Oman D, Reed D, Ferrara A
Epidemiology Department, Buck Center for Research in Aging, Novato, CA 94948-0638, USA.
Am J Epidemiol. 1999 Oct 15;150(8):834-42. doi: 10.1093/oxfordjournals.aje.a010088.
This study investigated whether the commonly observed higher prevalence of physical disability among women is due to higher incidence rates or to other factors such as selective mortality or poor recovery. Methods included observed measures of prevalent lower body physical disability and potential risk factors at baseline (1989-1991) and 4-year follow-up of 2,025 community-dwelling adults aged 55 years and older in Marin County, California. Incidence, recovery, and mortality rates were determined at the follow-up examination. Results indicated that women had higher age-specific and age-adjusted prevalence rates at both examinations (odds ratios = 1.66 and 1.60, p<0.001) but that incidence rates were not significantly different (odds ratio = 1.12, 95% confidence interval: 0.77, 1.64). In the classic formulation, prevalence = incidence x duration, the higher prevalence rates in women could not be due to a higher incidence rate, but could be explained by longer duration due to lower recovery and mortality rates in women. Incident physical disability was predicted by prevalent chronic illnesses, poor vision, obesity, physical inactivity, poor memory, fewer social activities, and higher depression scores, but not by sex. Prevention efforts should concentrate on reducing known risk factors in both men and women and on promoting higher recovery rates among women.
本研究调查了女性中普遍观察到的身体残疾患病率较高是由于发病率较高，还是由于其他因素，如选择性死亡率或恢复不佳。方法包括在基线（1989 - 1991年）观察普遍存在的下肢身体残疾和潜在风险因素，并对加利福尼亚州马林县2025名年龄在55岁及以上的社区居住成年人进行4年随访。在随访检查时确定发病率、恢复率和死亡率。结果表明，在两次检查中，女性的年龄特异性和年龄调整患病率均较高（优势比分别为1.66和1.60，p<0.001），但发病率没有显著差异（优势比 = 1.12，95%置信区间：0.77，1.64）。在经典公式患病率 = 发病率×病程中，女性较高的患病率并非由于发病率较高，而是可以用女性较低的恢复率和死亡率导致的病程较长来解释。新发身体残疾可由普遍存在的慢性疾病、视力不佳、肥胖、缺乏身体活动、记忆力差、社交活动较少以及抑郁评分较高预测，但与性别无关。预防措施应集中于降低男性和女性已知的风险因素，并提高女性的恢复率。
