自评健康状况与有或无中风病史的老年人中风发病率及死亡率的关系：医学研究委员会认知功能与衰老（CFAS）人群的纵向研究
Relationship of Self-Rated Health to Stroke Incidence and Mortality in Older Individuals with and without a History of Stroke: A Longitudinal Study of the MRC Cognitive Function and Ageing (CFAS) Population.
作者信息
Mavaddat Nahal, van der Linde Rianne, Parker Richard, Savva George, Kinmonth Ann Louise, Brayne Carol, Mant Jonathan
机构信息
Primary Care Unit, Department of Public Health and Primary Care, Strangeways Research Laboratory, Worts Causeway, Cambridge, United Kingdom, CB1 8RN.
Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, University Forvie Site, Robinson Way, Cambridge, United Kingdom, CB2 0SR.
出版信息
PLoS One. 2016 Feb 29;11(2):e0150178. doi: 10.1371/journal.pone.0150178. eCollection 2016.
INTRODUCTION
Poor self-rated health (SRH) has been associated with increased risk of death and poor health outcomes even after adjusting for confounders. However its' relationship with disease-specific mortality and morbidity has been less studied. SRH may also be particularly predictive of health outcomes in those with pre-existing conditions. We studied whether SRH predicts new stroke in older people who have never had a stroke, or a recurrence in those with a prior history of stroke.
METHODS
MRC CFAS I is a multicentre cohort study of a population representative sample of people in their 65th year and older. A comprehensive interview at baseline included questions about presence of stroke, self-rated health and functional disability. Follow-up at 2 years included self-report of stroke and stroke death obtained from death certificates. Multiple logistical regression determined odds of stroke at 2 years adjusting for confounders including disability and health behaviours. Survival analysis was performed until June 2014 with follow-up for up to 13 years.
RESULTS
11,957 participants were included, of whom 11,181 (93.8%) had no history of stroke and 776 (6.2%) one or more previous strokes. Fewer with no history of stroke reported poor SRH than those with stroke (5 versus 21%). In those with no history of stroke, poor self-rated health predicted stroke incidence (OR 1.5 (1.1-1.9)), but not stroke mortality (OR 1.2 (0.8-1.9)) at 2 years nor for up to 13 years (OR 1.2(0.9-1.7)). In those with a history of stroke, self-rated health did not predict stroke incidence (OR 0.9(0.6-1.4)), stroke mortality (OR 1.1(0.5-2.5)), or survival (OR 1.1(0.6-2.1)).
CONCLUSIONS
Poor self-rated health predicts risk of stroke at 2 years but not stroke mortality among the older population without a previous history of stroke. SRH may be helpful in predicting who may be at risk of developing a stroke in the near future.
引言
即使在对混杂因素进行调整之后，自我评估健康状况不佳（SRH）也与死亡风险增加及不良健康结局相关。然而，其与特定疾病死亡率和发病率的关系研究较少。SRH在已有疾病的人群中可能对健康结局具有特别的预测作用。我们研究了SRH是否能预测既往无卒中的老年人发生新的卒中，或既往有卒中病史者的卒中复发情况。
方法
医学研究委员会认知功能与衰老研究I（MRC CFAS I）是一项针对65岁及以上具有人群代表性样本的多中心队列研究。基线时的全面访谈包括有关卒中存在情况、自我评估健康状况和功能残疾的问题。2年随访包括从死亡证明中获取的卒中及卒中死亡的自我报告。多元逻辑回归确定了在对包括残疾和健康行为等混杂因素进行调整后2年发生卒中的几率。进行生存分析直至2014年6月，随访时间长达13年。
结果
纳入11957名参与者，其中11181名（93.8%）无卒中病史，776名（6.2%）有一次或多次既往卒中。无卒中病史者中报告SRH不佳者少于有卒中病史者（5%对21%）。在无卒中病史者中，自我评估健康状况不佳可预测2年时的卒中发病率（比值比[OR] 1.5[1.1 - 1.9]），但不能预测2年及长达13年的卒中死亡率（OR 1.2[0.8 - 1.9]）（OR 1.2[0.9 - 1.7]）。在有卒中病史者中，自我评估健康状况不能预测卒中发病率（OR 0.9[0.6 - 1.4]）、卒中死亡率（OR 1.1[0.5 - 2.5]）或生存率（OR 1.1[0.6 - 2.1]）。
结论
自我评估健康状况不佳可预测无既往卒中病史的老年人群2年时的卒中风险，但不能预测卒中死亡率。SRH可能有助于预测谁在近期可能有发生卒中的风险。
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