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目的系统评价老年人健康自评的影响因素及其影响程度。方法计算机检索MEDLINE、EMbase、CBM、CNKI、VIP和WanFang Data,收集国内外1960年1月至2011年4月公开发表的关于老年人健康自评影响因素的研究文献。采用相对危险度(RR)或比值比(OR)作为相关性分析合并统计量,并应用相关性分析合并统计量(RR或OR)和总体人群暴露率估计某影响因素的人群归因危险度百分比。采用RevMan 5.1软件进行Meta分析。结果纳入12个研究,35 349例研究对象。其中10个研究在中国完成,其余2个研究分别来自于巴西和美国;11个为横断面研究,1个为队列研究。导致老年人健康自评差的主要因素及OR值(95%CI)为生活需要照料12.1(06.31,23.20)、糖尿病6.49(3.21,13.09)、冠心病5.60(1.07,29.42);而人群归因危险度排名前三位的因素依次为冠心病(53.91%)、半年前患病(52.56%)和慢性疾病(50.09%)。因符合纳入标准的研究较少,未能作亚组分析。结论现有证据显示,老年人健康自评差的主要影响因素为慢性疾病,但由于纳入研究数量有限,且主要为横断面研究,因果论证强度不足,故目前尚不能确定老年人健康自评的影响因素及其影响程度,期待更多前瞻性队列研究提供高质量证据。
Objective To systematically evaluate the influential factors and their influence on health self-assessment of the elderly. METHODS: MEDLINE, EMbase, CBM, CNKI, VIP and WanFang Data were searched by computer. The research literature on the influential factors of health self-assessment of the elderly was collected from January 1960 to April 2011 in China. The relative risk (RR) or odds ratio (OR) was used as the correlation to analyze the combined statistic, and the correlation analysis was used to analyze the combined statistic (RR or OR) and the total population exposure rate to estimate the influential factors of the population attributable risk percentage . Meta-analysis was performed using RevMan 5.1 software. Results The study included 12 studies and 35 349 subjects. Ten of these studies were completed in China and the remaining two were from Brazil and the United States respectively; 11 were cross-sectional and 1 were cohort studies. The main factors that lead to poor self-evaluation of the elderly and OR (95% CI) were 12.1 (06.31,23.20), 6.49 (3.21, 13.09) and 5.60 (1.07, 29.42) The top three risk factors were coronary heart disease (53.91%), disease six months ago (52.56%) and chronic diseases (50.09%). Subsequent analyzes failed to meet the inclusion criteria. Conclusions The available evidence shows that the main influencing factors of poor health self-assessment of the elderly are chronic diseases. However, due to the limited number of included studies and the mainly cross-sectional studies, the strength of causal argumentation is not strong enough to determine the health self-assessment of the elderly Influencing factors and the extent of their impact, looking forward to more prospective cohort studies provide high-quality evidence.