基于竞争风险模型的北京市老年人健康自评与卒中发生关系的队列研究

Relationship between self-rated health of the elderly in Beijing and the occurrence of stroke based on a competitive risk model:a cohort study

目的探讨北京市年龄≥55岁老年人健康自评与卒中发生的风险。方法研究对象来源于1992年1月至2012年12月首都医科大学宣武医院收集的北京市老龄化多维纵向研究数据共2 101名,年龄≥55岁。排除基线患有卒中121名、信息不完整92名,最终1 888名基线无脑血管病的老年人纳入分析。健康自评的判定是调查对象根据自身的实际情况,从"良好、一般、差"中选择符合自身当前状态的项目。调查截止日期为2012年12月31日。采用竞争风险模型评价健康自评状态与卒中发生的风险,将非卒中死亡,包括癌症、车祸等作为竞争事件处理。结果纳入的1 888名研究对象中,健康自评良好者946名(50.1%)、一般者616名(32.6%)、差者326名(17.3%);发生卒中438名(23.2%),非卒中死亡751名(37.8%),右删失数据699名(37.0%)。采用竞争风险模型,调整年龄、性别、居住地区、婚姻状况、教育水平、吸烟、饮酒、体育锻炼、高血压、糖尿病、冠心病和体质量指数,健康自评差者发生卒中是良好者的1.44倍(95%CI:1.11~1.87,P<0.01)。结论北京市年龄≥55岁老年人健康自评中,考虑竞争风险后,健康自评差者增加了卒中发生的风险。

Objective To investigate the risks of self-rated health in the ≥55-year elderly in Beijing and the occurrence of stroke.Methods The subjects （n=2 101;aged ≥55） from Beijing longitudinal study of aging （BLSA） were collected by Xuanwu Hospital,Capital Medical University from January 1992 to December 2016.One hundred and twenty-one subjects with stroke at baseline and 92 with incomplete information were excluded,and finally,1 888 elderly patients without cerebrovascular disease at baseline were included in the analysis.Based on the actual situation,the self-rated health was to identify an item that matched their current state from ＂good,general to poor＂.The deadline for the survey was December 31,2012.The competitive risk model was used to assess the health self-rated status and the risk of stroke.Non-stroke deaths,including cancer and car accidents were treated as competitive events.Results Of the 1 888 subjects enrolled,946 （50.1%） self-rated health were good,616 （32.6%） were general,and 326 （17.3%） were poor;438 （23.2%） had stroke,751 （37.8%） had non-stroke death,and 699 （37.0%） were right censored data.Using the competing risk model and adjusting the age,sex,living area,marital status,education level,smoking,alcohol consumption,physical exercise,hypertension,diabetes mellitus,coronary heart disease,and body mass index,the occurrence of stroke in patients with poor self-rated health was 1.44 times （95%CI 1.11-1.87,P〈0.01） as good as those who were good.Conclusion In the self-rated health of the elderly ≥55 years old in Beijing,the people with poor self-rated health increased the occurrence of stroke after considering the competitive risks.