Hirani Vasant, Naganathan Vasi, Blyth Fiona, Le Couteur David G, Gnjidic Danijela, Stanaway Fiona F, Seibel Markus J, Waite Louise M, Handelsman David J, Cumming Robert G
Centre for Education and Research on Ageing, Concord Hospital, University of Sydney, Hospital Road, Concord, NSW, Sydney, 2137, Australia,
Age (Dordr). 2014;36(6):9732. doi: 10.1007/s11357-014-9732-2. Epub 2014 Nov 18.
This study aims to identify the common risk factors for mortality in community-dwelling older men. A prospective population-based study was conducted with a median of 6.7 years of follow-up. Participants included 1705 men aged ≥70 years at baseline (2005-2007) living in the community in Sydney, Australia. Demographic information, lifestyle factors, health status, self-reported history of diseases, physical performance measures, blood pressure, height and weight, disability (activities of daily living (ADL) and instrumental ADLs, instrumental ADLs (IADLs)), cognitive status, depressive symptoms and blood analyte measures were considered. Cox regression analyses were conducted to model predictors delete time until of mortality. During follow-up, 461 men (27 %) died. Using Cox proportional hazards model, significant predictors of delete time to time to mortality included in the final model (p < 0.05) were older age, body mass index < 20 kg m(2), high white cell count, anaemia, low albumin, current smoking, history of cancer, history of myocardial infarction, history of congestive heart failure, depressive symptoms and ADL and IADL disability and impaired chair stands. We found that overweight and obesity and/or being a lifelong non-drinker of alcohol were protective against mortality. Compared to men with less than or equal to one risk factor, the hazard ratio in men with three risk factors was 2.5; with four risk factors, it was 4.0; with five risk factors, it was 4.9; and for six or more risk factors, it was 11.4, respectively. We have identified common risk factors that predict mortality that may be useful in making clinical decisions among older people living in the community. Our findings suggest that, in primary care, screening and management of multiple risk factors are important to consider for extending survival, rather than simply considering individual risk factors in isolation. Some of the "traditional" risk factors for mortality in a younger population, including high blood pressure, hypercholesterolaemia, overweight and obesity and diabetes, were not independent predictors of mortality in this population of older men.
本研究旨在确定社区居住老年男性死亡的常见风险因素。开展了一项基于人群的前瞻性研究，中位随访时间为6.7年。参与者包括2005年至2007年基线时年龄≥70岁、居住在澳大利亚悉尼社区的1705名男性。研究考虑了人口统计学信息、生活方式因素、健康状况、自我报告的疾病史、身体机能指标、血压、身高和体重、残疾情况（日常生活活动（ADL）和工具性日常生活活动（IADL））、认知状态、抑郁症状和血液分析指标。进行Cox回归分析以建立预测死亡时间的模型。随访期间，461名男性（27%）死亡。使用Cox比例风险模型，最终模型中死亡时间的显著预测因素（p<0.05）包括年龄较大、体重指数<20kg/m²、白细胞计数高、贫血、白蛋白水平低、当前吸烟、癌症史、心肌梗死史、充血性心力衰竭史、抑郁症状以及ADL和IADL残疾和从椅子上站起能力受损。我们发现超重和肥胖以及/或者终身不饮酒对死亡具有保护作用。与具有小于或等于一个风险因素的男性相比，具有三个风险因素的男性的风险比为2.5；具有四个风险因素的男性，风险比为4.0；具有五个风险因素的男性，风险比为4.9；具有六个或更多风险因素的男性，风险比为11.4。我们确定了可预测死亡的常见风险因素，这可能有助于在社区居住的老年人中做出临床决策。我们的研究结果表明，在初级保健中，筛查和管理多种风险因素对于延长生存期很重要，而不是仅仅孤立地考虑个体风险因素。在较年轻人群中一些“传统”的死亡风险因素，包括高血压、高胆固醇血症、超重和肥胖以及糖尿病，在这群老年男性中并非死亡的独立预测因素。
