Division of Epidemiology, Human Genetics and Environmental Sciences, The University of Texas School of Public Health, Houston, Texas 77030, USA.
Ann Allergy Asthma Immunol. 2013 Apr;110(4):240-6, 246.e1. doi: 10.1016/j.anai.2013.01.002. Epub 2013 Feb 4.
Relatively little is known about the effect of age on asthma outcomes in adults, particularly at a national level.
To investigate age-related differences in asthma outcomes in a nationally representative, longitudinal study.
We analyzed data from the Third National Health and Nutrition Examination Survey (1988-1994) with linked mortality files through 2006. Adults with physician-diagnosed asthma were identified and were divided into 2 age groups: younger adults (17-54 years of age) and older adults (55 years or older). The outcome measures were both cross-sectional (health care use, comorbidity, and lung function) and longitudinal (all-cause mortality).
There were an estimated 9,566,000 adults with current asthma. Of these, 73% were younger adults and 27% older adults. Compared with younger adults, older adults had more hospitalizations in the past year, more comorbidities, and poorer lung function (eg, lower forced expiratory volume in 1 second) (P < .05 for all). During a median follow-up of 15 years, significant baseline predictors of higher all-cause mortality included older age (≥55 vs <55 years old: adjusted hazard ratio [HR], 6.77; 95% confidence interval [CI], 3.15-14.54), poor health status (fair and poor vs excellent health status: adjusted HR, 10.07; 95% CI, 3.75-27.01), and vitamin D deficiency (vitamin D level <30 vs ≥50 nmol/L: adjusted HR, 2.19; 95% CI, 1.05-4.58), whereas Mexican American ethnicity (adjusted HR, 0.31; 95% CI, 0.14-0.65) was associated with lower mortality. Controlling for age, asthma was not associated with increased all-cause mortality (adjusted HR, 1.28; 95% CI, 0.99-1.65).
Older adults with asthma have a substantial burden of morbidity and increased mortality. The ethnic differences in asthma mortality and the vitamin D-mortality link merit further investigation.
关于年龄对成年人哮喘结局的影响，我们知之甚少，尤其是在全国范围内。
在一项具有全国代表性的纵向研究中，探究年龄相关的哮喘结局差异。
我们分析了第三次全国健康和营养调查（1988-1994 年）的数据，并通过 2006 年的死亡记录进行了链接。确定了经医生诊断患有哮喘的成年人，并将其分为两组：年轻成年人（17-54 岁）和老年成年人（55 岁及以上）。研究的结局指标包括横断面（医疗保健利用、合并症和肺功能）和纵向（全因死亡率）。
据估计，有 956.6 万名成年人患有现患哮喘。其中，73%为年轻成年人，27%为老年成年人。与年轻成年人相比，老年成年人在过去一年中住院治疗的次数更多，合并症更多，肺功能更差（例如，一秒用力呼气容积较低）（所有 P 值均<.05）。在中位随访 15 年期间，全因死亡率的显著基线预测因素包括年龄较大（≥55 岁与<55 岁：调整后的危险比 [HR]，6.77；95%置信区间 [CI]，3.15-14.54）、健康状况较差（一般和较差与健康状况极好：调整后的 HR，10.07；95% CI，3.75-27.01）和维生素 D 缺乏（维生素 D 水平<30 与≥50 nmol/L：调整后的 HR，2.19；95% CI，1.05-4.58），而墨西哥裔美国人的种族（调整后的 HR，0.31；95% CI，0.14-0.65）与较低的死亡率相关。控制年龄后，哮喘与全因死亡率增加无关（调整后的 HR，1.28；95% CI，0.99-1.65）。
患有哮喘的老年成年人的发病率和死亡率均较高。哮喘死亡率的种族差异和维生素 D 与死亡率的关联值得进一步研究。
