中国老年人慢性病患病、失能与失智状况对死亡风险的影响:基于人群的前瞻性队列研究

The effect of chronic disease, disability, and dementia on all-cause mortality among older adults in China: a population-based prospective cohort study

目的 利用基于人群的前瞻性队列研究,分析协同控制后中国老年人慢性病患病、失能和失智对死亡风险的影响。方法 基于中国老年健康影响因素,跟踪调查2002―2018年共6期数据中13 540位65岁及以上老年人,采用Cox比例风险模型分析慢性病患病、失能和失智与死亡风险的关系。结果 65岁及以上老年人的生存平均时间为5.75(2.33.13.00)年。在充分调整混杂因素并协同控制三个维度健康因素后,本研究发现在慢性病患病维度,癌症患者比未患癌症者死亡风险高50%(HR=1.50, 95%CI:1.16~1.94),而非癌慢性病患病与否与死亡风险的关系差异无统计学意义。在失能维度,日常活动能力受限者比不受限者死亡风险高40%(HR=1.40, 95%CI:1.32~1.47)。在失智维度,认知受损者相较于未受损者死亡风险高30%(HR=1.30, 95%CI:1.23~1.37),痴呆患者相较于未患痴呆者死亡风险高26%(HR=1.26, 95%CI:1.09~1.46)。结论 在过去20年里,中国老年人健康相关的死亡风险因素主要来自患癌、日常活动能力受限、认知受损和罹患痴呆,提示对于老年人的死亡风险,相较于疾病特别是非癌慢性病患病本身,罹患疾病后的失能与失智尤为值得关注。

Objective To analyze the effects of chronic diseases, disability, and dementia on all-cause mortality among older adults in China using a prospective population-based cohort study. Methods Based on 13 540 older adults aged 65 years and above from the Chinese Longitudinal Healthy Longevity Survey, the Cox proportional hazard model was used to analyze the relationship between chronic diseases, disability as well as dementia, and all-cause mortality. Results The median survival time of older adults aged 65 years old and above was 5.75(2.33. 13.00) years. After adjusting for confounders, cancer respondents had a 50% risk of mortality than those without cancer(HR=1.50, 95% CI:1.16-1.94), while the relationship between noncancerous chronic disease and mortality risk was not statistically significant. With a view to a disability, the mortality risk increased by 40% in subjects with activities of daily living(ADL) restriction than in those without ADL restriction(HR=1.40, 95% CI:1.32-1.47). In terms of cognitive ability, subjects with cognitive impairment had a 30% higher risk of mortality than those without cognitive impairment(HR=1.30, 95% CI:1.23-1.37), and those with dementia had a 26% risk of mortality than those without dementia(HR=1.26, 95% CI:1.09-1.46). Conclusions During the past 20 years, the health factors associated with all-cause mortality risk among older adults in China are mainly cancer, ADL restriction, cognitive impairment, and dementia, suggesting that for the all-cause mortality risk of the older adults, compared with diseases, especially noncancerous chronic diseases themselves, the disability and dementia after suffering from diseases are particularly worthy of attention.