Cook N R, Evans D A, Scherr P A, Speizer F E, Taylor J O, Hennekens C H
Channing Laboratory, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Brookline, MA 02146.
Am J Epidemiol. 1991 Apr 15;133(8):784-94. doi: 10.1093/oxfordjournals.aje.a115957.
During a population survey in 1982-1983 among all community-dwelling elderly aged 65 years and over in East Boston, Massachusetts, measurements of peak expiratory flow rate using the mini-Wright peak flow meter were made on 3,582 participants (80% of those eligible). The average peak flow rate was 315 liters/minute, and a measure of peak flow rate adjusted for age, sex, height, and weight was computed. This was a highly significant (p less than 0.0001) predictor of 5-year total mortality, whose ascertainment was virtually complete. The relative risk was 1.27 (95 percent confidence interval 1.19-1.36) per 100 liters/minute decrease in peak flow rate, using a proportional hazards model including terms for age, sex, and smoking. There was no apparent modification of the effect of this measure in various categories of smoking, with relative risks of 1.24 for nonsmokers, 1.29 for ex-smokers, and 1.26 for current smokers. This finding also persisted after adjustments for other covariates, including respiratory symptoms such as cough, phlegm, and wheeze; cardiovascular risk factors such as history of myocardial infarction and stroke; and systolic and diastolic blood pressures; socioeconomic status; scores on simple tests of cognitive function; measures of physical activity and functional ability; and self-assessed state of health. In a stepwise model including all of these variables, the relative risk was 1.16 (p less than 0.0001) per 100 liters/minute decrease in peak flow rate, indicating that peak flow rate is a strong independent predictor of total mortality in the elderly.
在1982年至1983年对马萨诸塞州东波士顿所有65岁及以上社区居住老年人进行的一项人口调查中，使用小型赖特峰值流量计对3582名参与者（80%符合条件者）进行了呼气峰值流速测量。平均峰值流速为315升/分钟，并计算了根据年龄、性别、身高和体重调整后的峰值流速测量值。这是5年总死亡率的一个高度显著（p<0.0001）预测指标，其确定几乎是完整的。使用包含年龄、性别和吸烟因素的比例风险模型，每降低100升/分钟的峰值流速，相对风险为1.27（95%置信区间1.19 - 1.36）。在不同吸烟类别中，该指标的影响没有明显改变，非吸烟者的相对风险为1.24，既往吸烟者为1.29，当前吸烟者为1.26。在对其他协变量进行调整后，这一发现依然存在，这些协变量包括咳嗽、咳痰和喘息等呼吸道症状；心肌梗死和中风病史等心血管危险因素；收缩压和舒张压；社会经济地位；认知功能简单测试得分；身体活动和功能能力测量值；以及自我评估的健康状况。在包含所有这些变量的逐步模型中，每降低100升/分钟的峰值流速，相对风险为1.16（p<0.0001），表明峰值流速是老年人总死亡率的一个强有力的独立预测指标。
