北京城乡老年人血尿酸水平与全因死亡风险的关联研究

Correlation between serum uric acid level and all-cause death risk among urban and rural elderly in Beijing

目的探讨北京城乡老年人基线血尿酸(SUA)水平与全因死亡之间的关联,为明确老年人群SUA水平与全因死亡的关联提供科学依据。方法数据来源于北京城乡老年人群健康综合研究(Beijing Elderly Comprehensive Health Cohort Study,BECHCS)。于2009年9月—2010年6月和2014年6—9月,采用两阶段随机抽样方法分别选取北京市海淀区万寿路街道和密云区巨各庄镇及冯家峪镇≥60岁的老年居民为研究对象,进行问卷调查、体格检查和实验室检测,每2~3年随访1次,随访截至2021年3月31日。研究共纳入4471人,其中城市社区2075人,农村社区2396人。根据高尿酸血症的诊断标准(SUA水平>420μmol/L)分为非高尿酸血症组(4104人)和高尿酸血症组(367人)。使用SPSS 26.0和R 4.0.3软件进行秩和检验和χ^(2)检验,采用Cox比例风险回归模型分析基线SUA与全因死亡风险之间的关联并探讨城乡差异。结果截至2021年3月31日,研究的中位随访时间为6.75年(P25,P75:6.63,11.10年),死亡率为14.87%(665/4471),死亡密度为183.23/10000人年。多因素Cox比例风险回归模型分析结果显示,总人群中SUA水平每增加10μmol/L,全因死亡风险增加1.30%(HR=1.013,95%CI:1.003~1.022);高尿酸血症组全因死亡风险是非高尿酸血症组的1.280倍(HR=1.280,95%CI:1.013~1.618)。在农村老年人群中,SUA水平每增加10μmol/L,全国死亡风险增加2.10%(HR=1.021,95%CI:1.006~1.036),高尿酸血症组全因死亡风险是非高尿酸血症组的1.752倍(HR=1.752,95%CI:1.227~2.503)。在男性老年人群中,SUA水平每增加10μmol/L,全因死亡风险增加1.40%(HR=1.014,95%CI:1.001~1.027),高尿酸血症组全因死亡风险是非高尿酸血症组的1.291倍(HR=1.291,95%CI:0.974~1.711);在农村男性老年人群中,SUA水平每增加10μmol/L,全因死亡风险增加2.20%(HR=1.022,95%CI:1.002~1.043),高尿酸血症组全因死亡风险是非高尿酸血症组的1.804倍(HR=1.804,95%CI:1.169~2.783),均有统计学意义(P<0.05)。结论北京城乡老年人群中,SUA水平与全因死亡风险增加密切相关,高尿酸血症是全因死亡的独立危险因素,在农村老年人群和男性老年人群中尤为显著。

Objective To explore the correlation between baseline serum uric acid(SUA)level and the risk of all-cause death in urban and rural elderly in Beijing,and provide the scientific basis for the correlation between the elderly SUA level and the allcause death risk.Methods The data were from the Beijing Elderly Comprehensive Health Cohort Study(BECHCS).From September 2009 to June 2010 and from June to September 2014,the two-stage random sampling method was used to select elderly residents(≥60 years old)from Wanshou Road in Haidian district and Jugezhuang town and Miyun county of Beijing,respectively as the subjects.The investigation was performed with questionnaire,physical examination and laboratory test;and it took 2 to 3 years to follow up once.Following-up ended on March 31,2021.A total of 4471 people were included in the study,including 2075 urban residents and 2396 rural residents.According to the diagnostic criteria(SUA level>420μmol/L)of hyperuricemia,the subjects were divided into non-hyperuricemia group(4104 cases)and hyperuricemia group(367 cases).The rank sum test andχ^(2) test were used to analyze the data,and Cox proportional hazard regression model was used to analyze the association strength between baseline SUA level and the all-cause death risk,and to explore the difference between urban and rural areas.The used software was SPSS 26.0 and R 4.0.3.Results As of March 31,2021,the median of following-up time was 6.75 years(P25-P75:6.63-11.10 years),the mortality was 14.87%(665/4471),and the death density was 183.23/104 person-years.Multivariate Cox proportional hazard regression model showed that when SUA level in total population increased 10μmol/L,the all-cause death risk increased 1.30%(HR=1.013,95%CI:1.003-1.022);the all-cause death risk in the hyperuricemia group was 0.280 times higher than that in the non-hyperuricemia group(HR=1.280,95%CI:1.013-1.618).In rural elderly population,when SUA level increased 10μmol/L,HR value was 1.021(95%CI:1.006-1.036),and the all-cause death risk in hyperuricemia group was 0.752 times higher than that in non-hyperuricemia group(HR=1.752,95%CI:1.227-2.503).In the male elderly,when SUA level increased 10μmol/L,the all-cause death risk increased 1.40%(HR=1.014,95%CI:1.001-1.027),and the all-cause death risk in the hyperuricemia group was 0.291 times higher than that in the non-hyperuricemia group(HR=1.291,95%CI:0.974-1.711);in rural male elderly,when SUA level increased 10μmol/L,the all-cause death risk increased 2.20%(HR=1.022,95%CI:1.002-1.043),the all-cause death risk in hyperuricemia group was 0.804 times higher than that in non-hyperuricemia group(HR=1.804,95%CI:1.169-2.783),P<0.05.Conclusion In urban and rural elderly of Beijing,SUA level is closely related to the increased all cause risk,and hyperuricemia is an independent risk factor for all-cause death,specially in rural elderly and male elderly.