Inoue Yusuke, Koizumi Akio, Wada Yasuhiko, Iso Hiroyasu, Watanabe Yoshiyuki, Date Chigusa, Yamamoto Akio, Kikuchi Shogo, Inaba Yutaka, Toyoshima Hideaki, Tamakoshi Akiko
Department of Health and Environmental Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
J Epidemiol. 2007 Nov;17(6):194-202. doi: 10.2188/jea.17.194.
There have been few systematic investigations into risk and protective factors for pneumonia related mortality for community residents. This study investigated these factors utilizing a large cohort study on Japanese community residents.
Subjects, 110,792 individuals (aged 40-79 years) enrolled in 1988-1990, were followed until death, or when they moved away from the surveyed communities, or the end of 2003. Pneumonia death was defined following 480-486 (International Classification of Diseases, 9th Revision) or J12-J18 (10th Revision). Age-adjusted and multivariate hazard ratios were calculated along with 95% confidence intervals using the Cox proportional hazards model.
With 1,112,747 person-years of the study, a total of 1,246 persons died of pneumonia. We found history of blood transfusion (multivariate hazard ratio=2.0 [95% confidence interval: 1.7-2.4]) was a potent novel risk factor. Walking 0.5-1 hour/day (0.8 [0.6-1.0]), 1+ hour/day (0.7 [0.6-0.8]), and/or a history of pregnancy (0.6 [0.4-0.9]) were found to reduce pneumonia mortality. A large body mass index (BMI) (25+kg/m(2)) was a protective factor (0.7 [0.5-0.8]), while low BMI (<18) was confirmed as a risk one (2.1 [1.7-2.6]). Smoking was an important preventable risk factor (1.6 [1.3-1.9], population attributable risk proportion=14%), and its cessation reduced risk (0.7 [0.5-1.0]) to levels comparable to neversmokers (0.7 [0.5-1.0]).
The risk and protective factors ascertained here for pneumonia mortality among community residents, history of blood transfusion, large BMI, and walking habits, warrant further study. Smoking cessation may effectively reduce pneumonia mortality.
针对社区居民肺炎相关死亡率的风险因素和保护因素，系统研究较少。本研究利用一项针对日本社区居民的大型队列研究对这些因素进行了调查。
研究对象为1988年至1990年纳入的110,792名40至79岁个体，随访至死亡、搬离被调查社区或2003年底。肺炎死亡按照国际疾病分类第9版480 - 486编码或第10版J12 - J18编码定义。使用Cox比例风险模型计算年龄调整后的多变量风险比及95%置信区间。
在1,112,747人年的研究中，共有1246人死于肺炎。我们发现输血史（多变量风险比 = 2.0 [95%置信区间：1.7 - 2.4]）是一个新发现的重要风险因素。每天步行0.5至1小时（0.8 [0.6 - 1.0]）、每天步行1小时以上（0.7 [0.6 - 0.8]）和/或有妊娠史（0.6 [0.4 - 0.9]）可降低肺炎死亡率。高体重指数（BMI）（25 + kg/m²）是一个保护因素（0.7 [0.5 - 0.8]），而低BMI（<18）被确认为风险因素（2.1 [1.7 - 2.6]）。吸烟是一个重要的可预防风险因素（1.6 [1.3 - 1.9]，人群归因风险比例 = 14%），戒烟可降低风险（0.7 [0.5 - 1.0]）至与从不吸烟者相当的水平（0.7 [0.5 - 1.0]）。
本研究确定的社区居民肺炎死亡率的风险因素和保护因素，如输血史、高BMI和步行习惯，值得进一步研究。戒烟可能有效降低肺炎死亡率。
