Mnatzaganian George, Ryan Philip, Norman Paul E, Davidson David C, Hiller Janet E
School of Population Health and Clinical Practice, Discipline of Public Health, University of Adelaide, Adelaide, South Australia, Australia.
Arthritis Rheum. 2011 Aug;63(8):2523-30. doi: 10.1002/art.30400.
To assess the associations of smoking, body weight, and physical activity with risk of undergoing total joint replacement (TJR) in a population-based cohort of men.
A cohort study of 11,388 men that integrated clinical data with hospital morbidity data and mortality records was undertaken. The risk of undergoing TJR was modeled on baseline weight, height, comorbidity, socioeconomic status, years of smoking, and exercise in 3 separate age groups, using Cox proportional hazards regressions and competing risk regressions (CRRs).
Dose-response relationships between weight and risk of TJR and between smoking and risk of TJR were observed. Being overweight independently increased the risk of TJR, while smoking lowered the risk. The decreased risk among smokers was demonstrated in both Cox and CRR models and became apparent after 23 years of exposure. Men who were in the highest quartile (≥48 years of smoking) were 42-51% less likely to undergo TJR than men who had never smoked. Tests for trend in the log hazard ratios (HRs) across both smoking and weight quantiles yielded significant P values. Vigorous exercise increased the hazard of TJR; however, the association reached statistical significance only in the 70-74-year-old age group (adjusted HR 1.64 [95% confidence interval 1.19-2.24]). Adjusting for Deyo-Charlson Index or Elixhauser's comorbidity measures did not eliminate these associations.
Our findings indicate that being overweight and reporting vigorous physical activity increase the risk of TJR. This study is the first to demonstrate a strong inverse dose-response relationship between duration of smoking and risk of TJR. More research is needed to better understand the role of smoking in the pathogenesis of osteoarthritis.
在一个基于人群的男性队列中，评估吸烟、体重和身体活动与全关节置换术（TJR）风险之间的关联。
对11388名男性进行了一项队列研究，该研究将临床数据与医院发病率数据和死亡率记录相结合。使用Cox比例风险回归和竞争风险回归（CRR），在3个不同年龄组中，根据基线体重、身高、合并症、社会经济地位、吸烟年限和运动情况，对TJR风险进行建模。
观察到体重与TJR风险之间以及吸烟与TJR风险之间存在剂量反应关系。超重独立增加TJR风险，而吸烟降低风险。吸烟者风险降低在Cox模型和CRR模型中均得到证实，且在暴露23年后变得明显。处于最高四分位数（吸烟≥48年）的男性比从不吸烟的男性接受TJR的可能性低42%-51%。对吸烟和体重分位数的对数风险比（HRs）进行趋势检验，得到显著的P值。剧烈运动增加TJR风险；然而，这种关联仅在70-74岁年龄组达到统计学显著性（调整后HR 1.64 [95%置信区间1.19-2.24]）。调整Deyo-Charlson指数或Elixhauser合并症测量方法并不能消除这些关联。
我们的研究结果表明，超重和报告剧烈身体活动会增加TJR风险。本研究首次证明吸烟持续时间与TJR风险之间存在强烈的反向剂量反应关系。需要更多研究来更好地理解吸烟在骨关节炎发病机制中的作用。
