中国10个地区56~69岁成年人过早死亡及其影响因素的前瞻性队列研究

A prospective cohort study of premature death and influencing factors in adults aged 56-69 years from 10 regions of China

目的:描述和分析中国10个地区近10万成年人随访10年间过早死亡(死亡年龄<70岁)的流行病学特征及其影响因素。方法:数据来源于CKB研究基线调查(人口学特征、生活方式、体格指标等)及随访监测(截至2017年12月31日的健康结局事件),分地区、性别、基线生活方式等变量描述研究人群10年随访期间内的过早死亡,并分析其死因情况,并利用Cox比例风险回归模型分析过早死亡的相关影响因素。结果:研究纳入99993名研究对象(56~69岁),经过10年随访,每1000人年的过早死亡率为7.15,死因别死因以癌症(36.9%)和心脑血管疾病(35.2%)为主,过早死亡率(/1000人年)表现为农村高于城市(9.11 vs.4.78),北方高于南方(8.46 vs.6.41),男性高于女性(9.57 vs.5.31),随基线年龄增加而降低(均P<0.05)。过早死亡风险随吸烟量增加而增加,既往饮酒者和重度饮酒者(饮酒量≥60 g/d)过早死亡风险较高[HR值分别为1.25(95%CI:1.16~1.36)、1.20(95%CI:1.08~1.34)];过早死亡风险随体力活动水平增加而降低;相对于体重正常和非中心性肥胖者,低体重者与中心性肥胖者过早死亡风险更高[HR值分别为1.67(95%CI:1.55~1.81)、1.13(95%CI:1.05~1.21)]。结论:我国56~69岁成年人10年随访过早死亡以癌症和心脑血管疾病为主,存在明显的社会经人口济学特征差异,且其风险受到生活方式及体格指标等多因素影响。

Objective To describe and analyze the epidemiological characteristics of premature death(death before age of 70 years)and related risk factors in approximate 100000 adults recruited from 10 regions of China during a 10-year follow-up.Methods Data,including demographic characteristics,lifestyle and physical indicators as well as health outcomes as of December 31,2017,were obtained from baseline survey and long-term follow-up of the China Kadoorie Biobank(CKB)study.All-cause and cause-specific premature death in different areas,in men and women and in people with different lifestyles were analyzed.Cox proportional risk model was used to analyze the associations between baseline factors and premature death.Results A total of 99993 participants aged 56-69 years were included in the study.During 10 years of follow-up,7530 premature deaths were recorded and the premature death rate was 7.15 per 1000 person-years.The main causes of premature death were cancer and cardiovascular and cerebrovascular diseases.The premature mortality rate was higher in rural areas,in northern region and in men,and decreased with age(P<0.05).Premature death was more likely to occur in smokers,and a dose-response relationship was observed.Compared with non-drinkers,the risk for premature death was higher in ex-drinkers(HR:1.25[95%CI:1.16-1.36])and heavy drinkers(average alcohol consumption≥60 g/d)(HR:1.20[95%CI:1.08-1.34]).The risk for premature death decreased with the increase of physical activity.Low body weight and central obesity were independently associated with increased risk for premature death(HR:1.67[95%CI:1.55-1.81]and 1.13[95%CI:1.05-1.21],respectively).Conclusions The main causes of premature death in adults aged 56-69 years in China during 10-year follow-up were cancer and cardiovascular and cerebrovascular diseases.The premature mortality rate varied with socioeconomic and demographic characteristics.The risk for premature death was influenced by multi factors,such as lifestyle and physical conditions.