中国老年人多病共存情况下肥胖状态与死亡关系的队列研究

Relationship between obesity and death by multi-morbidity status in older adults in China

目的探索不同多病共存状态下,中国老年人肥胖状态与死亡的关系。方法采用2011-2018年中国老年人健康长寿影响因素调查数据,纳入基线≥65岁的老年人为研究对象,利用探索性因子分析探索多病共存模式,分别基于基线疾病数量和多病共存模式定义研究对象的多病共存状态。肥胖状态采用基线BMI和腰围进行定义分组。采用Cox比例风险回归模型分析不同多病共存状态下肥胖状态与死亡的关系。结果共纳入6272名调查对象,研究发现我国老年人多病共存模式包括感知觉类、心血管代谢类和其他类。基于不同疾病数量进行分层,基线无疾病人群中,相较非中心性肥胖,中心性肥胖(HR=1.66,95%CI:1.04~2.66)死亡风险更高;基线仅患一种疾病的人群中,相较正常体重,低体重(HR=1.41,95%CI:1.10~1.80)死亡风险更高;在基线多病共存人群中,相较正常体重,低体重(HR=1.19,95%CI:1.05~1.34)的死亡风险更高,相较于非中心性肥胖,中心性肥胖(HR=0.88,95%CI:0.78~0.99)的死亡风险更低。结论不同多病共存状态下,中国老年人肥胖状态与死亡的关系存在差异,在患有一种基础疾病或多病共存的老年人中,低体重和非中心性肥胖是死亡的危险因素。在进行老年人群肥胖管理时,建议同时关注其多病共存状态,从而为老年人提供有效的个性化体重管理方案。

Objective To explore the relationship between obesity status and death stratified by different multi-morbidity status in older adults in China.Methods Data for older Chinese adults aged≥65 years were from Chinese Longitudinal Healthy Longevity Survey(CLHLS).Multi-morbidity patterns based on 13 chronic conditions were explored using exploratory factor analysis.Cox models were used to examine relationships between obesity status and death stratified by disease count and multi-morbidity patterns at baseline,respectively.Besides,obesity status was defined by baseline body mass index and waist circumference.Results A total of 6272 participants were included in the analyses.Multi-morbidity including cardio-metabolic,sensory perception and other patterns were identified.For those without any chronic condition,compared with those without central obesity,central obesity was associated with a higher risk for death(HR=1.66,95%CI:1.04-2.66).For those only with one chronic condition,compared with normal weight,underweight was associated with a higher risk for death(HR=1.41,95%CI:1.10-1.80).For those with multi-morbidity,compared with normal weight,underweight increased the risk for death(HR=1.19,95%CI:1.05-1.34).Compared with those without central obesity,central obesity decreased the risk for death(HR=0.88,95%CI:0.78-0.99).Conclusions Relationships between obesity status and death varied by multi-morbidity status in older adults in China.Underweight and non-central obesity were associated with increased risks for death in older adults with only one chronic disease or multi-morbidity.Therefore,it is necessary to pay attention to multi-morbidity status in the management of obesity in older adults and provide effective targeted body weight management plan.