Ebrahim S, Wannamethee S G, Whincup P, Walker M, Shaper A G
Department of Social Medicine, University of Bristol, UK.
Int J Epidemiol. 2000 Jun;29(3):478-86.
Increasing life expectancy has brought public health concern about the increase in prevalence of disability in old age. Reducing the prevalence of disability in older age requires the identification of preventable or modifiable risk factors earlier in life. We have examined the relationship between lifestyle and other potential risk factors in men aged 40-59 years at screening and locomotor disability 12-14 years later to assess whether any of these factors have direct and independent roles in influencing disability in later life.
In 1978-1980, a longitudinal study of cardiovascular disease was initiated in 7735 men aged 40-59 years drawn from one general practice in each of 24 British towns. The present study concerns 5717 men, 88% of the surviving men who were available to follow-up (i.e. were registered with a GP and had an address) and who satisfactorily completed the disability section of a follow-up postal questionnaire in 1992 (Q92). The main endpoint from the questionnaire was locomotor disability based on self-reported inability in any one or more of the following: to get outdoors, walk 400 m, climb stairs, maintain balance, bend down, or straighten up.
In the 5717 men (mean age 63 years) who provided information on disability status, 25.0% reported locomotor disability and the majority of these men recalled a doctor-diagnosed disease of which cardiovascular disease was most strongly associated with locomotor disability. Lifestyle factors at screening (smoking, physical inactivity, obesity and heavy drinking) and manual social class were strongly and independently associated with increased odds of locomotor disability 12-14 years later. By contrast, baseline blood pressure and serum total cholesterol showed little relationship with locomotor disability. Among men with diagnosed major cardiovascular disease (stroke, myocardial infarction, angina or aortic aneurysm) those with locomotor disability showed significantly higher adverse lifestyle factors at screening than those who were able. Similarly, adverse lifestyle factors were also seen more frequently among disabled men with respiratory disease and among disabled men with other non-cardiovascular conditions than among their able counterparts.
Smoking, obesity, physical inactivity and heavy drinking in middle age are strong predictors of locomotor disability in later life independent of the presence of diagnosed disease. Leading a healthy lifestyle improves survival and reduces the incidence of disease. It also reduces the risk of locomotor disability and increases the odds of being disability-free even in the event of developing major cardiovascular disease.
预期寿命的延长引发了公众对老年残疾患病率上升的健康担忧。降低老年残疾患病率需要在生命早期识别出可预防或可改变的风险因素。我们研究了40 - 59岁男性在筛查时的生活方式及其他潜在风险因素与12 - 14年后运动功能残疾之间的关系，以评估这些因素是否在影响晚年残疾方面具有直接和独立的作用。
1978 - 1980年，对来自英国24个城镇中每个城镇一家普通诊所的7735名40 - 59岁男性开展了一项心血管疾病纵向研究。本研究涉及5717名男性，占可随访存活男性的88%（即已在全科医生处注册并有住址），且他们在1992年（Q92）圆满完成了随访邮政问卷中的残疾部分。问卷的主要终点是基于自我报告在以下任何一项或多项能力方面存在障碍的运动功能残疾：出门、步行400米、爬楼梯、保持平衡、弯腰或直起身体。
在提供残疾状况信息的5717名男性（平均年龄63岁）中，25.0%报告有运动功能残疾，且这些男性中的大多数回忆起曾被医生诊断患有疾病，其中心血管疾病与运动功能残疾的关联最为紧密。筛查时的生活方式因素（吸烟、缺乏身体活动、肥胖和酗酒）以及体力劳动者社会阶层与12 - 14年后运动功能残疾几率的增加密切且独立相关。相比之下，基线血压和血清总胆固醇与运动功能残疾的关系不大。在被诊断患有重大心血管疾病（中风、心肌梗死、心绞痛或主动脉瘤）的男性中，有运动功能残疾的人在筛查时不良生活方式因素显著高于没有残疾的人。同样，在患有呼吸系统疾病的残疾男性和患有其他非心血管疾病的残疾男性中，不良生活方式因素也比没有残疾的同龄人更常见。
中年时期的吸烟、肥胖、缺乏身体活动和酗酒是晚年运动功能残疾的有力预测因素，与是否患有已诊断疾病无关。保持健康的生活方式可提高生存率并降低疾病发病率。它还能降低运动功能残疾的风险，即使在患重大心血管疾病的情况下，也能增加无残疾的几率。
