Duan-Porter Wei, Hastings Susan Nicole, Neelon Brian, Van Houtven Courtney Harold
Health Services Research and Development, Durham VA Medical Center, Durham, NC, USA,
J Gen Intern Med. 2015 Aug;30(8):1156-63. doi: 10.1007/s11606-015-3275-9. Epub 2015 Mar 20.
Chronic health conditions account for the largest proportion of illness-related mortality and morbidity as well as most of healthcare spending in the USA. Control beliefs may be important for outcomes in individuals with chronic illness.
To determine whether control beliefs are associated with the risk for death, incident stroke and incident myocardial infarction (MI), particularly for individuals with diabetes mellitus (DM) and/or hypertension.
Retrospective cohort study.
A total of 5,662 respondents to the Health and Retirement Study with baseline health, demographic and psychological data in 2006, with no history of previous stroke or MI.
Perceived global control, measured as two dimensions--"constraints" and "mastery"--and health-specific control were self-reported. Event-free survival was measured in years, where "event" was the composite of death, incident stroke and MI. Year of stroke or MI was self-reported; year of death was obtained from respondents' family.
Mean baseline age was 66.2 years; 994 (16.7%) had DM and 3,023 (53.4%) hypertension. Overall, 173 (3.1%) suffered incident strokes, 129 (2.3%) had incident MI, and 465 (8.2%) died. There were no significant interactions between control beliefs and baseline DM or hypertension in predicting event-free survival. Elevated adjusted hazard ratios (HRs) were associated with DM (1.33, 95 % CI 1.07-1.67), hypertension (1.31, 95% CI 1.07-1.61) and perceived constraints in the third (1.55, 95% CI 1.12-2.15) and fourth quartiles (1.61, 95% CI 1.14-2.26). Health-specific control scores in the third (HR 0.78, 95% CI 0.59-1.03) and fourth quartiles (HR 0.70, 95% CI 0.53-0.92) were protective, but only the latter category had a statistically significant decreased risk. Combined high perceived constraints and low health-specific control had the highest risk (HR 1.93, 95% CI 1.41-2.64).
Control beliefs were not associated with differential risk for those with DM and/or hypertension, but they predicted significant differences in event-free survival for the general cohort.
在美国，慢性健康状况在与疾病相关的死亡率和发病率中占比最大，且占据了大部分医疗支出。控制信念可能对慢性病患者的预后很重要。
确定控制信念是否与死亡风险、中风发病率和心肌梗死（MI）发病率相关，尤其是对于患有糖尿病（DM）和/或高血压的个体。
回顾性队列研究。
共有5662名参与健康与退休研究的受访者，他们在2006年提供了基线健康、人口统计学和心理数据，且无既往中风或MI病史。
感知到的总体控制通过“限制”和“掌控”两个维度进行衡量，特定健康控制通过自我报告获得。无事件生存期以年为单位进行测量，其中“事件”是死亡、中风发病率和MI的综合情况。中风或MI的年份通过自我报告；死亡年份从受访者家属处获得。
平均基线年龄为66.2岁；994人（16.7%）患有DM，3023人（53.4%）患有高血压。总体而言，173人（3.1%）发生中风，129人（2.3%）发生MI，465人（8.2%）死亡。在预测无事件生存期时，控制信念与基线DM或高血压之间没有显著的相互作用。调整后的风险比（HR）升高与DM（1.33，95%CI 1.07 - 1.67）、高血压（1.31，95%CI 1.07 - 1.61）以及第三（1.55，95%CI 1.12 - 2.15）和第四四分位数（1.61，95%CI 1.14 - 2.26）中的感知限制相关。第三（HR 0.78，95%CI 0.59 - 1.03）和第四四分位数（HR 0.70，95%CI 0.53 - 0.92）中的特定健康控制得分具有保护作用，但只有后一组别的风险有统计学意义的降低。高感知限制和低特定健康控制相结合的风险最高（HR 1.93，95%CI 1.41 - 2.64）。
控制信念与DM和/或高血压患者的差异风险无关，但它们预测了总体队列无事件生存期的显著差异。
