Division of Endocrinology, Diabetes, and Metabolism, University of Pennsylvania School of Medicine, Philadelphia, USA.
J Gerontol A Biol Sci Med Sci. 2011 Jul;66(7):809-14. doi: 10.1093/gerona/glr063. Epub 2011 May 31.
Despite widespread use, there are no data on initiation of thyroid hormone use in older people. We report the prevalence of thyroid hormone use and predictors of thyroid hormone initiation in a population of older men and women.
Thyroid hormone medication data were collected annually from 1989 to 2006 in community-dwelling individuals aged 65 years and older enrolled in the Cardiovascular Health Study (N = 5,888). Associations of age, sex, race, body mass index, education, and coronary heart disease with initiation were evaluated using discrete-time survival analysis.
In 1989-1990, 8.9% (95% confidence interval 8.1%-9.7%) of participants were taking a thyroid hormone preparation, increasing to 20.0% (95% confidence interval 8.2%-21.8%) over 16 years. The average initiation rate was 1% per year. The initiation rate was nonlinear with age, and those aged 85 years and older initiated thyroid hormone more than twice as frequently as those aged 65-69 years (hazard ratio = 2.34; 95% confidence interval 1.43-3.85). White women were more likely to initiate thyroid hormone than any other race and sex group. Higher body mass index was independently associated with higher risk for initiation (p = .002) as was greater education (p = .02) and prevalent coronary heart disease (p = .03).
Thyroid hormone use is common in older people. The indications and benefits of thyroid hormone use in older individuals with the highest rate of thyroid hormone initiation-the oldest old, overweight and obese individuals, and those with coronary heart disease-should be investigated.
尽管甲状腺激素的应用已经广泛，但在老年人中关于其应用起始的相关数据仍然缺乏。本研究报告了在一个老年男性和女性人群中，甲状腺激素应用的流行情况及其起始应用的预测因素。
从 1989 年至 2006 年，我们每年收集一次参加心血管健康研究（CVHS）的年龄在 65 岁及以上的社区居住者的甲状腺激素药物数据（N=5888）。应用离散时间生存分析评估年龄、性别、种族、体重指数、教育程度和冠心病与起始应用的相关性。
在 1989-1990 年，8.9%（95%置信区间 8.1%-9.7%）的参与者正在服用甲状腺激素制剂，16 年内增加到 20.0%（95%置信区间 8.2%-21.8%）。起始应用的平均速率为每年 1%。起始应用率随年龄呈非线性变化，85 岁及以上的人群起始应用甲状腺激素的频率是 65-69 岁人群的两倍多（风险比=2.34；95%置信区间 1.43-3.85）。白种女性比任何其他种族和性别组更有可能起始应用甲状腺激素。较高的体重指数与较高的起始应用风险独立相关（p=0.002），受教育程度较高（p=0.02）和存在冠心病（p=0.03）也与较高的起始应用风险相关。
甲状腺激素在老年人中应用广泛。对于起始应用甲状腺激素频率最高的人群（最老的老年人、超重和肥胖的个体以及患有冠心病的个体），应该调查其应用甲状腺激素的指征和获益。
