量。根据健康生态学模型的五个维度确定自变量，采用多因素logistic回归分析湖北省中小学生超重肥胖与血压偏高共患的影响因素。

结果

湖北省中小学生超重肥胖的检出率为28.52%，血压偏高的检出率为20.52%，超重肥胖与血压偏高共患的检出率为7.95%。Logistic回归分析显示初中生和高中生、睡眠不足、处于大家庭、存在校园欺侮、未建立健康档案与超重肥胖和血压偏高共患风险呈正相关（OR=1.25、1.31、1.05、1.07、1.05、1.10，P值均<0.05），而女生、每周中高强度运动≥4 d、郊县、处于隔代家庭、住校与共患风险呈负相关（OR=0.69、0.92、0.87、0.88、0.76；P值均<0.05）。

结论

湖北省中小学生超重肥胖、血压偏高及其共患的检出率较高，影响因素涉及健康生态学模型的多个维度，建议从个人、行为、环境、政策等多个角度进行常见病多病共防综合干预，促进学生身心健康。

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刘爽，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=s9wQft4Id0tVeHjEz3g5PQ==, magXml=8xyz9RY7A93o/m55NM5uvA==, pdfUrl=null, pdf=/oBhAY0syjHhNHY5TiJ52g==, pdfFileSize=784373, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=x+Tr+ngVY0cScLzgapIH9g==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=RCvROlkM2JTJMMiWROF2gg==, mapNumber=null, authorCompany=null, fund=null, authors=

刘翎（1994—），女，博士，主管医师，研究方向：儿童青少年常见病多病同防

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刘翎（1994—），女，博士，主管医师，研究方向：儿童青少年常见病多病同防

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刘翎（1994—），女，博士，主管医师，研究方向：儿童青少年常见病多病同防

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Comparison of prevalences of overweight, obesity, elevated blood pressure and co-occurrence among children and adolescents in Hubei Province［ n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量统计值超重肥胖血压偏高共患
个人特质
性别
男（n=74 182）24 881 (33.54)14 866 (20.04)6 828 (9.20)
女（n=66 602）15 273 (22.93)14 026 (21.06)4 367 (6.56)
χ2值1 936.8422.30335.71
P值<0.001<0.001<0.001
学段
小学（n=50 324）15 491 (30.78)9 025 (17.93)3 602 (7.16)
初中（n=49 154）12 527 (25.49)11 565 (23.53)4 100 (8.34)
高中（n=41 306）12 136 (29.38)8 302 (20.1)3 493 (8.46)
χ2值363.43483.5567.91
P值<0.001<0.001<0.001
行为特征
吸烟
否（n=133 559）38 035 (28.48)27 479 (20.57)10 574 (7.92)
是（n=7 225）2 119 (29.33)1 413 (19.56)621 (8.6)
χ2值2.394.294.21
P值0.1220.0380.040
饮酒
否（n=115 935）32 541 (28.07)23 775 (20.51)9 001 (7.76)
是（n=24 849）7 613 (30.64)5 117 (20.59)2 194 (8.83)
χ2值66.100.0931.59
P值<0.0010.769<0.001
每天吃早餐
是（n=111 508）31 985 (28.68)22 469 (20.15)8 810 (7.9)
否（n=29 276）8 169 (27.9)6 423 (21.94)2 385 (8.15)
χ2值6.8945.411.88
P值0.009<0.0010.170
中高强度运动（d）
0（n=27 588）7 726 (28)5 688 (20.62)2 194 (7.95)
1～3（n=66 803）19 298 (28.89)14 157 (21.19)5 533 (8.28)
≥4（n=46 393）13 130 (28.3)9 047 (19.5)3 468 (7.48)
χ2值9.1148.2124.38
P值0.011<0.001<0.001
睡眠时间
充足（n=35 844）9 852 (27.49)7 152 (19.95)2 646 (7.38)
不足（n=104 940）30 302 (28.88)21 740 (20.72)8 549 (8.15)
χ2值25.249.5021.23
P值<0.0010.002<0.001
人际网络
监测点
城区（n=63 403）20 625 (32.53)12 444 (19.63)5 520 (8.71)
郊县（n=77 381）19 529 (25.24)16 448 (21.26)5 675 (7.33)
χ2值908.7256.6089.48
P值<0.001<0.001<0.001
家庭结构
核心家庭（n=53 665）15 867 (29.57)11 050 (20.59)4 378 (8.16)
大家庭（n=40 267）11 953 (29.68)8 207 (20.38)3 342 (8.3)
隔代家庭（n=13 863）3 306 (23.85)2 801 (20.2)920 (6.64)
单亲家庭（n=13 989）3 822 (27.32)2 917 (20.85)1 107 (7.91)
重组家庭（n=1 511）378 (25.02)314 (20.78)112 (7.41)
其他家庭（n=17 489）4 828 (27.61)3 603 (20.6)1 336 (7.64)
χ2值230.192.5645.51
P值<0.0010.767<0.001
校园欺侮
否（n=109 319）30 997 (28.35)22 411 (20.5)8 595 (7.86)
是（n=31 465）9 157 (29.1)6 481 (20.6)2 600 (8.26)
χ2值6.660.135.31
P值0.010.7130.021
住校
否（n=99 088）30 228 (30.51)20 168 (20.35)8 279 (8.36)
是（n=41 696）9 926 (23.81)8 724 (20.92)2 916 (6.99)
χ2值645.985.8074.16
P值<0.0010.016<0.001
政策环境
是（n=130 444）37 190 (28.51)26 653 (20.43)10 364 (7.95)
否（n=10 340）2 964 (28.67)2 239 (21.65)831 (8.04)
χ2值0.118.690.10
P值0.7450.0030.755
是（n=128 973）36 940 (28.64)26 213 (20.32)10 218 (7.92)
否（n=11 811）3 214 (27.21)2 679 (22.68)977 (8.27)
χ2值10.7836.741.76
P值0.001<0.0010.185
总体（n=140 784）40 154 (28.52)28 892 (20.52)11 195 (7.95)
), ArticleFig(id=1241329765286728436, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329575729361405, language=CN, label=表1, caption=

湖北省不同特征儿童青少年超重肥胖、血压偏高及其共患的检出情况比较［n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量统计值超重肥胖血压偏高共患
个人特质
性别
男（n=74 182）24 881 (33.54)14 866 (20.04)6 828 (9.20)
女（n=66 602）15 273 (22.93)14 026 (21.06)4 367 (6.56)
χ2值1 936.8422.30335.71
P值<0.001<0.001<0.001
学段
小学（n=50 324）15 491 (30.78)9 025 (17.93)3 602 (7.16)
初中（n=49 154）12 527 (25.49)11 565 (23.53)4 100 (8.34)
高中（n=41 306）12 136 (29.38)8 302 (20.1)3 493 (8.46)
χ2值363.43483.5567.91
P值<0.001<0.001<0.001
行为特征
吸烟
否（n=133 559）38 035 (28.48)27 479 (20.57)10 574 (7.92)
是（n=7 225）2 119 (29.33)1 413 (19.56)621 (8.6)
χ2值2.394.294.21
P值0.1220.0380.040
饮酒
否（n=115 935）32 541 (28.07)23 775 (20.51)9 001 (7.76)
是（n=24 849）7 613 (30.64)5 117 (20.59)2 194 (8.83)
χ2值66.100.0931.59
P值<0.0010.769<0.001
每天吃早餐
是（n=111 508）31 985 (28.68)22 469 (20.15)8 810 (7.9)
否（n=29 276）8 169 (27.9)6 423 (21.94)2 385 (8.15)
χ2值6.8945.411.88
P值0.009<0.0010.170
中高强度运动（d）
0（n=27 588）7 726 (28)5 688 (20.62)2 194 (7.95)
1～3（n=66 803）19 298 (28.89)14 157 (21.19)5 533 (8.28)
≥4（n=46 393）13 130 (28.3)9 047 (19.5)3 468 (7.48)
χ2值9.1148.2124.38
P值0.011<0.001<0.001
睡眠时间
充足（n=35 844）9 852 (27.49)7 152 (19.95)2 646 (7.38)
不足（n=104 940）30 302 (28.88)21 740 (20.72)8 549 (8.15)
χ2值25.249.5021.23
P值<0.0010.002<0.001
人际网络
监测点
城区（n=63 403）20 625 (32.53)12 444 (19.63)5 520 (8.71)
郊县（n=77 381）19 529 (25.24)16 448 (21.26)5 675 (7.33)
χ2值908.7256.6089.48
P值<0.001<0.001<0.001
家庭结构
核心家庭（n=53 665）15 867 (29.57)11 050 (20.59)4 378 (8.16)
大家庭（n=40 267）11 953 (29.68)8 207 (20.38)3 342 (8.3)
隔代家庭（n=13 863）3 306 (23.85)2 801 (20.2)920 (6.64)
单亲家庭（n=13 989）3 822 (27.32)2 917 (20.85)1 107 (7.91)
重组家庭（n=1 511）378 (25.02)314 (20.78)112 (7.41)
其他家庭（n=17 489）4 828 (27.61)3 603 (20.6)1 336 (7.64)
χ2值230.192.5645.51
P值<0.0010.767<0.001
校园欺侮
否（n=109 319）30 997 (28.35)22 411 (20.5)8 595 (7.86)
是（n=31 465）9 157 (29.1)6 481 (20.6)2 600 (8.26)
χ2值6.660.135.31
P值0.010.7130.021
住校
否（n=99 088）30 228 (30.51)20 168 (20.35)8 279 (8.36)
是（n=41 696）9 926 (23.81)8 724 (20.92)2 916 (6.99)
χ2值645.985.8074.16
P值<0.0010.016<0.001
政策环境
是（n=130 444）37 190 (28.51)26 653 (20.43)10 364 (7.95)
否（n=10 340）2 964 (28.67)2 239 (21.65)831 (8.04)
χ2值0.118.690.10
P值0.7450.0030.755
是（n=128 973）36 940 (28.64)26 213 (20.32)10 218 (7.92)
否（n=11 811）3 214 (27.21)2 679 (22.68)977 (8.27)
χ2值10.7836.741.76
P值0.001<0.0010.185
总体（n=140 784）40 154 (28.52)28 892 (20.52)11 195 (7.95)
), ArticleFig(id=1241329765379003138, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329575729361405, language=EN, label=Table 2, caption=

Multivariate Logistic regression analysis of factors associated with the co-occurrence of overweight, obesity, and elevated blood pressure among children and adolescents in Hubei Province (n=140 784)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2模型3模型4模型5
OR (95%CI)P值OR (95%CI)P值OR (95%CI)P值OR (95%CI)P值OR (95%CI)P值
个人特质
性别（ref：男）
女0.69 (0.66, 0.72)<0.0010.68 (0.66, 0.71)<0.0010.69 (0.66, 0.72)<0.0010.69 (0.66, 0.72)<0.0010.69 (0.66, 0.72)<0.001
学段（ref：小学）
初中1.18 (1.13, 1.24)<0.0011.16 (1.11, 1.22)<0.0011.17 (1.11, 1.22)<0.0011.24 (1.18, 1.30)<0.0011.25 (1.19, 1.31)<0.001
高中1.21 (1.15, 1.27)<0.0011.17 (1.11, 1.23)<0.0011.13 (1.07, 1.19)<0.0011.30 (1.22, 1.37)<0.0011.31 (1.23, 1.38)<0.001
行为特征
吸烟（ref：否）
是——0.94 (0.85, 1.02)0.1470.94 (0.86, 1.03)0.1770.96 (0.87, 1.05)0.3250.95 (0.87, 1.05)0.320
饮酒（ref：否）
是——1.06 (1.00, 1.12)0.0411.05 (0.99, 1.11)0.0741.06 (1.00, 1.11)0.0501.06 (1.00, 1.11)0.051
每天吃早餐（ref：是）
否——1.00 (0.96, 1.05)0.8821.01 (0.96, 1.06)0.7751.00 (0.96, 1.05)0.8721.00 (0.96, 1.05)0.879
中高强度运动（d，ref：0）
1～3——1.05 (1.00, 1.11)0.0751.04 (0.99, 1.10)0.1111.05 (0.99, 1.10)0.0881.05 (0.99, 1.10)0.079
≥4——0.92 (0.87, 0.98)0.0070.92 (0.86, 0.97)0.0030.92 (0.87, 0.98)0.0060.92 (0.87, 0.98)0.007
睡眠时间（ref：充足）
不足1.10 (1.05, 1.15)<0.0011.09 (1.04, 1.14)<0.0011.05 (1.00, 1.10)0.0351.05 (1.00, 1.10)0.036
人际网络
监测点（ref：城区）
郊县———0.85 (0.82, 0.89)<0.0010.88 (0.84, 0.91)<0.0010.87 (0.84, 0.91)<0.001
家庭结构（ref：核心家庭）
大家庭———1.05 (1.00, 1.10)0.0461.07 (1.02, 1.12)0.0071.07 (1.02, 1.12)0.008
隔代家庭———0.85 (0.79, 0.92)<0.0010.89 (0.82, 0.95)0.0020.88 (0.82, 0.95)0.001
单亲家庭———0.99 (0.93, 1.07)0.8850.99 (0.92, 1.06)0.7830.99 (0.92, 1.06)0.769
重组家庭———0.93 (0.76, 1.12)0.4400.94 (0.77, 1.14)0.5690.95 (0.77, 1.14)0.574
其他家庭———0.97 (0.91, 1.04)0.3981.00 (0.93, 1.06)0.9000.99 (0.93, 1.06)0.855
校园欺侮（ref：否）
是———1.04 (0.99, 1.09)0.0931.05 (1.00, 1.10)0.0411.05 (1.00, 1.10)0.046
生活和学习条件住校（ref：否）
是—————0.76 (0.72, 0.80)<0.0010.76 (0.72, 0.80)<0.001
政策环境
健康档案（ref：是）
否————————1.10 (1.02, 1.18)0.008
), ArticleFig(id=1241329765462889225, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329575729361405, language=CN, label=表2, caption=

湖北省儿童青少年超重肥胖与血压偏高共患影响因素的logistic回归分析（n=140 784）

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2模型3模型4模型5
OR (95%CI)P值OR (95%CI)P值OR (95%CI)P值OR (95%CI)P值OR (95%CI)P值
个人特质
性别（ref：男）
女0.69 (0.66, 0.72)<0.0010.68 (0.66, 0.71)<0.0010.69 (0.66, 0.72)<0.0010.69 (0.66, 0.72)<0.0010.69 (0.66, 0.72)<0.001
学段（ref：小学）
初中1.18 (1.13, 1.24)<0.0011.16 (1.11, 1.22)<0.0011.17 (1.11, 1.22)<0.0011.24 (1.18, 1.30)<0.0011.25 (1.19, 1.31)<0.001
高中1.21 (1.15, 1.27)<0.0011.17 (1.11, 1.23)<0.0011.13 (1.07, 1.19)<0.0011.30 (1.22, 1.37)<0.0011.31 (1.23, 1.38)<0.001
行为特征
吸烟（ref：否）
是——0.94 (0.85, 1.02)0.1470.94 (0.86, 1.03)0.1770.96 (0.87, 1.05)0.3250.95 (0.87, 1.05)0.320
饮酒（ref：否）
是——1.06 (1.00, 1.12)0.0411.05 (0.99, 1.11)0.0741.06 (1.00, 1.11)0.0501.06 (1.00, 1.11)0.051
每天吃早餐（ref：是）
否——1.00 (0.96, 1.05)0.8821.01 (0.96, 1.06)0.7751.00 (0.96, 1.05)0.8721.00 (0.96, 1.05)0.879
中高强度运动（d，ref：0）
1～3——1.05 (1.00, 1.11)0.0751.04 (0.99, 1.10)0.1111.05 (0.99, 1.10)0.0881.05 (0.99, 1.10)0.079
≥4——0.92 (0.87, 0.98)0.0070.92 (0.86, 0.97)0.0030.92 (0.87, 0.98)0.0060.92 (0.87, 0.98)0.007
睡眠时间（ref：充足）
不足1.10 (1.05, 1.15)<0.0011.09 (1.04, 1.14)<0.0011.05 (1.00, 1.10)0.0351.05 (1.00, 1.10)0.036
人际网络
监测点（ref：城区）
郊县———0.85 (0.82, 0.89)<0.0010.88 (0.84, 0.91)<0.0010.87 (0.84, 0.91)<0.001
家庭结构（ref：核心家庭）
大家庭———1.05 (1.00, 1.10)0.0461.07 (1.02, 1.12)0.0071.07 (1.02, 1.12)0.008
隔代家庭———0.85 (0.79, 0.92)<0.0010.89 (0.82, 0.95)0.0020.88 (0.82, 0.95)0.001
单亲家庭———0.99 (0.93, 1.07)0.8850.99 (0.92, 1.06)0.7830.99 (0.92, 1.06)0.769
重组家庭———0.93 (0.76, 1.12)0.4400.94 (0.77, 1.14)0.5690.95 (0.77, 1.14)0.574
其他家庭———0.97 (0.91, 1.04)0.3981.00 (0.93, 1.06)0.9000.99 (0.93, 1.06)0.855
校园欺侮（ref：否）
是———1.04 (0.99, 1.09)0.0931.05 (1.00, 1.10)0.0411.05 (1.00, 1.10)0.046
生活和学习条件住校（ref：否）
是—————0.76 (0.72, 0.80)<0.0010.76 (0.72, 0.80)<0.001
政策环境
健康档案（ref：是）
否————————1.10 (1.02, 1.18)0.008
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健康生态学视角下中小学生超重肥胖与血压偏高共患的影响因素研究
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刘翎 1 , 彭飞 1 , 向晶晶 1 , 谭婷 1 , 焦佳怡 2 , 罗丹 2 , 刘爽 1
现代预防医学 | 儿少卫生与妇幼保健 2025,52(13): 2395-2400
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现代预防医学 | 儿少卫生与妇幼保健 2025, 52(13): 2395-2400
健康生态学视角下中小学生超重肥胖与血压偏高共患的影响因素研究
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刘翎1, 彭飞1, 向晶晶1, 谭婷1, 焦佳怡2, 罗丹2, 刘爽1
作者信息
  • 1.湖北省疾病预防控制中心卫生监测检验防护所，湖北 武汉 430079
  • 2.武汉大学

    • 刘翎（1994—），女，博士，主管医师，研究方向：儿童青少年常见病多病同防

通讯作者:

刘爽，E-mail:
Prevalence and influencing factors of overweight/obesity and elevated blood pressure comorbidity among primary and secondary school students from the perspective of health ecology
Ling LIU1, Fei PENG1, Jing-jing XIANG1, Ting TAN1, Jia-yi JIAO2, Dan LUO2, Shuang LIU1
Affiliations
  • Institute of Health Monitoring and Testing Protection, Hubei Provincial Center for Disease Control and Prevention, Wuhan,Hubei 430079, China
出版时间: 2025-07-10 doi: 10.20043/j.cnki.MPM.202502031
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摘要
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目的

基于健康生态学模型探究中小学生超重肥胖与血压偏高共患现状及其影响因素，为我国学生常见病多病共防提供依据。

方法

采用分层整群随机抽样的方法，于2022年选取湖北省140 784名7～18岁儿童青少年作为研究对象，对其进行问卷调查、体格检查和血压测量。根据健康生态学模型的五个维度确定自变量，采用多因素logistic回归分析湖北省中小学生超重肥胖与血压偏高共患的影响因素。

结果

湖北省中小学生超重肥胖的检出率为28.52%，血压偏高的检出率为20.52%，超重肥胖与血压偏高共患的检出率为7.95%。Logistic回归分析显示初中生和高中生、睡眠不足、处于大家庭、存在校园欺侮、未建立健康档案与超重肥胖和血压偏高共患风险呈正相关（OR=1.25、1.31、1.05、1.07、1.05、1.10，P值均<0.05），而女生、每周中高强度运动≥4 d、郊县、处于隔代家庭、住校与共患风险呈负相关（OR=0.69、0.92、0.87、0.88、0.76；P值均<0.05）。

结论

湖北省中小学生超重肥胖、血压偏高及其共患的检出率较高，影响因素涉及健康生态学模型的多个维度，建议从个人、行为、环境、政策等多个角度进行常见病多病共防综合干预，促进学生身心健康。

超重肥胖  /  血压偏高  /  多病共患  /  健康生态学模型  /  学生
Objective

To investigate the comorbidity status and influencing factors of overweight/obesity and elevated blood pressure among primary and secondary school students based on the health ecological model, providing evidence for integrated prevention of common student health issues.

Methods

Using stratified cluster random sampling, 140 784 children and adolescents aged 7-18 years in Hubei Province were selected in 2022 for questionnaire surveys, physical examinations, and blood pressure measurements. Independent variables were determined according to five dimensions of the health ecological model, and multivariate logistic regression was used to analyze influencing factors.

Results

The detection rates were 28.52% for overweight/obesity, 20.52% for elevated blood pressure, and 7.95%for comorbidity. Logistic regression showed that junior/senior high school students (OR=1.25), insufficient sleep (OR=1.31), large family structure (OR=1.05), school bullying (OR=1.07), and lack of health records (OR=1.10) were positively associated with comorbidity risk (all P<0.05). Female gender (OR=0.69), moderate-to-vigorous exercise ≥4 days/week (OR=0.92), suburban residence (OR=0.87), skip-generation family (OR=0.88), and boarding (OR=0.76) were protective factors (all P<0.05).

Conclusion

The comorbidity of overweight/obesity and elevated blood pressure is prevalent among Hubei students, with influencing factors spanning multiple dimensions of the health ecological model. Comprehensive interventions addressing individual, behavioral, environmental, and policy aspects are recommended for integrated disease prevention.

Overweight/obesity  /  Elevated blood pressure  /  Comorbidity  /  Health ecological model  /  Students
刘翎, 彭飞, 向晶晶, 谭婷, 焦佳怡, 罗丹, 刘爽. 健康生态学视角下中小学生超重肥胖与血压偏高共患的影响因素研究. 现代预防医学, 2025 , 52 (13) : 2395 -2400 . DOI: 10.20043/j.cnki.MPM.202502031
Ling LIU, Fei PENG, Jing-jing XIANG, Ting TAN, Jia-yi JIAO, Dan LUO, Shuang LIU. Prevalence and influencing factors of overweight/obesity and elevated blood pressure comorbidity among primary and secondary school students from the perspective of health ecology[J]. Modern Preventive Medicine, 2025 , 52 (13) : 2395 -2400 . DOI: 10.20043/j.cnki.MPM.202502031
正文
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中小学生肥胖和高血压问题日益凸显，已成为影响我国儿童青少年健康的重要公共卫生问题[1]。肥胖和高血压不仅会对儿童青少年生理、心理和精神上造成严重影响，还将增加其成年后相关心血管代谢疾病的发病风险[2]。目前，我国儿童青少年肥胖和高血压流行呈上升趋势[3-4]，截至2019年，儿童青少年超重肥胖的检出率为19%[5]，血压偏高的检出率为13%[6]。研究发现，超重肥胖学生群体中高血压的发生率较高，反之亦然[7-8]，提示两者之间可能存在相互关联。内蒙古地区研究结果也显示，2021年学生超重肥胖与血压偏高共患率已达到9.45%[9]。此外，超重肥胖和高血压的发生往往受到多种相同因素的共同作用，例如不良饮食习惯、缺乏身体活动及睡眠不足等[10-11]。
既往研究较少从多层面综合系统地分析超重肥胖与血压偏高共患的影响因素，而健康生态学模型（health ecological model，HEM）主要强调健康受自身状态、行为习惯与生活环境等方面的综合影响，现已被广泛用于慢性病影响因素的探究与干预管理[12]。因此，本研究将基于HEM框架，系统分析湖北省中小学生超重肥胖与血压偏高的共患现状及其影响因素，为后续开展学生常见病共病-共因-共防提供依据。
1　对象与方法
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1.1　研究对象
研究对象来源于湖北省学生常见病及健康影响因素监测与干预项目，在2022年9月采用分层整群随机抽样的方法，覆盖湖北省17个市（州）下辖的所有区县（103个），在每个城区抽取2所小学、2所初中、2所高中和1所职高，在每个郊县抽取2所小学、2所初中、1所高中。再按年级分层，整班抽取学生开展调查，每个年级至少调查80名学生。本次研究共纳入有效样本140 784名，其中男生74 182名，女生66 602名，年龄范围为7～18岁。调查前已获得调查对象知情同意。
1.2　方法
1.2.1　问卷调查
使用全国学生常见病和健康影响因素监测项目工作统一编制的《中小学校开展学校卫生工作情况调查表》和《学生健康状况及影响因素调查表》进行调查，在以往研究中两种量表显示出良好的信度和效度[13-14]。
1.2.2　体格测量
按照《学生健康检查技术规范》（GB/T 26343—2010）[15]规定，进行身高和体重测量，并计算身体质量指数（body mass index，BMI）=体重（kg）/[身高(m)]2；采用电子血压计测量血压，若2次血压测量值超过10 mm Hg以上，则需再次测量，取3次读数的平均值进行记录。
1.2.3　变量选择
本研究以HEM模型的理论框架为指导，从5个维度初步选取13个可能影响中小学生超重肥胖和血压偏高共患的变量进行综合分析，见图1。第一层个人特质主要包括性别、学段；第二层行为特征主要包括吸烟、饮酒、吃早餐、运动、睡眠；第三层人际网络主要包括监测点、家庭结构、校园欺侮；第四层生活和学习条件主要包括住校；第五层政策环境主要包括学生体检和健康档案。
1.2.4　指标定义
（1）超重肥胖：根据《学龄儿童青少年超重与肥胖筛查》（WS/T 586—2018）[16]进行判断。（2）血压偏高：根据《7～18岁儿童青少年分年龄、性别、身高的血压偏高筛查界值》（WS/T610—2018）[17]进行判断。（3）超重肥胖和血压偏高共患：将同时存在超重肥胖和血压偏高定义为共患。（4）睡眠不足：根据《中小学生一日学习时间卫生要求》[18]进行判断。（5）中高强度运动：根据《ACSM运动测试与运动处方指南》[19]进行定义。（6）校园欺侮：通过中国青少年健康相关行为调查问卷进行评估，将相关条目中未选择“从未”或“否”者定义为存在校园欺侮[20]。
1.3　统计学方法
采用R语言（4.3.2）和SPSS 26.0进行统计分析，计数资料采用人数和检出率（%）描述，组间比较采用χ2检验，影响因素分析采用多因素logistic回归。基于健康生态学模型（HEM）的五个维度，逐步构建五个多因素logistic回归模型。模型1仅包含个人特质变量，模型2在此基础上加入行为特征变量，依此类推，最终模型纳入全部五个维度的变量。检验水准α=0.05。
2　结果
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2.1　中小学生超重肥胖、血压偏高及共患情况
湖北省中小学生超重肥胖的检出率为28.52%，血压偏高的检出率为20.52%，超重肥胖与血压偏高共患的检出率为7.95%。见表1。
2.2　中小学生超重肥胖与血压偏高共患的影响因素分析
2.2.1　单因素分析
不同性别、学段、吸烟、饮酒、中高强度运动、睡眠时间、监测点分布、家庭结构、校园欺侮以及是否住校的中小学生的超重肥胖与血压偏高共患率差异均有统计学意义（P值均<0.05）。见表1。
2.2.2　多因素logistic回归分析
以是否存在超重肥胖和血压偏高共患情况为因变量（否=0，是=1），以单因素分析结果P<0.2的变量为自变量，将HEM中五个维度的指标逐步纳入logistic回归分析。模型5结果显示，个人特征层的性别、学段，行为特征层的运动情况、睡眠时间，人际网络层的城乡分布、家庭结构、校园欺侮，生活与学习层的住校，以及政策环境层的是否建立健康档案是中小学生超重肥胖和血压偏高共患的影响因素（P值均<0.05）。具体而言，初中生和高中生、睡眠不足、处于大家庭、存在校园欺侮、未建立健康档案的学生超重肥胖和血压偏高共患风险更高（OR=1.25、1.31、1.05、1.07、1.05、1.10，P值均<0.05），而女生、每周中高强度运动≥4 d、郊县、处于隔代家庭、住校的学生共患风险更低（OR=0.69、0.92、0.87、0.88、0.76；P值均<0.05）。上述关联在模型1至模型5中的结果均稳定一致。见表2和图2。
3　讨论
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本研究结果显示，湖北省中小学生超重肥胖和血压偏高的检出率分别为28.52%和20.52%，均高于全国平均水平[21]。超重肥胖和血压偏高共患的检出率为7.95%，低于2021年内蒙古地区研究结果（9.45%）[9]，而高于拉萨市藏族中学生的研究结果（5.00%）[22]。这些数据表明湖北省儿童青少年超重肥胖以及血压偏高的问题较为普遍，且常常同时存在。
Logistic回归分析发现，性别、学段、中高强度运动等9个变量与超重肥胖以及血压偏高共患风险有关。
个体特征层对超重肥胖与血压偏高共患影响最大。其中，女生的共患风险更低，而随着学段的增加，共患风险呈上升趋势，这与既往研究一致[9]。行为特征层是HEM中最具动态性和可塑性的因素，可成为健康干预和管理策略的首要切入点。本研究发现，睡眠不足的学生面临更高的共患风险，而每周中高强度运动≥4 d的学生共患风险更低。睡眠不足主要可通过影响食欲和代谢路径，导致超重和血压问题[23]。在人际网络层面，大家庭和存在校园欺侮的学生共患风险更高。大家庭中的学生可能由于家庭资源分配不均，缺乏个性化的健康管理；而校园欺侮则可能引发心理应激反应[24]，进一步增加共患风险。另外，郊县学生共患风险更低可能与较少暴露于城市生活中的高风险因素（如高密度的交通污染、不健康的饮食习惯和心理压力等）[25]有关。在生活和学习条件层面，住校的学生共患风险更低，这与柏丽丽等[26]、刘黎等[27]的研究结果相似，其原因可能是住校学生的生活更规律、每日运动量相对充足，并且学校饮食注重控油限盐。政策环境可通过社会物质环境等更为宏观的层面间接影响人群的健康。本研究发现，未建立健康档案的学生共患风险更高。《中共中央国务院关于加强青少年体育增强青少年体质的意见》等文件对建立学生健康档案提出了明确要求，湖北省中小学生的建档率已达到91.61%，但在实际工作中学生健康档案管理制度和信息化平台建设仍需进一步加强和完善。
综上所述，湖北省中小学生超重肥胖和血压偏高共患负担较重，且影响因素具有多层次、多维度特点。睡眠和运动行为可作为干预的优先切入点。
基金
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  • 中央财政项目（重大传染病防控-重点传染病及健康危害因素监测）(0000019Z195110010004)
  • 湖北省自然科学基金青年项目(2024AFB526)
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2025年第52卷第13期
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doi: 10.20043/j.cnki.MPM.202502031
  • 接收时间：2025-02-03
  • 首发时间：2026-03-19
  • 出版时间：2025-07-10
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  • 收稿日期：2025-02-03
基金
中央财政项目（重大传染病防控-重点传染病及健康危害因素监测）(0000019Z195110010004)
湖北省自然科学基金青年项目(2024AFB526)
作者信息
    1.湖北省疾病预防控制中心卫生监测检验防护所，湖北 武汉 430079
    2.武汉大学

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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 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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