使用残疾调整生命年来衡量髋部骨折的负担：CHANCE 联盟中前瞻性队列的汇总分析。

Burden of hip fracture using disability-adjusted life-years: a pooled analysis of prospective cohorts in the CHANCES consortium.

机构信息

Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece.

Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece; Hellenic Health Foundation, Athens, Greece; Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.

出版信息

Lancet Public Health. 2017 May;2(5):e239-e246. doi: 10.1016/S2468-2667(17)30046-4. Epub 2017 Apr 11.

DOI:10.1016/S2468-2667(17)30046-4

PMID:29253489

Abstract

BACKGROUND

No studies have estimated disability-adjusted life-years (DALYs) lost due to hip fractures using real-life follow-up cohort data. We aimed to quantify the burden of disease due to incident hip fracture using DALYs in prospective cohorts in the CHANCES consortium, and to calculate population attributable fractions based on DALYs for specific risk factors.

METHODS

We used data from six cohorts of participants aged 50 years or older at recruitment to calculate DALYs. We applied disability weights proposed by the National Osteoporosis Foundation and did a series of sensitivity analyses to examine the robustness of DALY estimates. We calculated population attributable fractions for smoking, body-mass index (BMI), physical activity, alcohol intake, type 2 diabetes and parity, use of hormone replacement therapy, and oral contraceptives in women. We calculated summary risk estimates across cohorts with pooled analysis and random-effects meta-analysis methods.

FINDINGS

223 880 men and women were followed up for a mean of 13 years (SD 6). 7724 (3·5%) participants developed an incident hip fracture, of whom 413 (5·3%) died as a result. 5964 DALYs (27 per 1000 individuals) were lost due to hip fractures, 1230 (20·6%) of which were in the group aged 75-79 years. 4150 (69·6%) DALYs were attributed to disability. Current smoking was the risk factor responsible for the greatest hip fracture burden (7·5%, 95% CI 5·2-9·7) followed by physical inactivity (5·5%, 2·1-8·5), history of diabetes (2·8%, 2·1-4·0), and low to average BMI (2·0%, 1·4-2·7), whereas low alcohol consumption (0·01-2·5 g per day) and high BMI had a protective effect.

INTERPRETATION

Hip fracture can lead to a substantial loss of healthy life-years in elderly people. National public health policies should be strengthened to reduce hip fracture incidence and mortality. Primary prevention measures should be strengthened to prevent falls, and reduce smoking and a sedentary lifestyle.

FUNDING

European Community's Seventh Framework Programme.

摘要

背景

目前尚无研究使用实际随访队列数据来评估髋部骨折所致的伤残调整生命年（DALY）损失。本研究旨在使用 CHANCES 研究联盟中前瞻性队列研究的数据来量化髋部骨折所致的疾病负担，并基于 DALY 计算特定危险因素的人群归因分数。

方法

我们从招募时年龄在 50 岁及以上的 6 个队列中获取数据，计算 DALY。我们采用了由国家骨质疏松基金会提出的伤残权重，并进行了一系列敏感性分析，以检验 DALY 估计值的稳健性。我们计算了吸烟、体质指数（BMI）、体力活动、饮酒、2 型糖尿病和产次、激素替代疗法和女性口服避孕药与髋部骨折相关的人群归因分数。我们采用汇总分析和随机效应荟萃分析方法计算了各队列的综合风险估计值。

结果

共随访了 223880 名男性和女性，平均随访时间为 13 年（SD 6 年）。7724 名（3.5%）参与者发生了髋部骨折事件，其中 413 名（5.3%）患者因此死亡。5964 个 DALY（27 个/1000 人）因髋部骨折而损失，其中 75-79 岁年龄组的 DALY 为 1230 个（20.6%）。4150 个 DALY（69.6%）归因于残疾。当前吸烟是髋部骨折负担最重的危险因素（7.5%，95%CI 5.2-9.7），其次是体力活动不足（5.5%，2.1-8.5）、糖尿病史（2.8%，2.1-4.0）和低-平均 BMI（2.0%，1.4-2.7），而低酒精摄入（0.01-2.5 g/天）和高 BMI 具有保护作用。