Fulks Michael, Stout Robert L, Dolan Vera F
Clinical Reference Laboratory, Jackson, CA, USA.
J Insur Med. 2009;41(4):244-53.
Determine the relationship between various lipid tests and all-cause mortality in life insurance applicants stratified by age and sex.
By use of the Social Security Death Master File, mortality was determined in 1,488,572 life insurance applicants from whom blood samples were submitted to Clinical Reference Laboratory. There were 41,020 deaths observed in this healthy adult population during a median follow-up of 12 years (range 10 to 14 years). Results were stratified by 4 age-sex subpopulations: females, ages 20 to 59 or 60+; and males, ages 20 to 59 or 60+. Those with serum albumin < 3.6 mg/dL or fructosamine > or = 2.1 mmol/L were excluded. The middle 50% of lipid values specific to each of these 4 age-sex subpopulations was used as the reference band. The mortality rates in bands representing other percentiles of lipid values were compared with the mortality rate in the reference band within each age-sex subpopulation.
In contrast to some published findings from general populations, lipid test results are only moderately predictive of all-cause mortality risk in a life insurance applicant population and that risk is dependent on age and sex. At ages below 60, HDL values are associated with a "J" shaped mortality curve and at ages 60+, total cholesterol is associated with a "U" shaped curve. The total cholesterol/HDL ratio may serve as a useful single measure to predict mortality risk, but only if stratified by age and sex, and only if high HDL values at younger ages and lower total cholesterol values at ages 60+ are recognized as being associated with increased risk as well. Using LDL or non-HDL cholesterol instead of total cholesterol does not improve mortality risk discrimination; neither does using total cholesterol or triglyceride values in addition to the total cholesterol/HDL ratio.
The total cholesterol/HDL ratio is the best single measure of all-cause mortality risk among the various lipid tests but is useful only if viewed on an age- and sex-specific basis and is only a modest risk predictor.
确定在按年龄和性别分层的人寿保险申请人中，各种血脂检测指标与全因死亡率之间的关系。
利用社会保障死亡主文件，确定了1,488,572名人寿保险申请人的死亡率，这些申请人的血样已提交至临床参考实验室。在这一健康成年人群中，中位随访12年（范围10至14年）期间观察到41,020例死亡。结果按4个年龄 - 性别亚组分层：20至59岁或60岁以上的女性；以及20至59岁或60岁以上的男性。血清白蛋白<3.6mg/dL或果糖胺>或=2.1mmol/L的患者被排除。这4个年龄 - 性别亚组各自特定的血脂值中间50%用作参考范围。将代表其他血脂值百分位数范围的死亡率与每个年龄 - 性别亚组内参考范围内的死亡率进行比较。
与一般人群中一些已发表的研究结果相反，血脂检测结果在人寿保险申请人人群中对全因死亡风险的预测作用仅为中等程度，且该风险取决于年龄和性别。在60岁以下，高密度脂蛋白（HDL）值与“J”形死亡率曲线相关，在60岁以上，总胆固醇与“U”形曲线相关。总胆固醇/HDL比值可作为预测死亡风险的有用单一指标，但前提是要按年龄和性别分层，并且只有在认识到年轻人群中高HDL值以及60岁以上人群中低总胆固醇值也与风险增加相关时才行。使用低密度脂蛋白（LDL）或非HDL胆固醇替代总胆固醇并不能改善对死亡风险的判别；同时使用总胆固醇或甘油三酯值以及总胆固醇/HDL比值也不行。
在各种血脂检测指标中，总胆固醇/HDL比值是全因死亡风险的最佳单一指标，但只有在按年龄和性别特定的基础上观察时才有用，并且只是一个中等程度的风险预测指标。
